Metabolic syndrome in obese Caucasian children: prevalence using WHO-derived criteria and association with nontraditional cardiovascular risk factors

Abstract

Objective: Studies on the prevalence of metabolic syndrome (MS) in European obese children using child-based criteria are scanty. Moreover, it is unknown if nontraditional cardiovascular disease (CVD) risk factors are associated with the MS at this early age in these subjects. Design and subjects: We studied the prevalence of the MS in 588 Caucasian obese children and adolescents by devising a World Health Organization derived definition and child-specific criteria, whose deviation from normalcy was based on an age, sex, and ethnically comparable control group of 1363 subjects. In a subgroup of 206 obese children, we investigated the association of the MS with nontraditional CVD risk factors. Measurements: Fasting blood samples for glucose and lipids measurements were taken in both control and obese children. In addition, the obese children underwent an oral glucose tolerance test. In the subgroup of 206 obese children, albumin excretion rate , plasma uric acid, fibrinogen, plasminogen activator inhibitor type 1(PAI-1), C-reactive protein, interleukin 6 and white blood cells were also measured. Results: The prevalence of MS was 23.3%. A similar prevalence of 23% of MS was recorded in the subgroup of 206 obese children in whom measurements of nontraditional CVD risk factors were available. After adjustment for the degree of obesity, subjects with MS had significantly higher uric acid (6.670.23 vs 6.170.12 mg/dl, Po0.0001) and PAI-1 plasma concentrations (231.4725.50 vs 214.3712.96 ng/ml, Po0.05) and a higher frequency of microalbuminuria (37 vs 20%, Po0.05) than those without MS. Microalbuminuria, uric acid and PAI-1 explained 10.6% of the variance of MS. Conclusion: Approximately, a quarter of Caucasian obese children have the MS. The association of MS with several nontraditional risk factors for CVD early in life suggests a heightened CVD risk in these individuals.

Sympathoadrenergic and metabolic factors are involved in ambulatory blood pressure rise in childhood obesity

“…In agreement with our previous report that nondiabetic obese children had a high prevalence of microalbuminuria, which was strongly related to the presence of MS, 38 in this cohort a high proportion of subjects had elevated AER levels. AER was associated with insulin resistance rather than with ABP levels as observed in adults, 39 suggesting that microalbuminuria precedes BP elevations in nondiabetic obese children.…”

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

“…In Table 1 we present 15 papers, [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] all of which used different sets of variables, number of criteria and cutoff points to define the risk-factors associated with the MS. [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] The main differences concern the techniques used to estimate adiposity (body mass index (BMI) and/or waist circumference (WC)), and the variable(s) chosen to evaluate glucose metabolism (fasting glucose, …”

“…59,69 Published papers concerning the MS in children and adolescents reported a high prevalence, ranging up to 50% of the obese patients studied. 18,19,22,24,27,29 This figure is definitely alarming, but we know that the prevalence recorded strongly depends on the definition chosen, with the estimate being much higher if insulin is part of the definition. 34 Regardless of insulin, a low-discrimination power parameter is the presence of obesity itself in the definition, either directly via BMI or indirectly via WC.…”

“…12 Nonetheless, the three proposed definitions have been used in several studies carried out in pediatric populations, which reported high-prevalence of the MS in obese children and adolescents. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] The results of these studies varied according to the selected diagnostic criteria used, as established by a recent comparison study. 34 Moreover, in an evaluation of the different prevalence yields using different definition, Goodman et al 35 found that ATP III definition identified half as many children and adolescents as having MS as did WHO definition in the same population.…”

Is sleep-disordered breathing an additional risk factor for the metabolic syndrome in obese children and adolescents?

“…In the pediatric population, the overall prevalence of the metabolic syndrome is estimated at 4%, but the prevalence of this syndrome is 20-50% in overweight children. [2][3][4] Furthermore, the metabolic syndrome during childhood and/or adolescence is already associated with cardiovascular morbidity in early adulthood, [5][6][7] which stresses the importance of early prevention, diagnosis and treatment for obesity and its related conditions. Although genetics, dietary habits and lack of physical activity mainly contribute to the onset of the metabolic syndrome, recent evidence suggests that other factors could in addition be involved in the onset of the metabolic syndrome.…”