Although metabolic syndrome (MetS) is normally considered an adult health issue, a growing number of children and adolescents are developing symptoms of this syndrome – putting them at risk for type 2 diabetes, heart disease, and other serious health conditions. The good news is that MetS is largely preventable, and lifestyle changes are usually sufficient to reduce the risk for serious diseases later in life.
What is Metabolic Syndrome?
Metabolic syndrome is a group of signs and symptoms that raise the risk of coronary heart disease, diabetes, stroke, and other health problems. For adults, MetS is defined as having three or more of the following:1,2
A large waistline (waist circumference of 35 inches or more for women and 40 inches or more for men). Also known as abdominal obesity or "having an apple shape." Extra fat in the stomach area is a greater risk factor for heart disease than extra fat in other parts of the body.
Elevated blood pressure (130/85 mmHg or higher). Continuously high blood pressure damages the heart and blood vessels. High blood pressure also causes plaque to build up in the lining of arteries, which can cause a heart attack or stroke.
High fasting blood sugar (100 mg/dL or greater). A high level of blood sugar (glucose) can be a sign of pre-diabetes or diabetes. It can also damage blood vessels and increase the risk of blood clots, which can lead to heart and blood vessel diseases.
High blood triglycerides (150 mg/dL or more). Triglycerides are a type of fat found in blood. A high level of triglycerides can raise the level of LDL cholesterol, commonly called "bad" cholesterol. High LDL cholesterol increases the risk of heart disease.
Low HDL (good) cholesterol (50 mg/dL or less in women and 40 mg/dL or less in men). HDL cholesterol helps remove LDL cholesterol from blood vessels.
Metabolic syndrome is common in the United States. About 1 in 3 adults has the condition. Recently, an increasing number of children and adolescents are being diagnosed with many of the symptoms associated with MetS.3
Determining how many young people have metabolic syndrome is complicated because there isn’t a standardized definition of the condition in pediatric medicine. That's mainly because a young person isn't a smaller version of an adult – the diagnostic criteria for the health conditions of MetS in adults might not apply to children and adolescents.4
Despite the lack of universal criteria for pediatric MetS, experts recommend that parents and caregivers address the causes of metabolic syndrome to help young people avoid future health issues.
What Causes Metabolic Syndrome?
Regardless of age, metabolic syndrome is closely linked to being overweight. A combination of interrelated bodily functions that affect one another can cause a cascade of health issues that lead to metabolic syndrome.1,4
Too much fat in the abdomen and around the organs, called visceral fat, is a main cause of insulin resistance – which raises blood sugar levels. In the case of insulin resistance, a person’s cells don't respond normally to insulin, which makes it difficult for glucose to enter these cells. As a result, blood sugar levels increase.5 In addition, fat cells, especially in the abdomen, raise the level of free fatty acids. Free fatty acids and insulin resistance increase LDL cholesterol and lower HDL levels.1
Inflammation also plays a role in the development of MetS. Cells in the immune system can cause fat cells to release chemicals that increase inflammation in the body. The higher the number of fat cells, the greater the inflammation. Chronic inflammation can lead to insulin resistance, high blood pressure, and heart and blood vessel diseases.1,3
Why are Children Developing Metabolic Syndrome?
MetS is on the rise in children and adolescents because of the high number of young people who are overweight.3,4 Childhood obesity has become a serious problem in the United States. A study by the Centers for Disease Control and Prevention shows that 19 percent of children and adolescents ages 2-19 were obese in 2018 (including six percent with severe obesity) – that's about 14 million. An additional 16 percent were considered overweight.6 A 2021 study of 432,302 children ages 2-19 found the rate of increase in body mass index (BMI) has nearly doubled during the COVID-19 pandemic.7
Studies show that children whose parents have MetS have a higher risk of developing the condition as well. Research indicates that learned lifestyle behaviors and genetics both play a role.4,8 Even though genetics might contribute to MetS, lifestyle habits are the primary factors for both adults and young people. Specific behaviors include excessive screen time, unhealthy eating habits, low physical activity, short duration of sleep, and exposure to tobacco smoke.4,8
Lifestyle Habits to Manage and Decrease the Risk of MetS in Children
Currently, treatment for pediatric MetS focuses on weight reduction through dietary modification, increased physical activity, and management of specific MetS-associated factors. Usually, reducing fat mass improves each aspect of MetS.3,4,9,10
Lifestyle management techniques for MetS:9,10
Improve what a child eats and drinks. A diet that is high in calories, low in nutrients, and includes fast food and sweetened beverages increases a child's risk for metabolic syndrome. In addition, a lack of whole grains and fiber is strongly correlated with developing insulin resistance, which can lead to elevated blood sugar – a component of MetS. Eating fruits and vegetables – good sources of fiber and other healthy nutrients – reduces the risk of atherosclerotic cardiovascular disease in adults and benefits children's health as well.3,4,11 Learn more by reading: Tips to Help Kids Make Healthy Food Choices
Reduce screen time. The number of hours a child spends in front of a screen is directly related to body mass index (BMI) and calories consumed per day.3 Eating while watching TV, scrolling on a phone, playing video games, or similar activities leads to mindless snacking, consumption of more calories, and reduced physical activity.11 In addition, increased television viewing in adolescence is associated with an increased risk of developing MetS in adulthood.3
The American Academy of Pediatrics (AAP) recommends avoiding screen time for babies and toddlers until they are 18-24 months old, except for video chatting. In addition, children ages 2-5 should get an hour or less of screen time per day. The AAP has also developed a Family Media Use Plan for older kids, in which parents and children negotiate limits and boundaries around screen usage.12,13 Because children have been exposed to more screen time due to hybrid and distance learning during the COVID-19 pandemic, it's more important than ever that parents and caregivers monitor and reduce how often children use electronics outside of schoolwork.
