Metabolic syndrome in pediatrics: Old concepts revised, new concepts discussed

摘要

The worldwide epidemic of childhood obesity in the last decades is responsible for the occurrence in pediatrics of disorders once mainly found in adults, such as the metabolic syndrome (MS). First described by Gerald Reaven, MS has been defined as "a link between insulin resistance, hypertension, dyslipidemia, impaired glucose tolerance and other metabolic abnormalities associated with an increased risk of athero-slerotic cardiovascular diseases in adults." A key factor in the pathogenesis of MS is insulin resistance, a phenomenon occurring mainly in obese subjects with a general resistance to the insulin effect only on carbohydrates and lipid metabolism. The pathogenesis of insulin resistance has been studied for many years and it is now known that free fatty acid (FFA) accumulation in the liver, fat cells, pancreas and, particularly, skeletal muscle of obese patients, interfering with the normal insulin signaling cascade, appears as the primary determinant of insulin resistance. Moreover, FFA accumulation in the liver makes it resistant to insulin in terms of the ability of the hormone to suppress glucose production!