Información del artículo
La dislipemia, hipertensión, insulinorresistencia, alteración hidrocarbonada y obesidad son potentes factores de riesgo de la enfermedad cardiovascular en el adulto. Esta constelación de situaciones patológicas se conoce como síndrome dismetabólico. La obesidad tiene un papel central en este síndrome. Aunque el impacto de la enfermedad cardiovascular y la muerte se ve en el adulto, el proceso patológico y los factores de riesgo asociados comienzan durante la infancia. Se han encontrado componentes del síndrome dismetabólico en el niño y en el adolescente. La obesidad en estas edades también se asocia con insulinorresistencia, junto a anomalías lipídicas y alteración de la presión arterial en el adulto joven. La diabetes tipo 2 se ha vuelto muy prevalente entre los adolescentes obesos, y el mejor predictor de la alteración de la tolerancia a la glucosa es la evidencia de insulinorresistencia.
Debido al gran incremento de la incidencia de obesidad en la edad pediátrica, sobre todo en algunos países y en ciertas etnias, tiene una gran importancia conocer y controlar estos factores de riesgo en las edades tempranas de la vida. Hay que prevenir e intervenir precozmente en los niños y adolescentes con sobrepeso y obesidad, sobre todo en los que pertenecen a los grupos de riesgo.
Palabras clave:
Obesidad
Lípidos
Infancia
Factores de riesgo cardiovascular
Insulinorresistencia
Diabetes
Dyslipidemia, hypertension, insulin resistance, alterations in carbohydrate metabolism, and obesity are potent risk factors for cardiovascular disease in adults. This constellation of pathological situations is known as dysmetabolic syndrome. Obesity plays a central role in this syndrome. Although the impact of cardiovascular disease and death is evident in adults, the pathological process and associated risk factors begin during childhood. Components of metabolic disease have been found in children and adolescents. Obesity at these ages is also associated with insulin resistance, together with lipid abnormalities and increased blood pressure in young adults. Type 2 diabetes has become highly prevalent among obese adolescents and insulin resistance is the best predictor of alterations in glucose tolerance.
Because of the large increase in the incidence of obesity in the pediatric age group, especially in certain countries and ethnic groups, knowledge and control of these risk factors at a young age are essential. Early prevention and intervention in overweight and obese children and adolescents, especially in those who belong to risk groups, is crucial.
Key words:
Obesity
Lipids
Childhood
Cardiovascular risk factors
Insulin resistance
Diabetes
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Bibliografía
[1.]
National Cholesterol Education Panel (NCEP)..
Adult Treatment Panel III (ATP III).
JAMA, 285 (2001), pp. 2486-2497
[2.]
S. Cook, M. Meitzman, P. Auinger, M. Nguyen, W.H. Dietz.
Prevalence of a metabolic syndrome phenotype in adolescents.
Arch Pediatr Adolesc Med, 157 (2003), pp. 821-827
[3.]
G.S. Berenson, S.R. Srinivasan, W. Bao, I.I.I. Newman WP, R.E. Tracy, W.A. Watligney.
Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults.
N Engl J Med, 338 (1998), pp. 1650-1656
[4.]
C.L. Willians, L.L. Hayman, S.R. Daniels, T.N. Robinson, J. Steinberger, S. Paridon, et al.
Cardiovascular health in childhood: a statement for health professionals from the Committee on Atherosclerosis, Hypertension, and Obesity in the Young (AHOY) of the Council on Cardiovascular Disease in Young. American Heart Association.
Circulation, 106 (2002), pp. 143-160
[5.]
J. Steinberger, S.R. Daniels.
Obesity, insulin resistance, diabetes, and cardiovascular risk in children: an American Heart Association scientific statement from the Atherosclerosis, Hypertension, and Obesity in the Young Committee (Council on Cardiovascular Disease in the Young) and the Diabetes Committee (Council on Nutrition, Physical Activity and Metabolism).
Circulation, 107 (2003), pp. 1448-1453
[6.]
M.I. Goran, G.D.C. Ball, M.L. Cruz.
Cardiovascular endocrinology 2: obesity and risk of type 2 diabetes and cardiovascular disease in children and adolescents.
J Clin Endocrinol Metab, 88 (2003), pp. 1417-1427
[7.]
J. Steinberger.
Diagnosis of the metabolic syndrome in children.
Curr Opin Lipidol, 14 (2003), pp. 555-559
[8.]
R.J. Kuczmarski, M.D. Carroll, K.M. Flegal, R.P. Troyano.
Varying body mass index cut-off points to describe overweight prevalence among U.S. adults: NHANES III (1988 to 1994).
Obes Res, 5 (1997), pp. 542-548
[9.]
Ford ESG.
Prevalence of the metabolic syndrome among US adults: findings from the Third National Health and Nutrition Examination Survey.
JAMA, 287 (2002), pp. 356-359
[10.]
G.S. Berenson, S.R. Srinivasan, W.A. Wattigney, D.W. Harsha.
