新定义可能有助于确认孩童发展代谢症候群的风险


  July 2, 2007 — 国际糖尿病联盟(IDF)已经针对代谢症候群发展新的定义,以确认孩童是否有发展成此症候群的风险,此评论的论述已发表在6月23日的Lancet上。
  
  澳洲维多利亚墨尔本国际糖尿病学院的Paul Zimmet博士与其国际糖尿病联盟流行病学与预防工作小组的同事指出,成人的代谢症候群指的是一群发展出心血管疾病、与第二型糖尿病的危险因子,其中包括腹部肥胖、血脂异常、葡萄糖不耐受与高血压;在2005年,国际糖尿病联盟发表了成人的代谢症候群定义,但是截至目前都还没有针对孩童或青少年的风险做出统一的定义。
  
  为了符合容易使用的需求,临床上为确认孩童及青少年的代谢症候群,国际糖尿病联盟扩大先前修正过的成人标准研究去调查年轻人的盛行率来发展新的、简单的定义。
  
  因为对6岁以下孩童没有足够数据,此年龄层的族群被排除在定义外。
  
  介于6至10岁的孩童,国际糖尿病联盟认为肥胖是造成之后代谢症候群的危险族群(腰围大于等于90分位数),虽然代谢症候群不应该被诊断于该年龄族群,但是减重的讯息应该传达给腹部肥胖的孩童,且有第二型糖尿病、血脂异常、心血管疾病、高血压或肥胖等代谢症候群家族史的孩童应被仔细评估。
  
  在青少年时期的10至16岁,代谢症候群可藉由肥胖(腰围大于等于90分位数、或是成人标准的低限)以及出现两种以上临床症状(三酸甘油酯≧ 1.7 mmol/L;高密度脂蛋白胆固醇< 1.03 mmol/L;收缩压≧ 130 mm Hg或舒张压≧ 85 mm Hg;血糖≧ 5.6 mmol/L或低于口服葡萄糖耐受测试建议;或是已知第二型糖尿病)。
  
  16岁以上的青少年,可适用国际糖尿病联盟的成人标准。
  
  作者指出,早期确认孩童处于发展代谢症候群、第二型糖尿病及心血管疾病在未来的生活是重要的;在胚胎时期或幼童期接触的环境与之后发展的疾病,例如肥胖、血糖异常以及代谢症候群有关,都市化、不健康的饮食与久坐的生活型态是造成此类疾病的主要原因。
  
  对于儿童与青少年体脂肪与其分布状况的关系还需更深入研究,评估早期的成长状况预测未来肥胖以及代谢症候群的其它特征;开始长期的世代研究,研究不同种族的孩童至成人阶段,去定义自然史及介入的有效性,特别是针对与生活型态相关的问题。
  
  作者最后提到,早期检测后治疗,尤其是生活型态的改变,可制止孩童与青少年代谢症候群的发展,如此可降低成人时期的罹病率与帮助维持全球心血管疾病与第二型糖尿病的负担;政府和社会必须警觉到孩童与青少年的肥胖可能与代谢症候群的发展有关。
  
  国际糖尿病联盟研讨会由Sanofi-Aventis公司赞助,其中咨询、演讲费用以及/或是研究经费来自于药厂,其中一名作者为糖尿病预防服务的股东。
  
  Lancet. 2007;369:2059-2061.

New Definition May Help Identi

By Laurie Barclay, MD
Medscape Medical News

July 2, 2007 — The International Diabetes Federation (IDF) has developed a new definition of metabolic syndrome to help identify children at risk of developing the syndrome. A commentary describing this consensus definition is published in the June 23 issue of The Lancet.

"The metabolic syndrome in adults is defined as a cluster of risk factors for cardiovascular disease and type 2 diabetes mellitus, which include abdominal obesity, dyslipidaemia, glucose intolerance, and hypertension," write Paul Zimmet, MD, PhD, from the International Diabetes Institute in Melbourne, Victoria, Australia, and colleagues from the IDF Task Force on Epidemiology and Prevention of Diabetes. "In 2005, the [IDF] published its definition of the metabolic syndrome in adults. However, to date no unified definition exists to assess risk or outcomes in children and adolescents."

To meet the need for an easy-to-use, clinically accessible diagnostic tool to identify metabolic syndrome in children and adolescents, the IDF developed a new, simple definition, extending previous studies using modified adult criteria to investigate prevalence in young people.

Because of insufficient data in children younger than 6 years, this age group was excluded from the definition.

In children aged 6 to younger than 10 years, the IDF definition of the at-risk group for later development of metabolic syndrome consists of obesity (waist circumference ≥ 90th percentile). Although metabolic syndrome should not be diagnosed in this age group, a strong message for weight reduction should be delivered for those with abdominal obesity, and further measurements should be made if there is a family history of metabolic syndrome, type 2 diabetes mellitus, dyslipidemia, cardiovascular disease, hypertension, or obesity.

In adolescents aged 10 to younger than 16 years, metabolic syndrome can be diagnosed by abdominal obesity (waist circumference ≥ 90th percentile, or adult cutoff if lower) and the presence of 2 or more other clinical features (triglycerides ≥ 1.7 mmol/L; high-density lipoprotein cholesterol < 1.03 mmol/L; blood pressure ≥ 130 mm Hg systolic or ≥ 85 mm Hg diastolic; glucose ≥ 5.6 mmol/L [oral glucose tolerance test recommended]; or known type 2 diabetes mellitus).

For adolescents older than 16 years, existing IDF criteria for adults should be used.

"Early identification of children who are at risk of developing the syndrome, type 2 diabetes mellitus, and cardiovascular disease in later life is important," the authors write. "Circumstances in utero and in early childhood predispose a child to disorders such as obesity, dysglycaemia, and the metabolic syndrome. Furthermore, urbanisation, unhealthy diet, and sedentary lifestyle are major contributors to such disorders."

Recommendations for future research include determining the relationship between body fat and its distribution in children and adolescents; evaluating whether early growth patterns predict future adiposity and other features of the syndrome; and beginning long-term studies following cohorts of children of different ethnicities into adulthood to define the natural history and effectiveness of interventions, especially those relating to lifestyle.

"Early detection followed by treatment — particularly lifestyle intervention — is vital to halt the progression of the metabolic syndrome in children and adolescents," the authors conclude. "Such action should reduce morbidity and mortality in adulthood and help keep to a minimum the global burden of cardiovascular disease and type 2 diabetes mellitus. Governments and society must be made more aware of the problems associated with obesity and the likelihood of progression to the metabolic syndrome in children and adolescents."

The IDF Consensus workshop was supported by Sanofi-Aventis. Some of the authors report consultancy, speaker fees, and/or research support from relevant drug companies, and one author is a shareholder in Diabetes Prevention Services.

Lancet. 2007;369:2059-2061.

    
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