Defining the Metabolic Syndrome in Children and Adolescents: Will the Real Definition Please Stand Up?

doi:10.1016/j.jpeds.2007.07.056

The Journal of Pediatrics

Volume 152, Issue 2, February 2008, Pages 160-164.e13

https://doi.org/10.1016/j.jpeds.2007.07.056 Get rights and content

Objectives

To review the use of definitions of the metabolic syndrome in studies of children and adolescents and to review results from studies that used factor analysis to examine structure among cardiometabolic variables.

Study design

Literature review.

Results

In 27 publications, authors used 40 unique definitions of the metabolic syndrome. Most of these definitions were adaptations of the adult definition developed by the National Cholesterol Education Program. In 11 studies that used exploratory factor analysis, the number of components ranged from 5 to 19, and the number of factors identified ranged from 1 to 5.

Conclusions

The use of multiple definitions of the metabolic syndrome argues strongly for the development of a standard pediatric definition.

Section snippets

Methods

We used PUBMED to look for studies, conducted among children and adolescents subsequent to the release of the WHO definition of the metabolic syndrome in 1998, in which the metabolic syndrome was defined or in which factor analysis was used to examine the underlying structure among a set of cardiometabolic factors. Additional studies were identified by reviewing cited reference in retrieved publications and by reviewing the authors’ personal files.

For publications of definitions of the

Definitions in Current Use

We found at least 27 articles with 46 definitions of the metabolic syndrome, most of them unique (Table I, Part A, Table I, Part B, Table I, Part C, Table I, Part D, Table I, Part E, Table I, Part F; available at www.jpeds.com).11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37 A few studies applied adult definitions to the young participants.18, 20, 35 Twenty-eight emulated the NCEP model, 9 the WHO model, 3 the EGIR model, 1 the American

Discussion

Our review shows a proliferation of definitions of the metabolic syndrome used in studies of children and adolescents in recent years. Although many studies opted to develop a definition with a similar approach, usually the NCEP one, studies rarely used identical definitions. The most commonly used definition was the one published by Cook et al.13, 50, 51, 52, 53, 54 Many studies included a core set of variables (anthropometric measures, concentrations of lipids, blood pressure, and glucose),

