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| EDITORIAL |
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| Year : 2013 | Volume
: 2
| Issue : 1 | Page : 1-2 |
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Pharmacotherapy of pediatric metabolic syndrome
Roya Kelishadi, Fahimeh Jamshidi
Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| Date of Web Publication | 27-Jun-2013 |
Correspondence Address:
Fahimeh Jamshidi
Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan
Iran
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2279-042X.114080
How to cite this article:
Kelishadi R, Jamshidi F. Pharmacotherapy of pediatric metabolic syndrome. J Res Pharm Pract 2013;2:1-2 |
Pediatric metabolic syndrome has become an emerging health problem world-wide, with a considerable increase in low- and middle-income countries. Given its short-term and long-term adverse health consequences, notably on chronic non-communicable diseases, its primordial/primary prevention and early management are of crucial importance.
Genetic-environment interaction is essential in the development of this syndrome. Given that the underlying modifiable risk factors that promote its development are excess weight, physical inactivity, and unhealthy atherogenic diet, all current guidelines on its management emphasize on the pivotal role of life-style change as the first-line clinical therapy.
Some non-pharmacological modalities are reported to be beneficial to be added to life-style modification for management of pediatric metabolic syndrome, e.g., consumption of dairy-rich diets, [1] synbiotics, [2] and juices rich in antioxidants. [3]
Using the herbal extracts revealed controversial results. Plant extracts like botanical therapeutics often contain natural active components that act upon numerous biological targets, providing an opportunity to simultaneously correct multiple defects associated with metabolic syndrome, in contrast to single-target drugs. The fermentability of dietary fiber seems important to generate specific effects on satiety and glycaemia through the release of gut peptides such as glucagon-like peptide-1 associated with the control of the metabolic syndrome. [4]
Although, therapeutic lifestyle modification is first-line therapy for the metabolic syndrome and thus, deserves initial attention, drug therapy may be necessary in many of the adults to achieve recommended goals. The ideal drug for metabolic risk factors would be one that simultaneously lowers apo B-containing lipoproteins, raises high-density lipoprotein (HDL) cholesterol, and reduces blood pressure and glucose levels. Such a drug has yet to be developed; it presumably will be necessary to target a master regulatory pathway. In adults, the use of combination therapy with fibrates or nicotinic acid plus a statin is attractive for metabolic-syndrome patients with atherogenic dyslipidemia; even so, efficacy over statins alone has not been documented through clinical trials. Low-dose aspirin to modify the prothrombotic pro-inflammatory state is justified for patients at intermediate risk and high risk. To date, management of insulin resistance with insulin-sensitizing agents in the absence of diabetes has not been shown to reduce cardiovascular risk; therefore, they are not recommended for this purpose. [5],[6]
Although in some cases, lipid-lowering medications are prescribed for management of hyperlipidemia in the pediatric age group, [7],[8] but this kind of therapy is usually indicated for those with very high cholesterol levels. As the lipid disorders considered as components of metabolic syndrome are high triglycerides and low HDL-cholesterol levels, generally they do not need pharmacotherapy unless being accompanied with other kinds of hyperlipidemia.
Some evidence exist on the beneficial effects of vitamin D, [9] zinc sulphate [10],[11] or omega-3 [12] on insulin resistance and components of metabolic syndrome in children and adolescents; however, long-term effects of such treatment modalities should be determined. Metformin is recommended for those cases of pediatric metabolic syndrome with confirmed insulin resistance and it cannot be generalized to all cases.
It can be concluded that still life-style change is the mainstay for management of pediatric metabolic syndrome; physicians, families, and patients cannot count on pharmacotherapy for treating this disorder. Primordial/primary prevention of pediatric metabolic syndrome should be underscored.
| References | |  |
| 1. | Kelishadi R, Zemel MB, Hashemipour M, Hosseini M, Mohammadifard N, Poursafa P. Can a dairy-rich diet be effective in long-term weight control of young children? J Am Coll Nutr 2009;28:601-10. 
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| 2. | Safavi M, Farajian S, Kelishadi R, Mirlohi M, Hashemipour M. The effects of synbiotic supplementation on some cardio-metabolic risk factors in overweight and obese children: A randomized triple-masked controlled trial. Int J Food Sci Nutr 2013; [Epub ahead of print]
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| 3. | Hashemi M, Kelishadi R, Hashemipour M, Zakerameli A, Khavarian N, Ghatrehsamani S, et al. Acute and long-term effects of grape and pomegranate juice consumption on vascular reactivity in paediatric metabolic syndrome. Cardiol Young 2010;20:73-7.
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| 4. | Delzenne NM, Cani PD. A place for dietary fibre in the management of the metabolic syndrome. Curr Opin Clin Nutr Metab Care 2005;8:636-40.
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| 5. | Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: An American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Curr Opin Cardiol 2006;21:1-6.
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| 6. | Grundy SM. Metabolic syndrome: A multiplex cardiovascular risk factor. J Clin Endocrinol Metab 2007;92:399-404.
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| 7. | Carreau V, Girardet JP, Bruckert E. Long-term follow-up of statin treatment in a cohort of children with familial hypercholesterolemia: Efficacy and tolerability. Paediatr Drugs 2011;13:267-75.
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| 8. | Wierzbicki AS, Viljoen A. Hyperlipidaemia in paediatric patients: The role of lipid-lowering therapy in clinical practice. Drug Saf 2010;33:115-25.
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| 9. | Belenchia AM, Tosh AK, Hillman LS, Peterson CA. Correcting vitamin D insufficiency improves insulin sensitivity in obese adolescents: A randomized controlled trial. Am J Clin Nutr 2013;97:774-81.
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| 10. | Kelishadi R, Hashemipour M, Adeli K, Tavakoli N, Movahedian-Attar A, Shapouri J, et al. Effect of zinc supplementation on markers of insulin resistance, oxidative stress, and inflammation among prepubescent children with metabolic syndrome. Metab Syndr Relat Disord 2010;8:505-10.
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| 11. | Hashemipour M, Kelishadi R, Shapouri J, Sarrafzadegan N, Amini M, Tavakoli N, et al. Effect of zinc supplementation on insulin resistance and components of the metabolic syndrome in prepubertal obese children. Hormones (Athens) 2009;8:279-85.
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| 12. | Juárez-López C, Klünder-Klünder M, Madrigal-Azcárate A, Flores-Huerta S. Omega-3 polyunsaturated fatty acids reduce insulin resistance and triglycerides in obese children and adolescents. Pediatr Diabetes 2013; [Epub ahead of print].
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