Pediatric Metabolic Syndrome Through the Lens of Cardiovascular-Kidney-Metabolic Syndrome: A Scoping Review of Definitions, Epidemiology, Outcomes, and Conceptual Implications for Children and Adolescents

Purpose of Review The pediatric metabolic syndrome (MetS) construct lacks an accepted definition, with frameworks yielding prevalence estimates that vary by an order of magnitude within the same populations. In 2023, the American Heart Association introduced cardiovascular-kidney-metabolic (CKM) syndrome, a staged model linking adiposity, metabolic risk, chronic kidney disease, and cardiovascular disease across the life course. This scoping review maps pediatric MetS definitions and prevalence, the longitudinal links between childhood metabolic risk and adult outcomes, how the CKM framework applies to youth, and the gaps in adapting CKM staging to children and adolescents. Recent Findings Across 53 included sources, five major pediatric definitions yielded prevalence estimates of 0.3% to 26.4%. Longitudinal cohorts linked childhood metabolic risk clustering to a two- to more than tenfold higher risk of adult type 2 diabetes and cardiovascular disease. Only one empirical study has applied CKM staging to adolescents (37% in stage 1, 7% in stage 2), and one of the first prospective adolescent-to-adult CKM cohorts (LIFECARD) is underway. The existing MetS literature aligns conceptually with CKM stages 0 through 2, though this mapping is prospectively unvalidated. Emerging pediatric evidence positions metabolic dysfunction-associated steatotic liver disease (MASLD) as a candidate hepatic risk modifier within the CKM framework. Summary The CKM framework offers a conceptually promising alternative to binary pediatric MetS definitions, but its application to youth remains early and hypothesis-generating. Prospective validation of pediatric CKM staging, age- and puberty-specific thresholds, and integration of social determinants of health into risk prediction are priority research needs.