Type 2 Diabetes, Metabolic Syndrome and Lipid Metabolism (original) (raw)
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Type 2 Diabetes, Metabolic Syndrome and Lipids
Yearbook of Pediatric Endocrinology 2012, 2012
The complexity of the development of type 2 diabetes mellitus (T2DM) is exhibited in the story of the Oji-Cree people. Long-term surveillance of the offspring of mothers who were diagnosed with T2DM in their own childhood demonstrates the interaction between the changing environment, genetics, and antenatal factors. This year we learnt of yet another group at risk for early-onset T2DM: children treated with growth hormone (GH). The results of the first long-term clinical trial to maintain glycemic control among adolescents with T2DM are worrisome. Even more worrisome are the findings of a computer model calculating the risk of morbidity and mortality for youngsters with T2DM. We learnt that the development of the metabolic syndrome (MetS) during adolescence can be predicted by natal and parental profiles. This is important since children with MetS are at risk for developing kidney stones. The hours of sleep and the quality of sleep contribute to the development of MetS. New guidelines for universal screening for dyslipidemia in children were published this year. Studies in adults show that intensive statin treatment is associated with an increased risk of new-onset T2DM. It is comforting to know that there are new drugs to reduce LDL levels in the pipeline.
From Metabolic Syndrome to Type 2 Diabetes in Youth
Children
In the frame of metabolic syndrome, type 2 diabetes emerges along a continuum of the risk from the clustering of all its components, namely visceral obesity, high blood pressure and lipids, and impaired glucose homeostasis. Insulin resistance is the hallmark common to all the components and, in theory, is a reversible condition. Nevertheless, the load that this condition can exert on the β-cell function at the pubertal transition is such as to determine its rapid and irreversible deterioration leading to plain diabetes. The aim of this review is to highlight, in the context of metabolic syndrome, age-specific risk factors that lead to type 2 diabetes onset in youth; resume age specific screening and diagnostic criteria; and anticipate potential for treatment. Visceral obesity and altered lipid metabolism are robust grounds for the development of the disease. Genetic differences in susceptibility to hampered β-cell function in the setting of obesity and insulin resistance largely exp...
Etiology of Metabolic Syndrome and Dietary Intervention
International Journal of Molecular Sciences
The growing prevalence of metabolic syndrome (MetS) in the U.S. and even worldwide is becoming a serious health problem and economic burden. MetS has become a crucial risk factor for the development of type 2 diabetes mellitus (T2D) and cardiovascular diseases (CVD). The rising rates of CVD and diabetes, which are the two leading causes of death, simultaneously exist. To prevent the progression of MetS to diabetes and CVD, we have to understand how MetS occurs and how it progresses. Too many causative factors interact with each other, making the investigation and treatment of metabolic syndrome a very complex issue. Recently, a number of studies were conducted to investigate mechanisms and interventions of MetS, from different aspects. In this review, the proposed and demonstrated mechanisms of MetS pathogenesis are discussed and summarized. More importantly, different interventions are discussed, so that health practitioners can have a better understanding of the most recent resear...
Metabolic Syndrome: Bridging the Gap from Childhood to Adulthood
Childhood and adolescence are particularly vulnerable periods of life to the effects of cardiometabolic risk and later development of atherosclerosis, hypertension, and diabetes mellitus. Developing countries with limited resources suffer most heavily from the consequences of cardiometabolic risk in children and its future implications to the global health burden. A better understanding of mechanisms leading to cardiometabolic risk in early life may lead to more effective prevention and intervention strategies to reduce metabolic stress in children and later disease. Longitudinal "tracking" studies of cardiometabolic risk in children provide a tremendous global resource to direct prevention strategies for cardiovascular disease. In this review, we will summarize the pathophysiology, existing definitions for cardiometabolic risk components in children. Screening and identifying children and adolescents of high cardiometabolic risk and encouraging them and their families through healthy lifestyle changes should be implemented to as a global public health strategy.
New Advances in Metabolic Syndrome, from Prevention to Treatment: The Role of Diet and Food
Nutrients
The definition of metabolic syndrome (MetS) has undergone several changes over the years due to the difficulty in establishing universal criteria for it. Underlying the disorders related to MetS is almost invariably a pro-inflammatory state related to altered glucose metabolism, which could lead to elevated cardiovascular risk. Indeed, the complications closely related to MetS are cardiovascular diseases (CVDs) and type 2 diabetes (T2D). It has been observed that the predisposition to metabolic syndrome is modulated by complex interactions between human microbiota, genetic factors, and diet. This review provides a summary of the last decade of literature related to three principal aspects of MetS: (i) the syndrome’s definition and classification, pathophysiology, and treatment approaches; (ii) prediction and diagnosis underlying the biomarkers identified by means of advanced methodologies (NMR, LC/GC-MS, and LC, LC-MS); and (iii) the role of foods and food components in prevention a...
EC DIABETES AND METABOLIC RESEARCH Opinion Type 2 Diabetes Mellitus in the Young: A Paradigm Shift
Type 2 diabetes Mellitus (T2DM) has changed from a disease of the old to a disease of the young and, to be more precise, from a disease of the parents to a disease of children. It has the potential to become a global public health issue with serious widespread health outcomes. As more and more children and young adults develop this devastating disease, it has become apparent that we have to learn much about who in the younger population is at risk to develop type 2 diabetes, how to manage, and, most importantly, how to prevent it from destroying future generations.
