Metabolic syndrome in young children: definitions and results of the IDEFICS study

Abstract

on behalf of the IDEFICS consortium OBJECTIVE: To estimate the prevalence of the metabolic syndrome (MetS) using reference standards obtained in European children and to develop a quantitative MetS score and describe its distribution in children. DESIGN AND METHODS: Population-based survey in eight European countries, including 18 745 children 2.0 to 10.9 years, recruited during a second survey. Anthropometry (weight, height and waist circumference), blood pressure and serum-fasting triglycerides, HDL cholesterol, glucose and insulin were measured. We applied three widely accepted definitions of the pediatric MetS and we suggest a new definition, to guide pediatricians in decisions about close monitoring or even intervention (values of at least three of the MetS components exceeding the 90th or 95th percentile, respectively). We used a z-score standardisation to calculate a continuous score combining the MetS components. RESULTS: Among the various definitions of MetS, the highest prevalence (5.5%) was obtained with our new definition requiring close observation (monitoring level). Our more conservative definition, requiring pediatric intervention gives a prevalence of 1.8%. In general, prevalences were higher in girls than in boys. The prevalence of metabolic syndrome is highest among obese children. All definitions classify a small percentage of thin or normal weight children as being affected. The metabolic syndrome score shows a positive trend with age, particularly regarding the upper percentiles of the score. CONCLUSIONS: According to different definitions of pediatric MetS, a non-negligible proportion of mostly prepubertal children are classified as affected. We propose a new definition of MetS that should improve clinical guidance. The continuous score developed may also serve as a useful tool in pediatric obesity research. It has to be noted, however, that the proposed cutoffs are based on a statistical definition that does not yet allow to quantify the risk of subsequent disease.

Abdominal obesity and cardiometabolic risk in children and adolescents, are we aware of their relevance?

“…In accordance, studies have shown a high prevalence of MetS, not only in pubertal but also in prepubertal obese children [127,128].…”

Associations between early body mass index trajectories and later metabolic risk factors in European children: the IDEFICS study

“…Fasting blood was collected either by venipuncture or by capillary sampling as described in detail in Ahrens et al [25]. To ensure that basic data on metabolic disorders were available for as many children as possible a point-of-care analyser (Cholestech LDX, Cholestech Corp.) was used to assess blood glucose, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol and triglycerides.…”

Obesity and Cardiovascular Disease

“…We anticipate that if an equivalent (to adult) definition of MHO is used, the prevalence of MHO in youth will be higher than in adults because children and adolescents are expected to be healthier and metabolic abnormalities are known to increase with age. Several large-scale studies in youth have examined the prevalence of MetS (using different definitions) in children and adolescents in the United States [95][96][97] and Europe 98,99 ; however, the prevalence of MHO was not provided nor could be calculated from the data reported.…”