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Vol. 66. Núm. 2.
Páginas 159-166 (Febrero 2007)
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Vol. 66. Núm. 2.
Páginas 159-166 (Febrero 2007)
Artículo especial
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Síndrome metabólico en la infancia
Metabolic syndrome in childhood
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L. Tapia Ceballos??
Autor para correspondencia
leotapiaceb@hotmail.com

Correspondencia: Dr. L. Tapia Ceballos. Hospital Costa del Sol. Ctra. Nacional 340, km 187. 29600 Marbella. Málaga. España.
Departamento de Pediatría. Hospital Costa del Sol. Marbella. España
Información del artículo

La Organización Mundial de la Salud (OMS) ha calificado a la obesidad de epidemia mundial del siglo XX, convirtiéndose en el primer problema de salud pública. En España, el estudio enKid realizado en la población entre los 2 y 24 años de edad, muestra unas cifras de prevalencia del 13,9 % para la obesidad y del 12,4% para el sobrepeso.

Estudios longitudinales sugieren que la obesidad infantil después de los 3 años de edad se asocia a un mayor riesgo de obesidad en la edad adulta, con un aumento de la morbilidad y mortalidad debido a la persistencia de los trastornos metabólicos asociados, entre los que se encuentran el síndrome metabólico, definido como la asociación de varios factores de riesgo precursores de enfermedad cardiovascular arterioesclerótica y de diabetes tipo 2 en el adulto y en cuya fisiopatología desempeña un papel fundamental la insulinorresistencia.

A pesar de su trascendencia, no existe aún una definición pediátrica del mismo universalmente aceptada, lo que dificulta el conocimiento exacto de su magnitud, si bien la prevalencia hallada en numerosos estudios realizados en pacientes pediátricos obesos oscila entre el 20-30%.

Palabras clave:
Obesidad
Síndrome metabólico
Insulinorresistencia
Key words:
Obesity
Metabolic syndrome
Insulin resistance

The World Health Organization has described obesity as the world epidemic of the twentieth century, ranking as the main problem in public health. In Spain, the enKid study, undertaken in a population aged between 2 and 24 years, shows prevalences of 13.9% for obesity and 12.4% for overweight.

Longitudinal studies suggest that childhood obesity after the age of 3 years correlates with a greater risk of obesity in adulthood, with an increase in morbility and mortality due to the persistence of associated metabolic disorders. Among these disorders is the metabolic syndrome, defined as the association of several risk factors that herald arteriosclerotic cardiovascular disease and type 2 diabetes in adulthood, with insulin resistance playing a major role in its pathophysiology.

Despite its importance, there is still no universally accepted pediatric definition of this syndrome, hampering exact knowledge of its scope, although the prevalence observed in numerous studies performed in obese pediatric patients ranges from 20-30%.