Obesity and cardiovascular risk in children.
Ann NY Acad Sci, 699 (1993), pp. 93-110
[11.]
D.S. Freedman, W. Dietz, S.R. Srinivasan, G.S. Berenson.
The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study.
Pediatrics, 103 (1999), pp. 175-182
[12.]
J. Steinberger.
Insulin resistance and cardiovascular risk in the pediatric patient.
Prog Pediatr Cardiol, 12 (2002), pp. 169-175
[13.]
G.M. Reaven.
Insulin resistance, compensatory hyperinsulinemia, and coronary heart disease. Syndrome X revisited.
Handbook of physiology, pp. 1169-1197
[14.]
S. Lillioja, D.M. Mott, M. Spraul, R. Ferraro, J.E. Foley, E. Ravussin, et al.
Insulin resistance and insulin secretory dysfunction as precursors of non-insulin-dependent diabetes mellitus. Prospective studies of Pima Indians.
N Engl J Med, 329 (1993), pp. 1988-1992
[15.]
I. Zavaroni, I. Bonni, P. Gasparini, A.L. Barilli, A. Zuccarelli, E. Dalláglio, et al.
Hyperinsulinemia in normal population as a predictor of non-insulin-dependent diabetes mellitus, hypertension and coronary heart disease; the Barilla factory revisited.
Metabolism, 48 (1999), pp. 989-994
[16.]
J.F. Ascaso, S. Pardo, J.T. Real, R.I. Lorente, A. Priego, R. Carmena.
Diagnosing insulin resistance by simple quantitative methods in subjects with normal glucose metabolism.
Diabetes Care, 26 (2003), pp. 3320-3325
[17.]
F. Jeppensen, H.O. Hein, P. Suadicani, F. Gyntelberg.
Low triglycerides-high density lipoprotein cholesterol and risk ischemic heart disease.
Arch Intern Med, 161 (2001), pp. 361-366
[18.]
T. McLaughlin, F. Abbasi, K. Cheal, J. Chu, C. Lamendola, G. Reaven.
Use of metabolic markers to identify overweight individuals who are insulin resistant.
Ann Intern Med, 139 (2003), pp. 802-809
[19.]
S.A. Amiel, R.S. Sherwin, D.C. Simonson, A.A. Lauritano, W.V. Tamborlane.
Impaired insulin action in puberty: a contributing factors to poor glycemic control in adolescents with diabetes.
N Engl J Med, 315 (1986), pp. 215-219
[20.]
M.L. Cruz, M. Weigensberg, T. Huang, G. Ball, G. Shabi, M. Goran.
The metabolic syndrome in overweight Hispanic youth and the role of insulin sensitivity.
J Clin Endocrinol Metab, 89 (2004), pp. 108-113
[21.]
K.M. Flegal, M.D. Carroll, C.l. Ogden, C.L. Jonson.
Prevalence and trends in obesity among US adults, 1999-2000.
JAMA, 288 (2002), pp. 1723-1727
[22.]
C.L. Ogden, K.M. Flegal, M.D. Carroll, C.L. Jonson.
Prevalence and trends in overweight among US children and adolescents, 1999-2000.
JAMA, 288 (2002), pp. 1728-1732
[23.]
J. Skrha, T. Haas, G. Sindelka, M. Prazny, J. Widimsky, D. Cibula, et al.
Comparison of the insulin action parameters from hyperinsulinemic clamps with homeostasis model assessment and QUICKI indexes in subjects with different endocrine disorders.
J Clin Endocrinol Metab, 89 (2004), pp. 135-141
[24.]
M.D. Becque, V.L. Katch, A.P. Rocchinni, C.R. Marks, C. Moorehead.
Coronary risk incidence of obese adolescents: reduction by exercise plus diet intervention.
Pediatrics, 81 (1988), pp. 605-612
[25.]
R.J. Deckelbaum, C.L. Williams.
Childhood obesity: the health issue.
Obes Rev, 9 (2001), pp. 239-243
[26.]
C. Maffeis, P. Moghetti, A. Grezzani, M. Clementi, R. Gaudino, L. Tato.
Insulin resistance and the persistence of obesity from childhood into adulthood.
J Clin Endocrinol Metab, 87 (2002), pp. 71-76
[27.]
W.H. Dietz, T.N. Robinson.
Use of the body mass index as a measure of overweight in children and adolescent.
J Pediatr, 132 (1998), pp. 191-193
[28.]
T. Cole, M. Bellizzi, K. Flegal, W.H. Dietz.
Establishing a standard definition for child overweight and obesity worldwide: international survey.
BMJ, 320 (2000), pp. 1240-1243
[29.]
M.I. Goran, B.A. Gower.
Relation between visceral fat and disease risk in children.
Am J Clin Nutr, 70 (1999), pp. 149S-156S
[30.]
J.M. Kotchen, T.A. Kotchen, G.P. Guthrie, D.M. Cottrill, H.E. McKean.
