Department of Psychiatry, New York University School of Medicine, 145 East 32nd St, 8th Floor, New York, NY 10016, USA.
Pediatrics. 2012 Oct;130(4):e856-64. doi: 10.1542/peds.2012-0324. Epub 2012 Sep 3.
The prevalence of metabolic syndrome (MetS) parallels the rise in childhood obesity. MetS is associated with neurocognitive impairments in adults, but this is thought to be a long-term effect of poor metabolism. It would be important to ascertain whether these brain complications are also present among adolescents with MetS, a group without clinically manifest vascular disease and relatively short duration of poor metabolism.
Forty-nine adolescents with and 62 without MetS, matched on age, socioeconomic status, school grade, gender, and ethnicity, received endocrine, MRI, and neuropsychological evaluations.
Adolescents with MetS showed significantly lower arithmetic, spelling, attention, and mental flexibility and a trend for lower overall intelligence. They also had, in a MetS-dose-related fashion, smaller hippocampal volumes, increased brain cerebrospinal fluid, and reductions of microstructural integrity in major white matter tracts.
We document lower cognitive performance and reductions in brain structural integrity among adolescents with MetS, thus suggesting that even relatively short-term impairments in metabolism, in the absence of clinically manifest vascular disease, may give rise to brain complications. In view of these alarming results, it is plausible that obesity-associated metabolic disease, short of type 2 diabetes mellitus, may be mechanistically linked to lower the academic and professional potential of adolescents. Although obesity may not be enough to stir clinicians or even parents into action, these results in adolescents strongly argue for an early and comprehensive intervention. We propose that brain function be introduced among the parameters that need to be evaluated when considering early treatment of childhood obesity.
代谢综合征 (MetS) 的流行与儿童肥胖的增加是平行的。代谢综合征与成年人的神经认知障碍有关，但这被认为是代谢不良的长期影响。重要的是要确定代谢综合征的青少年是否也存在这些脑部并发症，他们没有明显的血管疾病，代谢不良的持续时间相对较短。
49 名患有和 62 名未患有代谢综合征的青少年，按年龄、社会经济地位、年级、性别和种族进行匹配，接受内分泌、MRI 和神经心理学评估。
患有代谢综合征的青少年在算术、拼写、注意力和思维灵活性方面表现明显较差，整体智力也呈下降趋势。他们的海马体体积也较小，脑脑脊液增加，主要白质束的微观结构完整性降低，呈代谢综合征剂量相关方式。
我们记录了患有代谢综合征的青少年的认知表现下降和大脑结构完整性降低，这表明即使是代谢不良的相对短期，在没有明显的血管疾病的情况下，也可能导致脑部并发症。鉴于这些令人震惊的结果，肥胖相关的代谢疾病，即使没有 2 型糖尿病，也可能在机制上与青少年的学业和职业潜力降低有关。尽管肥胖可能不足以引起临床医生甚至家长的关注，但这些青少年的结果强烈呼吁早期和全面的干预。我们建议将大脑功能引入需要评估的参数中，以便考虑早期治疗儿童肥胖。