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Intrauterine malnutrition and future risk of metabolic syndrome
2023, Metabolic Syndrome: From Mechanisms to Interventions
Metabolic syndrome, a clustering of cardiometabolic risk factors, is reportedly the most common precursor of type 2 diabetes and cardiovascular disease. Epidemiological and experimental evidence strongly suggest that unbalanced maternal nutrition causes permanent effects on physiological systems of the developing fetus (“programming”), predisposing them to increased risk of non-communicable disease. The Developmental Origins of Health and Disease (DOHaD) model combines post-natal environmental insults to fetal programming to describe lifetime trajectories of health and disease. Birth cohort studies in India have provided evidence that both maternal undernutrition and overnutrition increase the risk of metabolic syndrome risk in the offspring (“Dual-teratogenesis”). These studies show that maternal nutrient imbalance of vitamins (vit B12, vit D, and folate) and maternal diabetes influence offspring birth size and body composition and postnatal growth trajectory which in turn predict adiposity, insulin resistance, and metabolic syndrome. The characteristic Indian “thin-fat” phenotype is thought to be a consequence of fetal programming of body composition and may underlie the high disease susceptibility. Epigenetic basis of these findings is being evaluated. Pre-conceptional intervention studies have provided initial evidence for a causal association for nutritional programming in India. Future analyses of these studies will help elucidate mechanisms and could provide a key to successful interventions for primordial prevention of metabolic syndrome.
Metabolic syndrome screening in adolescents: New scores AI_METS based on artificial intelligence techniques
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Metabolic syndrome (MetS) definitions in adolescents based on the percentiles of its components are rather complicated to use in clinical practice. The aim of this study was to test the validity of artificial intelligence (AI)-based scores (AI_METS) that do not use these percentiles for MetS screening for adolescents.
This study included 1086 adolescents aged 12 to 18. The cohort underwent anthropometric measurements and blood tests. Mean blood pressure (MBP), and triglyceride glucose index (TyG) were calculated. Explainable AI methods are used to extract the learned function. Gini importance techniques were tested and used to build new scores for the screening of MetS. IDF, Cook, De Ferranti, Viner, and Weiss definitions of MetS were used to test the validity of these scores.
MetS prevalence was 0.4%–4.7% according to these definitions. AI_METS used age, waist circumference, MBP, and TyG index. They offer area under the curves (AUCs) 0.91, 0.93, 0.89, 0.93, and 0.98; specificity 81%, 75%, 72%, 80%, and 97%; and sensitivity 90%, 100%, 90%, 100%, and 100%, respectively, for the detection of MetS according to these definitions. Considering only MBP offers a better specificity and sensitivity to detect MetS than considering only TyG index. MBP offers slightly lower performance than AI_METS.
AI techniques have proven their ability to extract knowledge from data. They allowed us to generate new scores for MetS detection in adolescents without using specific percentiles for each component. Although these scores are less intuitive than the percentile-based definition, their accuracy is rather effective for the detection of MetS.
Global, regional, and country estimates of metabolic syndrome burden in children and adolescents in 2020: a systematic review and modelling analysis
2022, The Lancet Child and Adolescent Health
Citation Excerpt :
We reported prevalence estimates considering the context-specific and adapted version of the diagnostic criteria of metabolic syndrome definition by Ford and colleagues.13,22 In the population of interest, with a high prevalence of dyslipidaemia and a lower prevalence of abdominal obesity and hyperglycaemia, the recommendation for diagnosing metabolic syndrome was per Ford and colleagues' definition.13,22,23 Two components of the definition were adapted for countries or regions, to limit heterogeneity of diagnosis across regions: high blood pressure (systolic or diastolic blood pressure ≥90th percentile for age, sex, and height) and waist circumference (in at least the 90th centile for age, sex, and ethnic group).
Halting the rise in cardiometabolic risk factors in children and adolescents is crucial to curb the global burden of cardiovascular diseases. We aim to provide global, regional, and national estimates of the prevalence of metabolic syndrome in children and adolescents to support the development of evidence-based prevention strategies.
In this systematic review with modelling analysis, we searched PubMed, Embase, Africa Journal Online, and Global Index Medicus from database inception to Jan 30, 2021, with no restriction on language or geographical location. We included community-based and school-based cross-sectional studies and cross-sectional analysis of cohort studies that reported prevalence of metabolic syndrome in the general population of children (6–12 years) and adolescents (13–18 years). Only studies with a low risk of bias were considered. Eligible studies included at least 200 participants and used probabilistic-based sampling. Diagnosis of metabolic syndrome had to meet at least three of the following criteria: high systolic or diastolic blood pressure (≥90th percentile for age, sex, and height); waist circumference in at least the 90th percentile for age, sex, and ethnic group; fasting plasma glucose 5·6 mmol/L or greater; fasting plasma triglycerides 1·24 mmol/L or greater; and fasting plasma high density lipoprotein cholesterol 1·03 mmol/L or less. Independent investigators selected eligible studies and extracted relevant data. The primary outcome was a crude estimate of metabolic syndrome prevalence, assessed using a Bayesian hierarchical model.
Our search yielded 6808 items, of which 169 studies were eligible for analysis, including 306 prevalence datapoints, with 550 405 children and adolescents from 44 countries in 13 regions. The between-study variance (τ²) was 0·52 (95% CI 0·42–0·67), which could reflect the measurement of each component of the metabolic syndrome and covariates as sources of between-study heterogeneity. We estimated the global prevalence of metabolic syndrome in 2020 at 2·8% (95% uncertainty interval [UI] 1·4–6·7) for children and 4·8% (2·9–8·5) for adolescents, equating to around 25·8 (12·6–61·0) million children and 35·5 (21·3–63·0) million adolescents living with metabolic syndrome. In children, the prevalence of metabolic syndrome was 2·2% (95% UI 1·4–3·6) in high-income countries, 3·1% (2·5–4·3) in upper-middle-income countries, 2·6% (0·9–8·3) in lower-middle-income countries, and 3·5% (1·0–8·0) in low-income countries. In adolescents, the prevalence of metabolic syndrome was 5·5% (4·1–8·4) in high-income countries, 3·9% (3·1–5·4) in upper-middle-income countries, 4·5% (2·6–8·4) in lower-middle-income countries, and 7·0% (2·4–15·7) in low-income countries. Prevalence in children varied from 1·4% (0·6–3·1) in northwestern Europe to 8·2% (6·9–10·1) in Central Latin America. Prevalence for adolescents ranged from 2·9% (95% UI 2·6–3·3) in east Asia to 6·7% (5·9–8·3) in high-income English-speaking countries. The three countries with the highest prevalence estimates in children were Nicaragua (5·2%, 2·8–10·4), Iran (8·8%, 8·0–9·6), and Mexico (12·3%, 11·0–13·7); and the three countries with the highest prevalence estimates in adolescents were Iran (9·0%, 8·4–9·7), United Arab Emirates (9·8%, 8·5–10·3), and Spain (9·9%, 9·1–10·8).
In 2020, about 3% of children and 5% of adolescents had metabolic syndrome, with some variation across countries and regions. The prevalence of metabolic syndrome was not consistently higher with increasing level of development, suggesting that the problem is not mainly driven by country wealth. The high number of children and adolescents living with metabolic syndrome globally highlights the urgent need for multisectoral interventions to reduce the global burden of metabolic syndrome and the conditions that lead to it, including childhood overweight and obesity.
None.
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2022, International Journal of Cardiology
The clinical significance of metabolic syndrome (MetS) during adolescence and its association with adulthood adverse outcomes is a controversial issue. This study aimed to investigate the association of MetS and metabolic phenotypes with a high carotid intima-media thickness (CIMT) in early adulthood.
MetS was defined as proposed by Cook, de Ferranti, the National Cholesterol Education Program (NCEP), and the pediatric International Diabetes Federation (IDF). Metabolic phenotypes were defined based on the binary clustering of cardiovascular risk factors. The participants were adolescent's individual selected from a large cohort study and followed for 18.2 years. Multivariate-adjusted odds ratios (ORs) were calculated for a high CIMT incidence (≥95th percentile).
In this study, 862 adolescents (52.3% males), with the mean age of 13.4 ± 2.2 years, were included. The presence of MetS, based on the definitions proposed by Cook (OR = 1.90, 95% CI: 1.01–3.57, P = 0.046) and de Ferranti (OR = 1.74; 95% CI: 1.04–2.90, P = 0.033), was associated with the increased risk of a high CIMT in early adulthood. Metabolic phenotypes, including high waist circumference (WC)/hypertension (HTN), high WC/low high-density lipoprotein-cholesterol (HDL-C), and high triglyceride (TG)/high WC, showed higher risks of a high CIMT. However, these positive associations become insignificant after adjusting for the adulthood BMI, except for the high WC/low HDL-C phenotype (OR = 2.04, 95% CI: 1.02–4.11, P = 0.044).
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View all citing articles on Scopus