Correlates of adolescent blood pressure at five year follow-up.
Hypertension, 2 (1980), pp. 124-129
[31.]
H.C. McGill, C.A. McMahan, E.E. Herderick, A.W. Zieske, G.T. Malcom, R.E. Tracy, et al.
Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. Obesity accelerates the progression of coronary atherosclerosis in young men.
Circulation, 105 (2002), pp. 2712-2718
[32.]
G.S. Berenson, W.A. Wattigney, R.E. Tracy, I.I.I. Newman WP, S.R. Srinivasan, L.S. Webber, et al.
Atherosclerosis of the aorta and coronary-arteries and cardiovascular risk-factors in persons aged 6 to 30 years and studied at necropsy (the Bogalusa Heart study).
Am J Cardiol, 70 (1992), pp. 851-885
[33.]
M.A. Ferguson, B. Gutin, S. Owens, M. Litaker, R.P. Tracy, J. Allison.
Fat distribution and hemostatic measures in obese children.
Am J Clin Nutr, 67 (1998), pp. 1136-1140
[34.]
S.R. Srinivasan, F. Myers, G.S. Berenson.
Predictability of childhood adiposity and insulin for developing insulin resistance syndrome in young adulthood: the Bogalusa Heart Study.
Diabetes, 51 (2002), pp. 204-209
[35.]
S. Arslanian, C. Suprasongsin.
Insulin sensitivity, lipids and body composition in childhood: is “syndrome X” present?.
J Clin Endocrinol Metb, 81 (1996), pp. 1058-1062
[36.]
R. Bonadonna, L. Groop, N. Kraemer, R.A. DeFronzo.
Obesity and insulin resistance in man: a dose response study.
Metabolism, 39 (1990), pp. 452-459
[37.]
O. Pinhas-Hamiel, L.M. Dolan, S.R. Daniels, D. Standiford, P.R. Khoury, P. Zeitler.
Increased incidence of non-insulin-dependent diabetes mellitus among adolescents.
J Pediatr, 128 (1996), pp. 608-615
[38.]
R. Sinha, G. Fish, B. Teague, W.V. Tamborlane, B. Banyas, K. Allen, et al.
Prevalence of impaired glucose tolerance among children and adolescents with marked obesity.
N Engl J Med, 346 (2002), pp. 802-810
[39.]
E.P. Paulsen, L. Richenderfer, F. Ginsberg-Fellner.
Plasma glucose, free fatty acids and immunoreactive insulin in sixty-six obese children.
Diabetes, 17 (1968), pp. 261-269
[40.]
S.R. Srinivasan, M.G. Fronton, G.S. Berenson.
Longitudinal changes in risk variables of insulin resistance syndrome from childhood to young adulthood in offspring of parents with type 2 diabetes: the Begolusa Heart study.
Metabolism, 52 (2003), pp. 443-450
[41.]
M.I. Goran, R.N. Bergman, Q. Avila, M. Watkins, G. Ball, G.Q. Shaibi, et al.
Impaired glucose tolerance and reduced β-cell function in overweight latino children with a positive family history for type 2 diabetes.
J Clin Endocrinol Metab, 89 (2004), pp. 207-212
[42.]
National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents.
Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents: a working group report from the National High Blood Pressure Education Program.
Pediatrics, 98 (1996), pp. 649-658
[43.]
J. Sorof, S. Daniels.
Obesity hypertension in children: a problem of epidemic proportions.
Hypertension, 40 (2002), pp. 441-447
[44.]
A.R. Sinaiko, J. Steinberger, A. Moran, R.J. Prineas, D.R. Jacobs Jr..
Relation of insulin resistance to blood pressure in childhood.
J Hypertens, 20 (2002), pp. 509-517
[45.]
R. Kohen-Avramoglu, A. Theriault, K. Adeli.
Emergence of the metabolic syndrome in childhood: an epidemiological overview and mechanistic link to dyslipemia.
Clin Biochem, 36 (2003), pp. 413-420
[46.]
E.A. Roberts.
Steatohepatitis in children.
Best Pract Res Clin Gastroenterol, 16 (2002), pp. 749-765
[47.]
N. Kocak, A. Yuce, F. Gurakan, H. Ozen.
Obesity: a cause of steatohepatitis in children.
Am J Gastroenterology, 95 (2000), pp. 1099-1100
[48.]
N.D. Monton, J. Lipsett, D.J. Moore, G.P. Davidson, A.J. Bourne, R.T. Couper.
Non-alcoholic steatohepatitis in children and adolescents.
Med J Aust, 173 (2000), pp. 476-479
[49.]
M. Alonso, C. Mustieles, M. Lopez-Capape, M. San Jose, R. Barrio.
Insulin resistance syndrome in obese Spanish pediatric population. Programme of the Endocrine Society. Proceedings of the 85th Annual Meeting [resumen 584].
Philadelphia, (2003),
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