Identification and treatment of metabolic complications in pediatric obesity

Abstract

Metabolic consequences of obesity including insulin resistance, type 2 diabetes mellitus, hyperlipidemia, hypertension, polycystic ovarian syndrome, and non-alcoholic fatty liver infiltration are rapidly emerging in the pediatric population. Identifying effective strategies for identifying and treating these obesity related comorbidities in children are crucial to the prevention of future cardiovascular disease and poor health outcomes.This review discusses the pathophysiologic connections between obesity, metabolic disease and cardiovascular risk. Current evidence and recommendations for screening and treatment for the metabolic consequences of pediatric obesity are reviewed.

Fig. 1

Energy excess, systemic inflammation and metabolic consequences. Excess dietary carbohydrates cause glucotoxicity and impaired insulin secretion in the pancreatic beta cell as well as steatohepatitis and insulin resistance in the hepatocyte. Excess dietary fats cause adipocyte hypertrophy and adipose hyperplasia, which leads to oxidative stress and altered production of adipokines and inflammatory mediators as well as increased circulating free fatty acids. This leads to a generalized inflammatory state and lipid accumulation in muscles, liver, vascular tissue, heart and beta cells. Adapted from reference [204]