Jill Hamilton and Denis Daneman
The complex association of impaired glucose metabolism (including insulin resistance, glucose intolerance, or type 2 diabetes), obesity (particularly visceral adiposity), hyperlipidemia, and hypertension has been well documented in adults. Initially termed 'syndrome X' by Reaven, this clustering of factors has subsequently been known as the metabolic syndrome, dysmetabolic syndrome, or insulin resistance syndrome. 1,2 Recently, the World Health Organization proposed a unifying definition for the metabolic syndrome in adults (Table 8.1). Irrespective of the term applied to this disorder, the health and economic burden to society is enormous, and will continue to escalate as the prevalence of type 2 diabetes and the metabolic syndrome rises worldwide.
There is no doubt that the metabolic syndrome has its roots in early life. 3 Adaptations to glucose metabolism and 'programming' for later development of insulin resistance may even begin in utero (see Chapter 7). The global increase in type 2 diabetes includes older children and adolescents and, as in adults, this closely parallels the rising trend of obesity. 4-6 Despite predictions of an epidemic of type 2 diabetes in young individuals,