Increase physical activity. Physical activity helps maintain a healthy weight and benefits the mind and body in numerous ways. Exercise can dramatically improve blood pressure, cholesterol, and insulin sensitivity. Moderate and vigorous physical activity in adults and adolescents lowers the risk of developing MetS.9,10
Get enough sleep. Adequate sleep is fundamental to good health. Proper sleep aids in the prevention of obesity, type 2 diabetes, and many adverse issues related to mental health, attention, and behaviour.14
Avoid tobacco smoke exposure. Either alone or in combination with metabolic syndrome risk factors, smoking greatly increases a child's risk for heart disease.3
Given the ongoing obesity epidemic and large number of children who are overweight, it is critical for parents, caregivers, and clinicians to identify overweight and obese children who are at high risk for cardiovascular disease and type 2 diabetes.
Lifestyle changes greatly impact the course of MetS and can reverse aspects of the condition.3,9,10 It's never too late to start a wellness plan to help the children and adults in your household live a healthy, disease-free life.
Content from the Mayo Clinic, via Thorne Research
What is metabolic syndrome. National Institutes of Health. https://www.nhlbi.nih.gov/health/metabolic-syndrome. [Accessed June 20, 2022]
Moore JX, Chaudhary N, Akinyemiju T. Metabolic syndrome prevalence by race/ethnicity and sex in the United States, national health and nutrition examination survey, 1988-2012. Prev Chronic Dis 2017;14:160287.
Wittcopp C, Conroy R. Metabolic syndrome in children and adolescents. Pediatr Rev 2016;37(5):193-202.
Magge SN, Goodman E, Armstrong SC. Committee on nutrition; section on endocrinology; section on obesity. The metabolic syndrome in children and adolescents: shifting the focus to cardiometabolic risk factor clustering. Pediatrics 2017;140(2):e20171603.
Insulin resistance and prediabetes. National Institutes of Health. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance#causes. [Accessed June 20, 2022].
Fryar CD, Carroll MD, Afful J. Prevalence of overweight, obesity, and severe obesity among children and adolescents aged 2-19 years: United States, 1963-1965 through 2017-2018. NCHS Health E-Stats. 2020. https://www.cdc.gov/nchs/data/hestat/obesity-child-17-18/overweight-obesity-child-H.pdf. [Accessed June 23, 2022]
Lange SJ, Kompaniyets L, Freedman DS, et al. Longitudinal trends in body mass index before and during the COVID-19 pandemic among persons aged 2-19 years – United States, 2018-2020. Morb Mortal Wkly Rep 2021;70:1278-1283.
Wu YE, Zhang CL, Zhen Q. Metabolic syndrome in children (Review). Exp Ther Med 2016;12(4):2390-2394.
Tagi VM, Samvelyan S, Chiarelli F. Treatment of metabolic syndrome in children. Horm Res Paediatr 2020;93(4):215-225.
Fornari E, Maffeis C. Treatment of metabolic syndrome in children. Front Endocrinol (Lausanne). 2019;10:702.
Centers for Disease Control and Prevention. Tips to help children maintain a healthy weight. https://www.cdc.gov/healthyweight/children/index.html. [Accessed June 20, 2022]
COUNCIL ON COMMUNICATIONS AND MEDIA. Media use in school-aged children and adolescents. Pediatrics. 2016;138(5):e20162592.
COUNCIL ON COMMUNICATIONS AND MEDIA. Media and young minds. Pediatrics 2016;138(5):e20162591.
Do your children get enough sleep? Centers for Disease Control and Prevention. https://www.cdc.gov/chronicdisease/resources/infographic/children-sleep.htm. [Accessed June 20, 2022]