An American Academy of Pediatrics (AAP) clinical report advises pediatricians to focus their clinical screening and treatment on cardiometabolic risk factors—especially obesity—rather than strict reliance on the metabolic syndrome (MetS) in managing cardiovascular disease (CVD) and diabetes risk in children (Pediatrics 2017;140:e20171603).

MetS describes a cluster of factors that put people at risk for developing CVD and diabetes. While five health organizations have developed criteria for insulin resistance or MetS in adults, more than 40 different definitions have been proposed for children and youth, and there’s no clear consensus on whether MetS definitions even should be used in kids.

This confusion stems not only from the many MetS definitions but also the instability of MetS components as children transition through adolescence, as well as the predictive value of MetS thresholds in pediatrics for future health outcomes.

Given these unsettled practice parameters, AAP recommends focusing on managing obesity in children, with annual body mass index (BMI) and blood pressure checks. The report also endorses universal nonfasting non-high-density lipoprotein cholesterol or fasting lipid screening in children between 9 and 11 years. Those ages 10 or older with BMI ≥85th percentile plus two additional risk factors should undergo fasting glucose testing every 2 years.

The authors concluded, “Continued efforts to prevent and treat obesity and its associated metabolic abnormalities among children and adolescents and vigilant attention to the early diagnosis of diabetes provide the pediatrician with the most evidence-based methods for addressing cardiometabolic risk factor clustering (MetS) in adolescence.”