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Bibliografía
[1.]
G. Reaven.
Banting lecture: Role of insulin resistance in human disease.
Diabetes, 37 (1988), pp. 1595-1607
[2.]
Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Final report. 2002. Report No.: 106.
[3.]
K. Alberti, P. Zimmet.
Definition, diagnosis and classification of diabetes mellitus and its complications Part 1: diagnosis and classification of diabetes mellitus: provisional report of a WHO consultation.
[4.]
World Health Oganization. Definition, diagnosis and classification of diabetes mellitus and its complications: Report of a WHO consultation. Part 1: diagnosis and classification of diabetes mellitus. Genève: World Health Organization; 1999.
[5.]
B. Balkau, M. Charles.
Comment on the provisional report from the WHO consultation European Group for the Study of Insulin Resistance (EGIR).
Diabet Med., 16 (1999), pp. 442-443
[6.]
J.B. Meigs, R.B. D’Agostino, P.W. Wilson, L.A. Cupples, D.M. Nathan, D.E. Singer.
Risk variable clustering in the insulin resistance syndrome. The Framingham Offspring Study.
Diabetes, 46 (1997), pp. 1594-1600
[7.]
J. Lee, D. Sparrow, P. Vokonas, L. Landsberg, S.T. Weiss.
Uric acid coronary heart disease risk: Evidence for a role of uric acid in the obesity-insulin resistance syndrome The Normative Aging Study.
Am J Epidemiol., 142 (1995), pp. 288-294
[8.]
R. Weiss, J. Dziura, T. Burgert, W. Tamborlane, S. Taksali, C. Yeckel, et al.
Obesity and the Metabolic Syndrome in Children and Adolescents.
N Engl J Med., 350 (2004), pp. 2362-2374
[9.]
O. Nygard, S. Vollset, H. Refsum, I. Stensvold, A. Tverdal, J.E. Nordrehaug, et al.
Total homocysteine and cardiovascular disease.
J Intern Med., 246 (1999), pp. 425-454
[10.]
G. Hotamiligil, B. Spiegelman.
Tumor necrosis factor alpha: A key component of the obesity-diabetes link.
Diabetes, 43 (1994), pp. 1271-1278
[11.]
M. Campos, R. Cañete, I. Villada, J. Linde, M.C. Ramírez-Tortosa, A. Gil.
Relaciones de la adiponectina con la resistencia insulínica, lípidos plasmaticos y TNF-alfa, en el niño obeso prepúber.
An Pediatr., 60 (2004), pp. 153
[12.]
E. Ford, W. Giles, W. Dietz.
Prevalence of the metabolic syndrome among US adults: Findings from the third National and Nutrition Examination Survey.
JAMA, 287 (2002), pp. 356-359
[13.]
E. Ford, W. Giles, A. Mokdad.
Increasing prevalence of the metabolic syndrome among US adults.
Diabetes Care, 27 (2004), pp. 2444-2449
[14.]
Y. Park, S. Zhu, L. Palaniappan, S. Heshka, M.R. Carnethon, S.B. Heymsfield, et al.
The metabolic syndrome: Prevalence and associated risk factors findings in the US population from de Third National Health and Nutrition Examination Survey 1988-1994.
Arch Intern Med., 163 (2003), pp. 427-436
[15.]
G.W. Mills, P. Avery, M. McCarthy, A.T. Hattersley, J.C. Levy, G.A. Hitman, et al.
Heritability estimates for beta cell function and features of the insulin resistance syndrome in UK families with an increased susceptibility to type 2 diabetes.
Diabetologia, 47 (2004), pp. 732-738
[16.]
S. Srinivasan, L. Myers, G. Berenson.
Predictability of childhood adiposity and insulin for developing insulin resistance syndrome (syndrome X) in young adulthood: The Bogalusa Heart Sudy.
Diabetes, 51 (2002), pp. 204-209
[17.]
M. Cruz, M. Weigensberg, T. Huang, G. Ball, G. Shaibi, M. Goran.
The metabolic syndrome in overweight Hispanic youth and the role on insulin sensitivity.
Clin Endocrinol Metab., 89 (2004), pp. 108-113
[18.]
E. Colino, L. Peña, P. Saavedra, S. Quinteiro, A. Domínguez, J.C. Ramos.
Síndrome de insulinorresistencia en niños obesos.
An Pediatría, 58 (2003), pp. 176
[19.]
E. García, I. Lafuente, J. Talavera, J. Ramos, M.R. Jiménez-Uría, F.I. Rodríguez.
Resistencia insulínica en niños obesos y adolescentes obesos.
An Pediatr., 58 (2003), pp. 177
[20.]
G. Bueno, L. Moreno, B. Tresaco, M. Bueno, J. Garagorri.
Análisis clínico-metabólico de la insulinorresistencia en niños y adolescentes obesos.
