Behind and beyond the pediatric metabolic syndrome

A recent scientific statement from the American Heart Association and other related Committees focussed the topic of the Metabolic Syndrome (MetS) in pediatric age [1]. The paper provided a set of fundamental questions about what the pediatric MetS means in clinical or research setting. The Authors concluded defining limits of our current knowledge and providing suggestions for needed future research [1]. This position paper outlined most of the concerns that pediatricians feel about the usefulness of MetS diagnosis in day by day clinical practice. Concerns also are referred to which MetS definition has to be used for children. Controversies are mainly related to two diverging approaches: one adapting the definition of MetS from adults [2-4], the other considering the peculiarities of children and adolescents [5,6].Aim of the present paper is to discuss difficulties found by pediatricians facing to MetS definition and usefulness.Metabolic syndrome is the clustering of specific metabolic abnormalities found in overweight and obese subjects, but present also in some normal weight subjects. In adults, the presence of three among clinical (obesity or abdominal obesity, hypertension) and metabolic parameters (hyperglycemia, high triglycerides, low HDL-cholesterol) is used to define MetS [2-4]. In the last decade, many studies in paediatrics derived MetS definition from those used for adults, mostly adapting cut-off points for each parameter to children or adolescents. For this purpose, the percentile methodology was generally used. Recently, the International Diabetes Federation (IDF) proposed a new pediatric definition according to age groups [7]. In particular, IDF suggested that the MetS should not be diagnosed in children younger than 10 yrs, while for subjects 10 to 16 years they proposed the use of adult IDF MetS definition [3] with the only difference represented by waist 90th percentile instead of absolute values. Therefore, the IDF defined a 10-16 yrs old subjec