LOW BIRTHWEIGHT, RAPID WEIGHT GAIN AND METABOLIC SYNDROME IN ADOLESCENCE: AN ILLUSTRATIVE CASE REPORT
A 16-year-old boy whose diabetes mellitus was diagnosed 3 months previously in a private hospital but was not placed on medication. The presenting complaints were fast breathing for 24 hours, weakness for 2 hours, and unresponsiveness to calls for 0.5 hours. His father was obese with type 2 diabetes mellitus and died 8 months earlier from cardiac arrest. His birthweight was low, 2.2kg. At first presentation, his weight, BMI and blood pressure were 60kg (25th-50th percentile), 19.4kg/m2 (25thpercentile) and 110/70mmHg (systolic BP 50th percentile, diastolic BP 50th-90th percentile), respectively. He was managed for diabetic ketoacidosis and was discharged on subcutaneous premixed insulin, 1 Unit/kg/day. At point of discharge, weight and BP were 60.5 kg and 120/70 mmHg, respectively. The patient defaulted but presented again 6 months later at the age of 17 years. At second presentation, his weight, BMI and BP were 89 kg (95th percentile), 27.5 kg/m2 (90th-95th percentile) and 180/80 mmHg (systolic 99th percentile; diastolic 90th percentile), respectively. His waist circumference was 98.7cm (> 90th percentile). We had no record of previous waist circumference. His lipid profile showed low HDL-cholesterol 0.7252 mmol/L [(28mg/dl); <5thpercentile]. His fasting blood glucose and HbA1C were 6.5 mmol/L (117mg/dl) and 34 mol/mol (5.3%), respectively. A diagnosis of metabolic syndrome in a patient with ketosis-prone type 2 diabetes was made. He was referred to the pediatric cardiologist for management of his hypertension. He defaulted again and was lost to follow up. Conclusion: This report illustrates the association of low birth weight and rapid weight gain with metabolic syndrome in adolescence.