An Pediatr., 5 (2003), pp. 177
[21.]
A.R. Sinaiko, D.R. Jacobs Jr, J. Steinberger, A. Morán, R. Luepker, A.P. Rocchini, et al.
Insulin resistance syndrome in childhood: Associations of the euglycemic insulin clamp and fasting insulin with fatness and other risk factors.
J Pediatr., 139 (2001), pp. 700-707
[22.]
M.L. Cruz, T.T. Huang, M.S. Johnson, B.A. Gower, M.I. Goran.
Insulin sensitivity and blood pressure in black and white children.
Hypertension, 40 (2002), pp. 18-22
[23.]
S. Barlow, W. Dietz.
Obesity evaluation and treatment: Expert committee recommendations. The Maternal and Child Health Bureau, Health Resources and Services Administration, and the Deparment of Health and Human Services.
Pediatrics, 102 (1998), pp. E29
[24.]
T. Cole, M. Bellizi, K. Flegal, W. Dietz.
Establishing a standard definition for child overweight and obesity worlwide: International survey.
BMJ, 320 (2000), pp. 1240-1243
[25.]
C. Dobbelsteyn, M. Joffres, D. MacLean, G. Flowerdew.
A comparative evaluation of waist circumference, waist-to-hip ratio and body mass index as indication of cardiovascular risk factors: The canadian Health Surveys.
Int J Obes Relat Metab Disord., 25 (2001), pp. 652-661
[26.]
I. Janssen, S. Heymsfield, D. Allison, D. Kotler, R. Roos.
Body mass index and waist circumference independently contribute to the prediction of nonabdominal, abdominal subcuaneous, and visceral fat.
Am J Clin Nutr., 75 (2002), pp. 683-688
[27.]
C. Maffeis, A. Pietrobelli, A. Grezzani, S. Provera, L. Tato.
Waist circumference and cardiovascular risk factors in prepuberal children.
Obes Res., 9 (2001), pp. 179-187
[28.]
S. Savva, M. Tornaritis, M. Savva, Y. Kourides, A. Panagi, N. Silikiotou, et al.
Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index.
Int J Obes Relat Metab Disord., 24 (2000), pp. 1453-1458
[29.]
L.A. Moreno, I. Pineda, G. Rodríguez, J. Fleta, A. Sarría, M. Bueno.
Waist circumference for the screening of the metabolic syndrome in children.
Acta Paediatr., 91 (2002), pp. 1307-1312
[30.]
S. Daniels, P. Khoury, J. Morrison.
Utility of different measures of body fat distribution in childre and adolescents.
Am J Epidemiol., 152 (2000), pp. 1179-1184
[31.]
Curvas de Referencia para la Tipificación Ponderal. Dossier de consenso. Grupo colaborativo AEP-SENC-SEEDO. 2002.
[32.]
C. Ogden, K. Flegal, M. Carrol, C. Johnson.
Prevalence and trends in overweight among US children and adolescents 1999-2000.
JAMA, 288 (2002), pp. 1728-1732
[33.]
L. Serra Manjen, L. Ribas Barba, J. Arancete Bartrina, C. Pérez Rodrigo, P. Saavedra Santana, L. Peña Quintana.
Obesidad infentil y juvenil en España Resultados del estudio En Kid (1998-2000).
Medicina Clínica, 121 (2003), pp. 725-732
[34.]
M. Wabitsch.
Overweight and obesity in European children: Definition and diagnosis procedures, risk factors and consequences for later health outcome.
Eur J Pediatr., 159 (2000), pp. 8-13
[35.]
H. McGill, C. McMahan, E. Herderick, A.W. Zieske, G.T. Malcom, R.E. Tracy, et al.
Obesity accelerates the progression of coronary atherosclerosis in young men.
Circulation, 105 (2002), pp. 2712-2718
[36.]
T. Decsi, D. Molnar.
Insulin resistance syndrome in children.
Pediatr Drugs, 5 (2003), pp. 291-299
[37.]
R. Bergman.
Toward physiological understanding of glucose tolerance: minimal model approach.
Diabetes, 38 (1989), pp. 1527
[38.]
E. Ferannini, A. Mari.
How to measure insulin sensitivity.
J Hypertens, 16 (1998), pp. 895-906
[39.]
R. De Fronzo, J. Tobin, R. Andrés.
Glucosa clamp technique: A method for the quantification of beta cell sensitivity to glucose and of tissue sensitivity to insulin.
Am J Physiol., 237 (1979), pp. 214-223
[40.]
S. Soonthornpun, W. Setasuban, A. Thamprasit, W. Chayanunnukul, C. Rattarasarn, A. Geater.
Novel insulin sensitivity index derived from oral glucose tolerance test.
J Clin Endocrinol Metab., 88 (2003), pp. 1019-1023
[41.]
C. Yeckel, R. Weiss, J. Dziura, S. Taksali, S. Dufour, T. Burgert, et al.