Novel Insights into the Pathogenesis and Management of the Metabolic Syndrome
Pediatric Gastroenterology, Hepatology & Nutrition, 2020
The metabolic syndrome, by definition, is not a disease but is a clustering of individual metabolic risk factors including abdominal obesity, hyperglycemia, hypertriglyceridemia, hypertension, and low high-density lipoprotein cholesterol levels. These risk factors could dramatically increase the prevalence of type 2 diabetes and cardiovascular disease. The reported prevalence of the metabolic syndrome varies, greatly depending on the definition used, gender, age, socioeconomic status, and the ethnic background of study cohorts. Clinical and epidemiological studies have clearly demonstrated that the metabolic syndrome starts with central obesity. Because the prevalence of obesity has doubly increased worldwide over the past 30 years, the prevalence of the metabolic syndrome has markedly boosted in parallel. Therefore, obesity has been recognized as the leading cause for the metabolic syndrome since it is strongly associated with all metabolic risk factors. High prevalence of the metabolic syndrome is not unique to the USA and Europe and it is also increasing in most Asian countries. Insulin resistance has elucidated most, if not all, of the pathophysiology of the metabolic syndrome because it contributes to hyperglycemia. Furthermore, a major contributor to the development of insulin resistance is an overabundance of circulating fatty acids. Plasma fatty acids are derived mainly from the triglycerides stored in adipose tissues, which are released through the action of the cyclic AMP-dependent enzyme, hormone sensitive lipase. This review summarizes the latest concepts in the definition, pathogenesis, pathophysiology, and diagnosis of the metabolic syndrome, as well as its preventive measures and therapeutic strategies in children and adolescents.
Diabetology & Metabolic Syndrome, 2010
Overweight and obesity in youth is a worldwide public health problem. Overweight and obesity in childhood and adolescents have a substantial effect upon many systems, resulting in clinical conditions such as metabolic syndrome, early atherosclerosis, dyslipidemia, hypertension and type 2 diabetes (T2D). Obesity and the type of body fat distribution are still the core aspects of insulin resistance and seem to be the physiopathologic links common to metabolic syndrome, cardiovascular disease and T2D. The earlier the appearance of the clustering of risk factors and the higher the time of exposure, the greater will be the chance of developing coronary disease with a more severe endpoint. The age when the event may occur seems to be related to the presence and aggregation of risk factors throughout life. The treatment in this age-group is non pharmacological and aims at promoting changes in lifestyle. However, pharmacological treatments are indicated in special situations. The major goals in dietary treatments are not only limited to weight loss, but also to an improvement in the quality of life. Modification of risk factors associated to comorbidities, personal satisfaction of the child or adolescent and trying to establish healthy life habits from an early age are also important. There is a continuous debate on the best possible exercise to do, for children or adolescents, in order to lose weight. The prescription of physical activity to children and adolescents requires extensive integrated work among multidisciplinary teams, patients and their families, in order to reach therapeutic success. The most important conclusion drawn from this symposium was that if the growing prevalence of overweight and obesity continues at this pace, the result will be a population of children and adolescents with metabolic syndrome. This would lead to high mortality rates in young adults, changing the current increasing trend of worldwide longevity. Government actions and a better understanding of the causes of this problem must be implemented worldwide, by aiming at the prevention of obesity in children and adolescents.
Pharmacologic Approaches to the Prevention of Type 2 Diabetes in High Risk Pediatric Patients
The Journal of Clinical Endocrinology & Metabolism, 2003
The past generation has witnessed a surge in the number of children, adolescents, and young adults with type 2 diabetes (1-3). In most cases the illness begins with excess weight gain, insulin resistance, and dyslipidemia and progresses through a stage of fasting or postprandial hyperglycemia [impaired glucose tolerance (IGT)] before the emergence of clinical symptoms (4). IGT, dyslipidemia, and overt type 2 diabetes predispose to hepatic steatosis and microvascular and macrovascular complications, which may arise early in the course of the illness (5-9). The threat of vascular and hepatic complications makes the prevention of type 2 diabetes of paramount importance. Recent studies delineate risk factors for the development of type 2 diabetes in children and young adults. Chief among these are poorly defined genetic factors, ethnic background, and obesity (1-3). Rates of type 2 diabetes increase with age, as puberty is associated with a decline in insulin sensitivity (1-4). In the prodromal state, the risk of diabetes is highest among obese patients with severe insulin resistance and fasting or postprandial hyperglycemia. Emerging evidence suggests that lifestyle intervention and pharmacotherapy may reduce the rates of development of type 2 diabetes in subjects at highest risk (see below). This manuscript summarizes current views of the pathogenesis of type 2 diabetes in children and adolescents and discusses potential roles for pharmacological agents in the prevention of diabetes in high risk subjects. Abbreviations: ACE, Angiotensin-converting enzyme; BMI, body mass index; FFA, free fatty acid; HbA 1c , hemoglobin A 1c ; HDL, high density lipoprotein; IFG, impaired fasting glucose; IGT, impaired glucose tolerance; UCP-2, uncoupling protein-2; VLDL, very low density lipoprotein.
Current and Future Treatment of Metabolic Syndrome and Type 2 Diabetes in Children and Adolescents
Diabetes Spectrum, 2005
In Brief The metabolic syndrome and type 2 diabetes are occurring at alarming rates in children. Obesity plays an important role in the increased prevalence of its comorbid conditions including dyslipidemia, hypertension,and type 2 diabetes. Lifestyle modification is the mainstay of prevention and treatment for metabolic syndrome and type 2 diabetes; however, it can be costly and labor-intensive. Pharmacotherapy is considered a second line of therapy in adults, but its use in children is controversial. This article reviews current and potential future drugs for the treatment of obesity,dyslipidemia, hypertension, and type 2 diabetes in children. Surgical procedures for treating severely obese adolescents are also discussed.