Age-related patterns of the clustering of cardiovascular risk variables of syndrome X from childhood to young adulthood in a population made up of black and white subjects: the Bogalusa Heart Study.

Abstract

The age-related patterns of clustering of cardiovascular risk variables of Syndrome X from childhood to adulthood were examined in a community-based sample of black and white children (aged 5-10 years, n = 2,389), adolescents (aged 11-17 years, n = 3,371), and young adults (aged 18-37 years, n = 2,115). In the analysis of clustering, insulin resistance index, BMI, triglycerides/ HDL cholesterol ratio, and mean arterial pressure were used either as categorical variables (age-, race-and sexspecific values >75th percentiles) to calculate risk ratios (observed frequency/expected frequency) or as continuous variables (normal scores based on ranks) to compute intraclass correlations. In the total sample, the risk ratio for clustering of adverse levels of all 4 variables was 9.8 for whites (P < 0.01) versus 7.4 for blacks (P < 0.01); the intraclass correlation was 0.33 for whites (P < 0.001) versus 0.26 for blacks (P < 0.001). Both the risk ratio and intraclass correlation were significantly higher in whites than in blacks in the total sample. The intraclass correlations of the 4 variables were significant (P < 0.001) in all race and age-groups, and they were higher during preadolescence and adulthood than during adolescence. Furthermore, unlike risk ratios, intraclass correlations showed a continuous increase with age during adulthood. When BMI was adjusted, the intraclass correlations involving the other 3 variables were reduced by ~50%, and the age-related pattern was no longer evident. These results suggest that the degree of clustering of risk variables of Syndrome X varies with age from childhood to adulthood and is likely influenced by the age-related changes in obesity and the attendant insulin resistance. Diabetes 49:1042-1048, 2000 D yslipidemia, hypertension, hyperinsulinemia, and obesity have been recognized as potent risk factors for coronary heart disease in adults (1-3). These risk factors have also been found to be associated with early atherosclerotic lesions in youth (4,5). Further, the extent of coronary atherosclerosis in youth increased markedly with the number of multiple risk factors (6). Coexistence of the above cardiovascular risk variables often occurs in both children (7-10) and adults (7,8,(11)(12)(13). Such a condition has been termed Syndrome X (14), deadly quartet (15), insulin resistance syndrome (11,16), and multiple metabolic syndrome (17).Although the clustering of cardiovascular risk factors related to Syndrome X has been found to occur at a very early age (7-10) and persist from childhood into adulthood (8), very little is known about the age-related trend in clustering of risk variables during this period. The Bogalusa Heart Study, a long-term community-based investigation of cardiovascular disease risk factors in black and white children and young adults (18)(19)(20), provided a unique opportunity to examine the age-related trend in clustering of risk variables during this period. The objective of the present study was to determine the age-related patterns in the magnitude of clus...

Metabolic risk-factor clustering estimation in children: to draw a line across pediatric metabolic syndrome

“…12 Consequently, very recent reports discussed the possibility of discouraging the growing use of the term 'metabolic syndrome', in favor of considering and subsequently treating each component separately. 9,11,13,14 Several authors have tried to give different names to the MS, adding components to improve the validity of the overall diagnosis, 13,14,16,36 but these may simply be causing confusion in Metabolic risk-factor clustering estimation in children P Brambilla et al daily clinical practice. 13,14 In light of this background, and taking into account the major and minor concerns discussed above, we argue that pediatricians need to consider a novel approach to assessing obese children, and should not simply derive or adapt definitions from adults.…”

“…12 The parameters of the MS develop in stages, according to age-related changes in obesity, so the full syndrome cannot generally be expressed at an early age. 36 Moreover, it is fundamental to take into account that in children and adolescents, the pathophysiological basis and characteristics of the MS are also influenced by growth and puberty, 36,37 and not only by gender, ethnicity and body composition as they are in adults. The available literature has focused on the assessment of the MS in overweight and obese children; however, we suspect that a clustering of risk-factors can also be observed in normal-weight children and adolescents, 18,22 as already shown in adults.…”

Short-term predictors of overweight in early adolescence

“…It has also been shown that there is a clustering of cardiovascular disease-risk factors, such as dyslipidemia, high blood pressure, and obesity from childhood to young adolescence, which is influenced by age-related changes in obesity. 38 Obesity in children and adolescents is associated with a characteristic pattern of increased blood lipids, consisting of elevated LDL-C and triglycerides and low HDL-C levels. 7 This pattern is confirmed by the present study (Figure 1), where baseline triglyceride levels are elevated in always overweight subjects compared to never overweight, whereas HDL-C levels were significantly lower.…”

Irisin is a biomarker for metabolic syndrome in prepubertal children

“…The incidence of childhood metabolic syndrome (MetS), which is closely related to insulin resistance, is defined as a clustering of abdominal obesity, hypertension, dyslipidemia and glucose intolerance and is increasing around the world, including in Korea [2]. The clustering of metabolic risk factors begins in childhood [3], and these multiple risk factors tend to persist from childhood into adulthood [4]. Childhood MetS is a risk factor for MetS, cardiovascular diseases and Submitted Jun.…”