Department of Pediatrics, Scott and White Hospital, Texas A&M University Health Science Center College of Medicine, 2401 South 31st Street, Temple, TX 76508, USA; Department of Internal Medicine, Scott and White Hospital, Texas A&M University Health Science Center College of Medicine, 2401 South 31st Street, Temple, TX 76508, USA.
J Clin Lipidol. 2008 Jun;2(3):147-55. doi: 10.1016/j.jacl.2008.04.005. Epub 2008 Apr 12.
Obesity is a well-known risk factor for metabolic syndrome. Although the cause or causes of metabolic syndrome are debated, insulin resistance, dyslipidemia, and hypertension are increasingly recognized in children and adolescents, especially those who are overweight or obese. Although adoption of a healthy lifestyle early in life offers the best long-term solution, many children and adolescents are currently at risk for future cardiovascular disease. Although long-term outcome data are lacking, the dyslipidemic triad commonly seen in youth with metabolic syndrome (elevated triglycerides, low high-density lipoprotein, and small dense low-density lipoprotein) is likely to significantly contribute to future vascular disease. Surrogate markers (carotid intima-media thickness and flow-mediated vasodilatation) for the precursors of cardiovascular disease are increased in obese youth, consistent with early vascular damage. In this work, we review the features of metabolic syndrome in children and adolescents, including age- and gender-specific norms for lipid values. Diagnostic criteria and modifications of screening guidelines unique to youth are discussed. Although recommendations for lifestyle modification are suggested for all, many youth at high risk of future cardiovascular risk may need more aggressive medical interventions to improve insulin sensitivity, achieve a less atherogenic lipid profile, and lower blood pressure.
肥胖是代谢综合征的一个已知危险因素。虽然代谢综合征的病因仍存在争议，但胰岛素抵抗、血脂异常和高血压在儿童和青少年中越来越常见，尤其是那些超重或肥胖的儿童和青少年。虽然在生命早期采用健康的生活方式是解决问题的最佳长期方法，但目前许多儿童和青少年都存在未来发生心血管疾病的风险。虽然缺乏长期的结果数据，但代谢综合征患儿中常见的血脂异常三联征（甘油三酯升高、高密度脂蛋白降低和小而密的低密度脂蛋白）很可能会对未来的血管疾病产生重大影响。肥胖青少年的心血管疾病前体的替代标志物（颈动脉内膜中层厚度和血流介导的血管扩张）增加，与早期血管损伤一致。在这项工作中，我们回顾了儿童和青少年代谢综合征的特征，包括脂质值的年龄和性别特异性正常值。讨论了针对青少年的独特诊断标准和筛查指南的修改。虽然建议所有患者都进行生活方式的改变，但许多未来心血管风险较高的青少年可能需要更积极的医疗干预来提高胰岛素敏感性、实现更不易发生动脉粥样硬化的血脂谱，并降低血压。
