Treating metabolic syndrome in kids

As a clinical pharmacist, you should know how to treat metabolic syndrome in PEDIATRIC patients. There will be more focus on treating metabolic syndrome in kids. This combination of obesity, insulin resistance, dyslipidemia, and hypertension is becoming more common in kids as well as adults. It's especially important to control these factors in kids, to prevent or delay the onset of diabetes and heart disease. Lifestyle changes are the key to management, but drugs are sometimes used in certain situations.

• Obesity drugs are for adolescents who are very overweight, those with a BMI greater than the 99th percentile for their age.
• Now, clinicians can use semaglutide (Ozempic, Wegovy) safely in kids, others may use orlistat (Xenical) for modest weight loss in kids age 12 and up.
• Suggest a multivit to prevent deficiency of fat-soluble vitamins, taken at least 2 hours before or after orlistat.
• Consider metformin as a possible alternative to orlistat. Early evidence shows it causes weight loss in kids, and it has beneficial effects on insulin and lipid levels.
• Insulin resistance is treated if kids develop type 2 diabetes. Recommend starting with metformin, it's not likely to cause weight gain or hypoglycemia. Suggest adding a sulfonylurea or insulin if metformin alone is not enough.
• Dyslipidemia usually consists of high triglycerides and low HDL, and sometimes high LDL.
• Recommend statins for most kids with metabolic syndrome age 10 and up if LDL is 154 mg/dL (4 mmol/L) or higher, or 130 mg/dL (3.4 mmol/L) with diabetes. Keep in mind some experts are now using statins in kids as young as age 8.
• Suggest fibrates for triglycerides above 500 mg/dL (6-8 mmol/L).
• Discourage niacin (NOT available in Egypt) because of tolerability concerns, flushing and increased liver enzymes.
• Hypertension drugs are needed when lifestyle changes aren't enough.
• Recommend an ACE inhibitor or ARB for kids with diabetes and evidence of kidney problems. Counsel teenage girls about appropriate pregnancy precautions while taking ACEIs, ARBs, or statins.
• Also feel comfortable suggesting a calcium channel blocker to lower BP in children with metabolic syndrome.
• Continue to recommend exercise and a healthy weight in all kids with metabolic syndrome including those receiving drugs.

References

• Wilfley DE, Vannucci A, White EK. Early intervention of eating- and weight-related problems. J Clin Psychol Med Settings. 2010 Dec;17(4):285-300. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705973

  Type 2 diabetes in children and adolescents. American Diabetes Association. Diabetes Care. 2000 Mar;23(3):381-9. Available at: https://diabetesjournals.org/care/article/23/3/381/20771/Type-2-diabetes-in-children-and-adolescents

  NHLBI (2005). The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. [online] Available at: https://www.nhlbi.nih.gov/files/docs/resources/heart/hbp_ped.pdf

  McCrindle BW, Urbina EM, Dennison BA, Jacobson MS, Steinberger J, Rocchini AP, Hayman LL, Daniels SR; American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee; American Heart Association Council of Cardiovascular Disease in the Young; American Heart Association Council on Cardiovascular Nursing. Drug therapy of high-risk lipid abnormalities in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee, Council of Cardiovascular Disease in the Young, with the Council on Cardiovascular Nursing. Circulation. 2007 Apr 10;115(14):1948-67. Available at: https://pubmed.ncbi.nlm.nih.gov/17377073