IDF definition of metabolic syndrome in children and adolescents

The International Diabetes Federation (IDF) has launched a new definition to identify children and adolescents at increased risk of developing type 2 diabetes and cardiovascular disease in later life. The definition has been published in The Lancet¹ and is also available as a booklet.

The metabolic syndrome is a cluster of the most dangerous risk factors for type 2 diabetes and cardiovascular disease. Its early identification is very important to facilitate preventive action. This first simple, unified definition from the IDF for children and adolescents is consistent with that available for adults².

“Diabetes and cardiovascular disease cause death and disability,” said Professor Paul Zimmet, Chair of the IDF Task Force on Epidemiology and Prevention and co-author of the definition. “Almost 4 million deaths every year are a consequence of diabetes-related causes. And with diabetes set to reach 380 million people within a generation, the death toll can only rise.³. This is the first generation where children may die before their parents.”

Intrauterine events for the unborn child and factors during early development years predispose a child to disorders such as obesity, prediabetes, and metabolic syndrome. At the same time, urbanization, unhealthy diet and sedentary lifestyle are increasing the risks for the coming generations.

The new definition is simple and easy to apply in clinical practice. Waist measurement is the main component. Percentiles, rather than absolute values of waist circumference have been used to compensate for variation in child development and ethnic origin.

The definition is divided according to age-groups: age 6 to 10; 10 to 16; and 16 or older. IDF suggests that the metabolic syndrome should not be diagnosed in children younger than 10, but that a strong message for weight reduction should be delivered for those with abdominal obesity.

For children age 10 or older, metabolic syndrome can be diagnosed with abdominal obesity (using waist circumference percentiles) and the presence of two or more other clinical features (elevated triglycerides, low HDL-cholesterol, high blood pressure, increased plasma glucose). Although some of these as well as body size and proportions change with age and development, in the absence of contemporary definitive data, the criteria adhere to the absolute values in IDF’s adult definition. The exception is that one (rather than a sex-specific) cut-off is used for HDL. For children older than 16, the IDF adult criteria can be used.

“Early detection followed by treatment—particularly lifestyle intervention—is vital to halt the progression of the metabolic syndrome and safeguard the future health of children and adolescents”, said Professor Sir George Alberti, past President of IDF and co-author of the definition. “We call on governments to create environments that allow for lifestyle changes. This will require a coordinated approach across all sectors including health, education, sports and agriculture, but it is the only way we can curb the burden of type 2 diabetes and cardiovascular disease.”

See also:

The metabolic syndrome in children and adolescents: the IDF consensus, article published in Vol 52 Issue 4 of Diabetes Voice.

References

Alberti KGMM, Zimmet PZ, Shaw JE. The metabolic syndrome in children and adolescents, Lancet 2007; 369:2059-2061  
Alberti KGMM, Zimmet PZ, Shaw JE. The metabolic syndrome—a new world-wide definition from the International Diabetes Federation Consensus. Lancet 2005; 366: 1059–62.
Diabetes Atlas, 3rd Edition, International Diabetes Federation, 2006
Alberti G, Zimmet P, Shaw J, Bloomgarden Z, Kaufman F, Silink M. Type 2 diabetes in the young: the evolving epidemic: the International Diabetes Federation consensus workshop. Diabetes Care 2004; 27: 1798–811.