NON-PHARMACOLOGICAL TREATMENT OF PEDIATRIC METABOLIC SYNDROME

The global epidemic of childhood obesity is responsible for the rapid increase in the prevalence of metabolic syndrome (MetS) in the pediatric age group. Although different definitions exist for pediatric MetS, but all definitions consist of co-existence of three of following components: obesity, elevated fasting blood glucose, ypertriglyceridemia, low levels of high-density lipoprotein cholesterol, and elevated blood pressure. MetS is much more prevalent in obese children and adolescents, but it can also occur in normal-weight individuals.Lifestyle interventions are the main treatment modalities for prevention and control of obesity and associated metabolic consequences, including MetS, in childhood and adolescence. Dietary regimens should be specific for the age of each individual, thus supplying the appropriate nutrient intake for healthy growth and development. Recommendations comprise reducing calorie intake while maintaining a well-balanced diet with diversity. Adherence to a Mediterranean diet is effective in controlling pediatric MetS and its components. Western diet contains added sugar and one of its major sources is thought to be sugar-sweetened beverages (SSBs). Fructose is a lipogenic sugar present in processed and industrial beverages; it increases the risk of some components of MetS including increased waist circumference and serum triglycerides, as well as decreased levels of high density lipoprotein (HDL) among children and adolescents. Discouraging of the SSB consumption has beneficial roles in management of pediatric MetS. The use of the meal replacement therapy has very limited potential for long-term weight management in the pediatric age group. Moreover, it is shown that by such treatment weight regain would rapidly begin at the end of therapy and resumption of normal diet. The enhancement of daily regular physical activity is a key component for treatment of pediatric MetS. The first step for increasing physical activity of children and adolescents is reducing the screen time. Although the effect of physical activity alone in the absence of calorie restriction is essentially unclear on weight management, but it is well documented that vigorous physical activity, mainly aerobic exercise, is beneficial against MetS in children and adolescents.Some studies have considered nutraceuticals as an alternative and complementary therapy for pediatric MetS. The nutraceutical approach includes chronic supplementation of a large number of natural compounds, such as active ingredients including macronutrients, micronutrients, probiotics, prebiotics, and symbiotic, as well as extracts, food supplements, and functional foods. It is shown that a diet rich in fiber, flavonoids, polyunsaturated fatty acids and antioxidants might improve lipid profile and anthropometric measures in children and adolescents. In general, studies in the pediatric age group have shown inconsistent effects of vitamin D, E, fish oil, and probiotics in controlling the components of MetS.Elevated blood pressure is one of the components of MetS. Studies in obese adolescents have demonstrated that moderate weight loss might decrease the blood pressure. It is shown that a reduction of 10% in body mass index is associated with short-term reduction of 8-10 mmHg in the mean blood pressure. Dietary changes include an increase in fresh vegetables, fruits, fiber, non-fat dairy, along with a reduction in sodium to 1-2 g/day for 4-8- year- old children, and to 1.5 g/day for older children and adolescents. A meta-analysis of 10 controlled trials concluded that a modest reduction in salt intake was associated with significant reductions in systolic and diastolic blood pressure of children and adolescents. Physical activity has also been considered as an important management modality for controlling elevated blood pressure. Lifestyle interventions generally include adopting of behavioral therapy techniques as self-instruction, impulse control techniques, cognitive restructuring, development of problem-solving strategies, booster systems, behavioral contracts, model learning by parents, and self-reflection curves. All these items aim to establish new eating and exercise habits and in turn changing the individual’s obesogenic environment. Without the family cooperation, lifestyle intervention are more likely to fail. Given that most lifestyle interventions are difficult to sustain after the intervention period, the maintenance period should be also cautiously considered. In general, the promotion of compliance with commonly accepted pediatric recommendations for healthy lifesyle should remain the main focus of clinical management for MetS. A crucial component in the treatment of childhood obesity and MetS is parental involvement and modelling of healthy behaviors