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Pathogenesis and Management of Dyslipidemia in Obese Children

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Pediatric Obesity

Part of the book series: Contemporary Endocrinology ((COE))

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Abstract

Combined dyslipidemia is a major component of the metabolic syndrome related to overweight and obesity in youth, is highly atherogenic, and is characterized by high triglyceride levels, low HDL-C levels, and increased numbers of small, dense LDL particles. These abnormalities are primarily driven by elevation in plasma free fatty acids derived from metabolically active visceral adipose tissue, particularly ectopic hepatic fat, resulting in increased hepatic triglyceride synthesis and overproduction of VLDL particles. Assessment of lipid abnormalities relies on a fasting lipid profile. A high non-HDL-C level together with high triglyceride:HDL-C ratio reliably identifies increased numbers of small, dense LDL particles. Reduction in adiposity through healthy lifestyle behavior change is the cornerstone of therapy, although dietary and physical activity interventions may have direct benefits independent of weight loss. Drug therapy may be required for those with severe lipid abnormalities and associated risk factors and risk conditions. Evidence-based research in many areas is lacking; the intersection of clinical care recommendations with the health care system has assumed increasing importance.

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  1. Department of Pediatrics, University of Toronto, Toronto, ON, Canada

    Brian W. McCrindle MD, MPH

  2. Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada

    Brian W. McCrindle MD, MPH

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  1. Duke University School of Medicine , Durham, North Carolina, USA

    Michael S. Freemark

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McCrindle, B.W. (2018). Pathogenesis and Management of Dyslipidemia in Obese Children. In: Freemark, M. (eds) Pediatric Obesity. Contemporary Endocrinology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-68192-4_25

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