The MS represents a constellation of risk factors, including obesity, dyslipidemia, fasting hyperglycemia or IGT, and hypertension, that predispose to ASCVD and type 2 DM. The prevalence in children and adolescents is low, at about 4% of the general population. However, in those who are overweight, these rates are much higher at 30% or greater, with many more having at least one of the features. Ethnicity appears to affect the observed rates of the MS in various adolescent populations. Insulin resistance and obesity underlie the pathophysiology of the MS, each most likely contributing both individually and synergistically. Because obesity has become epidemic in children and adolescents, and diagnosis of type 2 DM is on the rise, it is clear that interventions need to be made early, in an effort to prevent the morbidity and mortality associated with the MS. The most effective treatment for the MS in most adolescents is TLC. When this is insufficient, an insulin-sensitizing medication, such as metformin, may be a useful adjunct. In addition, antihypertensives and lipid-lowering modalities may be necessary in certain cases.
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