Dietary determinants of subclinical inflammation, dyslipidemia and components of the metabolic syndrome in overweight children: a review

Objective: To review and summarize the dietary determinants of the metabolic syndrome, subclinical inflammation and dyslipidemia in overweight children. Design: Review of the current literature, focusing on pediatric studies. Participants: Normal weight, overweight, or obese children and adolescents. Results: There is a growing literature on the metabolic effects of excess body fat during childhood. However, few pediatric studies have examined the dietary determinants of obesity-related metabolic disturbances. From the available data, it appears that dietary factors are not only important environmental determinants of adiposity, but also may affect components of the metabolic syndrome and modulate the actions of adipokines. Dietary total fat and saturated fat are associated with insulin resistance and high blood pressure, as well as obesity-related inflammation. In contrast to studies in adults, resistin and adiponectin do not appear to be closely linked to insulin resistance or dyslipidemia in childhood. However, circulating leptin and retinol-binding protein (RBP) 4 correlate well with obesity, central obesity and the metabolic syndrome in children. Intakes of antioxidant vitamins tend to be low in obese children and may be predictors of subclinical inflammation. Higher fructose intake from sweets and sweetened drinks in overweight children has been linked to decreased low-density lipoprotein (LDL) particle size. Conclusions: Dietary interventions aimed at reducing intakes of total fat, saturated fat and free fructose, whereas increasing antioxidant vitamin intake may be beneficial in overweight children. More research on the relationships between dietary factors and the metabolic changes of pediatric obesity may help to identify the dietary changes to reduce health risks.