Jan 14, 2009

Lifestyle - US;Kids at Risk of Metabolic Syndrome

Nancy Shute

The nation's cardiologists aren't quite ready to start diagnosing children with metabolic syndrome, a group of interrelated risk factors for heart disease, such as high blood sugar and high triglycerides. But parents can act now to make sure their children don't end up with this scary syndrome. That's the message from the American Heart Association, which says it's time for families to work together to live a healthy life.

Parents should be worried, because obesity is the main culprit causing metabolic syndrome, and the huge increases in obesity among children and teenagers are almost certainly setting up our kids for a vastly increased risk of diabetes and heart disease as adults. More than 17 percent of American children ages 6 to 19 are now obese, compared with about 5 percent in 1974. Here's one case where prevention is really the way to go--and under everyone's control.

"There are families where it's not really on their radar screen," says Julia Steinberger, an associate professor in pediatric cardiology at the University of Minnesota Children's Hospital. "They may think that because the child doesn't look sick or doesn't complain about anything that the child is healthy." That's particularly true if parents are heavy themselves. (I keep telling myself I'm "big boned," but I know that's not the reason my pants are getting tight.)

Adults are diagnosed with metabolic syndrome when they have at least three of these five risk factors: abdominal obesity; high triglycerides (150 mg/dL or more); low HDL, the good cholesterol (less than 40 mg/dL in men and less than 50 mg/dL in women); high blood pressure (130/85 mm Hg or above); and high fasting glucose (100 mg/dL or more). But it turns out that deciding when a kid has metabolic syndrome--and when to treat it--is more complicated.

First, there's very little information on what happens to a child with metabolic syndrome when she or he grows up. What are the odds that that child will get diabetes or heart disease? That information's critical in deciding how aggressively to treat metabolic syndrome in kids, such as with statin drugs. More confusion arises because children's metabolism changes a lot when they enter puberty. Gender, race, and ethnicity cloud the picture even more. As a result, countries are all over the map as to when to decide that children have metabolic syndrome and when to use drug therapy. "Children are not small adults," says Steinberger, who led the group that wrote the American Heart Association's new scientific statement on children and metabolic syndrome, just released in Circulation. But the cardiologists say they're not confused on what parents should do: eat better and exercise. Increasing exercise and eating better improve the structure and function of blood vessels, even if no weight is lost. And this message isn't just for kids.

"If the parents just tell the child, 'You have to exercise, you have to eat healthy,' nothing will happen," Steinberger says. "I truly feel the family has to be on board and has to be supportive of this entire concept, or nothing will happen."

Message received. I'm thinking back to the leftover Christmas chocolates my 5-year-old and I plowed through this weekend, leaving a giant pile of candy wrappers on the coffee table. Big oops. And I'm thinking how easy it is for me to cave in when she whines about playing outside, particularly since I'd rather be parked on the couch myself. One easy fix: get the TV out of the kids' bedroom. Another is this one endorsed by Uncle Sam in October: more tree-climbing for kids. I've resolved to have fun being active with my daughter; we had a blast at the YMCA pool this weekend. And next time, I'll limit the chocolates to one apiece. I'll be happy to fit in my pants again, and I'll be happier still to know my daughter can look forward to a healthy future.

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