Department of Child Health Faculty of Medicine, Public Health and Nursing
Dr Sardjito Hospital, Yogyakarta, Indonesia
The worldwide prevalence of obesity is increasing rapidly. The increase is especially alarming in countries in transition like Indonesia because their health systems are not ready to handle the consequences of obesity. Even in developed countries, obesity is related to shorter life expectancy. The younger the obesity commences, the higher the prevalence of premature death, i.e. death before the age of 70 years.
Most of the obesity related mortality is associated with the metabolic syndrome. A syndrome linking obesity with other risk factors of cardiovascular disease, i.e. insulin resistance and type 2 diabetes mellitus, dyslipidemia and hypertension. Although onset of metabolic syndrome occurs mostly in adulthood, there have been reports on the occurrence of metabolic syndrome in childhood or adolescents, both in developed and developing countries.
Insulin resistance is thought to be central to the development of the metabolic syndrome. Insulin sensitivity is significantly lower in patients with either two or three features of metabolic syndrome than in those with none of the features. The classification of children and adolescents into presence or absence of metabolic syndrome is not simple. There has been many classification proposed. In 2014, a definition of metabolic syndrome for pre-pubertal children in Europe was proposed by investigators of the Identification and prevention of dietary- and lifestyle-induced health effects in children and infants (IDEFICS) study. According to the study, children require close monitoring if three or more of the risk factors, i.e. central obesity, blood pressure, level of triglyceride, insulin or fasting glucose exceed the 90th percentile, or less than the 10th percentile for HDL cholesterol. Intervention is needed when three or more of these risk factors exceed the 95th percentile (or less than the 5th percentile for HDL cholesterol).
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