Validation of Insulin Sensitivity Indices from Oral Glucose Tolerance Test Parameters in Obese Children and Adolescents.
J Clin Endocrinol Metab., 89 (2004), pp. 1096-1101
[42.]
M. Goran, B. Gower.
Longitudinal study on pubertal insulin resistance.
Diabetes, 50 (2001), pp. 2444-2450
[43.]
M. Lambert, G. Paradis, J. O’Loughlin, E.E. Delvin, J.A. Hanley, E. Levy.
Insulin resistance syndrome in a representative sample of children and adolescents from Quebec, Canada.
Int J Obes Relat Metab Disord., 28 (2004), pp. 833-841
[44.]
G. Csabi, K. Torok, S. Jeges, D. Molnar.
Presence of metabolic cardiovascular syndrome in obese children.
Eur J Pediatr., 159 (2000), pp. 91-94
[45.]
D. Matthews, J. Hosker, A. Rudenski, B. Naylor, D. Treacher, R. Turner.
Homeostasis model assessment: Insulin resistance and B-cell function from fasting plasma glucose and insulin concentrations in man.
Diabetologia, 28 (1985), pp. 412-419
[46.]
M. Keskin, S. Kurtoglu, M. Kendirci, M. Atabek, M. Yazici.
Homeostasis Model Assessment Is More Reliable Than the Fasting Glucosa/Insulin Ratio and Quantitative Insulin Sensitivity Chack Index for AssessingInsulin Resistance Among Obese Children and Adolescents.
Pediatrics, 115 (2005), pp. 500-503
[47.]
T. Reinehr, W. Andler.
Changes in the atherogenic risk factos profile according to degree of weight loss.
Arch Dis Child, 89 (2004), pp. 419-422
[48.]
P. Allard, E. Delvin, G. Paradis, J. Hanley, J. O’Loughlin, C. Lavallée, et al.
Distribution of fasting plasma insulin, free fatty acids and glucose concentrations and of homeostasis model assessment of insulin resistance in a representative sample of Quebec children and adolecents.
Clin Chem., 49 (2003), pp. 644-649
[49.]
B. Tresaco, G. Bueno, I. Pineda, L.A. Moreno, J.M. Garagorri, M. Bueno.
Homeostatic model assessment (HOMA) index cut-off values to identify the metabolic syndrome in children.
J Physiol Biochem., 61 (2005), pp. 381-388
[50.]
S. Shalitin, M. Abrahami, P. Lilos, M. Phillip.
Insulin resistance and impaired glucose tolerance in obese children and adolescents referred to a tertiary-care center in Israel.
Intern J Obesity, 29 (2005), pp. 571-578
[51.]
C. Mazza, B. Ozuna, A. Krochik, M. Araujo.
Prevalence of type 2 diabetes mellitus and impaired glucose tolerance in obese Argentinean children and adolescents.
J Pediatr Endocrinol Metab., 18 (2005), pp. 491-498
[52.]
A. Katz, S. Nambi, K. Mather, A. Baron, D. Follman, G. Sullivan, et al.
Quantitative insulin sensitivity check index: A simple, accurate method for assesing insulin sensitivity in humans.
J Clin Endocrinol Metab., 85 (2000), pp. 2402-2410
[53.]
J. Hrebicek, V. Janout, J. Malincikova, D. Horakova, L. Cizek.
Detection of insulin resistance by simple quantitative insulin sensitivity check index QUICKI for epidemiological assessment and prevention.
J Clin Endocrinol Metab., 87 (2002), pp. 144-147
[54.]
R. Legro, D. Finegood, A. Dunaif.
A fasting glucose to insulin ratio is a useful measure of insulin sensitivity in women with polycystic ovary syndrome.
J Clin Endocrinol Metab., 83 (1998), pp. 2698
[55.]
J. Dimartino-Nardi.
Premature adrenarche: Findings in prepuberal African-American and Caribbean-Hispanic girls.
Acta Paediatr., 433 (1999), pp. 67-72
[56.]
W. Cutfield, C. Jefferies, W. Jackson, E. Robinson, P. Hofman.
Evaluation of HOMA and QUICKI as measures of insulin sensitivity in prepuberal children.
Pediatr Diabetes, 4 (2003), pp. 115-118
[57.]
L. Conwell, S. Trost, W. Brown, J. Batch.
Indexes of insulin resistance and secretion in obese children and adolescents: A validation study.
Diabetes Care, 27 (2004), pp. 314-319
[58.]
B. Klein, R. Klein, K. Lee.
Components of the metabolic syndrome and risk of cardiovascular disease and diabetes in Beaver Dam.
Diabetes Care, 25 (2002), pp. 1790-1794
[59.]
N. Sattar, A. Gaw, O. Scherbakova, I. Ford, D.S. O’Reilly, S.M. Haffner, et al.
Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention study.
Circulation, 108 (2003), pp. 414-419
[60.]
S. Malik, N.D. Wong, S.S. Franklin, T.V. Kamath, G.J. L’Italien, J.R. Pio, et al.
Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults.
Circulation, 110 (2004), pp. 1245-1250
[61.]
P. Marceau, S. Biron, F. Hould, S. Marceau, S. Simard, S.N. Thung, et al.
Liver pathology and the metabolic syndrome X in severe obesity.
J Clin Endocrinol Metab., 84 (1999), pp. 1513-1517
[62.]
J. Chen, P. Muntner, L.L. Hamm, D.W. Jones, V. Batuman, V. Fonseca, et al.
The metabolic syndrome and chronic kidney disease in U.S. adults.
Arch Intern Med., 140 (2004), pp. 167-174
[63.]
M. Ip, B. Lam, M. Ng, W.K. Lam, K.W. Tsang, K.S. Lam.
Obstructive sleep apnea is independently associated with insulin resistance.
Am J Respir Crit Care Med., 165 (2002), pp. 670-676
[64.]
R. Pasquali, A. Gambineri, B. Anconetani, V. Vicennati, D. Colitta, E. Caramelli, et al.
The natural history of the metabolic syndrome in young women with the polycystic ovary syndrome and the effect of long-term estrogen-progestagen treatment.
Clin Endocrinol (Oxf), 50 (1999), pp. 517-527
[65.]
K. Yaffe, A. Kanaya, K. Lindquist, E.M. Simonsick, T. Hams, R.I. Shorr, et al.
The metabolic syndrome, inflammation, and risk of cognitive decline.
JAMA, 292 (2004), pp. 2237-2242
[66.]
W. Chen, W. Bao, S. Begum, A. Elkasabany, S.R. Srinivasan, G.S. Berenson.
Age-related patterns of the clustering of cardiovascular risk variables of syndrome X from childhood to young adulthood in a population made up of black and white subjects: The Bogalusa Heart Study.
Diabetes, 49 (2000), pp. 1042-1048
[67.]
S. Cook, M. Weitzman, P. Auinger, M. Nguyen, W. Dietz.
Prevalence of a metabolic syndrome phenotype in adolescents: Findings from the third National Health and Nutrition Examination Survey 1988-1994.
Arch Pediatr Adolesc Med., 157 (2003), pp. 821-827
[68.]
R. Viner, T. Segal, E. Lichtarowicz-Krynska, P. Hindmarsh.
Prevalence of the insulin resistance syndrome in obesity.
Arch Dis Child, 90 (2005), pp. 10-14
[69.]
O. Raitakari, K. Porkka, L. Rasanen, T. Ronnemaa, J. ViiKari.
Clustering and six years cluster-tracking of serum total cholesterol HDL-cholesterol an diastolic blood pressure in children and young adults. The Cardiovascular Risk in Youngs Finns Study.
J Clin Epidemiol., 47 (1994), pp. 1085-1093
[70.]
W. Bao, S. Srinivasan, W. Wattigney, G. Berenson.
Persistence of multiple cardiovascular risk related to syndrome X from childhood to young adulthood.
Arch Intern Med., 154 (1994), pp. 1842-1847
[71.]
P. Katzmarzyk, L. Perusse, R. Malina, J. Bergeron, J. Despres, C. Bouchard.
Stability of indicators of metabolic syndrome from chilhood and adolescence to young adult: the Quebec Family Study.
J Clin Epidemiol., 54 (2001), pp. 190-195
[72.]
The expert committee on the diagnosis and classification of diabetes mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2005;28 Suppl 1:37-42.
[73.]
Grupo Colaborativo Español para el estudio de los factores de riesgo cardiovascular en niños y adolescentes.
Factores de riesgo cardiovascular en la infancia y adolescencia en España Estudio RICARDIN. Valores de Referencia.
An Esp Pediatr., 43 (1995), pp. 11-17
[74.]
J.P. Kay, R. Alemzadeh, G. Langley, L. D’Angelo, P. Smith, S. Holshouser.
Beneficial effects of metformin in normoglucemic morbidly obese adolescents.
Metabolism, 50 (2001), pp. 1457-1461
[75.]
Y. Miyazeki, A. Mahonkali, M. Matsuda, S. Mahankali, J. Hardies, K. Cusi, et al.
Effect of pioglitazone on abdominal fat distribution and insulin sensitivity in type 2 diabetic patient.
J Clin Endocrinol Metab., 87 (2002), pp. 2784-2791
[76.]
A. Wiegman, B.A. Hutten, E. De Groot, J. Rodenburg, H.D. Bakker, H.R. Buller, et al.
Efficacy an safety of statin therapy in children with familial hypercholesterolemia: A randomized contolled trial.
JAMA, 292 (2004), pp. 331-337
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