: The findings and conclusions in this article are those of the authors and do not represent the views of the Centers for Disease Control and Prevention.

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Original articleDefining the Metabolic Syndrome in Children and Adolescents: Will the Real Definition Please Stand Up?

Objectives

Study design

Results

Conclusions

Section snippets

Methods

Definitions in Current Use

Discussion

Prev Med

J Pediatr

Atherosclerosis

Atherosclerosis

Diabetes Res Clin Pract

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

Atherosclerosis

Am J Cardiol

Soc Sci Med

J Pediatr

Am J Clin Nutr

J Pediatr

Studien ueber das hypertonie-hypeglykämie-hyperurikämiesyndrom

Zentralblatt fuer Innere Medizin

Banting lecture 1988Role of insulin resistance in human disease

Diabetes

Definition, diagnosis and classification of diabetes mellitus and its complicationsPart 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation

Diabet Med

Definition, diagnosis and classification of diabetes mellitus and its complications

Comment on the provisional report from the WHO consultationEuropean Group for the Study of Insulin Resistance (EGIR)

Diabet Med

Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III)

JAMA

Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement

Circulation

American College of Endocrinology position statement on the insulin resistance syndrome

Endocrinol Pract

Definitions of the insulin resistance syndrome: the 1st World Congress on the Insulin Resistance Syndrome

Diabetes Care

The IDF consensus worldwide definition of the metabolic syndrome. 2005

Insulin resistance syndrome in 8-year-old Indian children: small at birth, big at 8 years, or both?

Diabetes

Low physical performance in obese adolescent boys with metabolic syndrome

Int J Obes Relat Metab Disord

Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988-1994

Arch Pediatr Adolesc Med

The metabolic syndrome in overweight Hispanic youth and the role of insulin sensitivity

J Clin Endocrinol Metab

Obesity and the metabolic syndrome in children and adolescents

N Engl J Med

Insulin resistance syndrome in a representative sample of children and adolescents from Quebec, Canada

Int J Obes Relat Metab Disord

Prevalence of the metabolic syndrome in American adolescents: findings from the Third National Health and Nutrition Examination Survey

Circulation

Metabolic syndrome among children and adolescents aged 10-18 years

Diabetes Care

Clinical and biochemical manifestations of syndrome X in obese children

Eur J Pediatr

Usefulness of serum adiponectin level as a diagnostic marker of metabolic syndrome in obese Japanese children

Hypertens Res

Prevalence of the insulin resistance syndrome in obesity

Arch Dis Child

Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus

Pediatrics

Metabolic syndrome and insulin resistance in normal glucose tolerant Brazilian adolescents with family history of type 2 diabetes

Diabetes Care

Original article
Defining the Metabolic Syndrome in Children and Adolescents: Will the Real Definition Please Stand Up?