Comparison of Different Definitions of Pediatric Metabolic Syndrome: Relation to Abdominal Adiposity, Insulin Resistance, Adiponectin, and Inflammatory Biomarkers

Division of Weight Management & Wellness, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
The Journal of pediatrics (Impact Factor: 3.74). 03/2008; 152(2):177-84. DOI: 10.1016/j.jpeds.2007.07.053
Source: PubMed

ABSTRACT To examine the prevalence of the metabolic syndrome using different pediatric definitions reported in the literature and its relationship to abdominal adipose tissue (AT), in vivo insulin resistance, and inflammatory biomarkers in children and adolescents, as well as the utility of fasting insulin and adiponectin as predictors of the metabolic syndrome.
Cross-sectional measurements were obtained from 122 African Americans and 129 Caucasians age 8 to 19 years. Insulin sensitivity (IS) was measured by a 3-h hyperinsulinemic-euglycemic clamp. Blood pressure, fasting lipids, adiponectin, interleukin (IL)-6, adhesion molecules (intercellular adhesion molecule [ICAM]-1, vascular cell adhesion molecule [VCAM]-1, and E-selectin), and abdominal AT were measured.
Regardless of the metabolic syndrome criteria used, the prevalence of the metabolic syndrome was higher in overweight (24% approximately 51%) compared with non-overweight youths (1% approximately 3%) in both African Americans and Caucasians (P <.01). Youths with the metabolic syndrome had higher visceral AT and fasting insulin and lower IS and adiponetin independent of race (P < .01). In Caucasians, youths with the metabolic syndrome had higher levels of inflammatory biomarkers (IL-6, ICAM-1, and E-selectin). The area under the receiver operating curve (AUC) for insulin was 0.86 approximately 0.89 in African Americans and 0.86 approximately 0.89 in Caucasians, depending on the metabolic syndrome criteria used. For adiponetin, the AUC was 0.73 approximately 0.78 in African Americans and 0.81 approximately 0.86 in Caucasians.
The prevalence of metabolic syndrome varies depending on the definition used in the literature. Thus, there is a need for a unified definition of this syndrome in children and adolescents to streamline the research in this area. Independent of race, visceral obesity, insulin resistance, hyperinsulinemia, and hypoadiponectinemia are the common characteristics of youths with the metabolic syndrome. In Caucasians but not in African Americans, the metabolic syndrome is associated with increased inflammatory markers; however, the translation of such findings remains to be determined based on long-term longitudinal outcome studies in different racial groups.

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    • "Departamento de Pediatria Hospital de Zaragoza 103 29,9 – Cook (5) 50,0 – Ferranti (6) Esmaillzadeh et al (25) 2006 Irã Adolescentes de 10 a 19 anos que participaram do estudo de dislipidemia 3.036 56,6 López-Capapé et al (26) 2006 Espanha Crianças e adolescentes de 11,2±2,8 anos que se apresentaram para avaliação da obesidade 429 18,0 Quintos et al (7) 2006 Estados Unidos Crianças e adolescentes obesos de 3 a 18 anos, inscritos em programa de perda de peso 194 35,5 Buff et al (27) 2007 Brasil Crianças e adolescentes, 10,9±0,48 anos matriculados no Ambulatório de Obesidade 59 42,4 Burrows et al (13) 2007 Chile Crianças com sobrepeso ou obesidade, 6 e 16 anos, atendidos no Programa Clínico de Obesidade 489 26,8 – Cook (5) 45,6 – Ferranti (6) Ceballos et al (28) 2007 Espanha Crianças e adolescentes obesos, 6 e 14 anos, da Endocrinologia Pediátrica 97 18,6 a 34,0 Dhuper et al (29) 2007 Estados Unidos Crianças e adolescentes obesos 3 e 19 anos, programa de obesidade de um Hospital Universitário 576 44,6 Serap et al (30) 2007 Turquia Crianças e adolescentes, 6 a 16 anos, em Hospital Universitário 284 2,1 Calcaterra et al (31) 2008 Itália Crianças e adolescentes obesos caucasianos, idade de 11,2±3,4 anos 191 13,9 Carceres et al (32) 2008 Bolívia Crianças e adolescentes obesos, 4 a 18 anos 61 36,1 Çizmecioglu et al (33) 2008 Turquia Crianças e adolescentes obesos, 2 a 18 anos, buscando atenção de Hospital Universitário 112 24,0 – NCEP 30,0 – OMS Kolsgaard et al (34) 2008 Noruega Crianças e adolescentes obesos de Oslo, 6 a 17 anos, participantes de programa de intervenção 203 24,7 Lee et al (35) 2008 Estados Unidos Crianças e adolescentes participantes de estudos metabólicos 251 24,0 a 51,0 Mimoun et al (18) 2008 França Crianças e adolescentes obesos, 2,5 a 18 anos recrutados em três hospitais-escola 384 10,4 Sen et al (36) 2008 Turquia Crianças obesas, 2 a 19 anos, buscando atenção de Hospital Universitário 352 41,8 Tabela 1 – Prevalência de síndrome metabólica na infância e adolescência em populações referidas por unidades de saúde (ambulatórios e hospitais), revisão sistemática da literatura, 2003-2009 "
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    ABSTRACT: OBJECTIVE: To describe the prevalence of the metabolic syndrome in children and adolescents, as well as the adopted classification criteria. DATA SOURCE: Systematic review performed by electronic search on PubMed and Virtual Library in Health database. The inclusion criteria were: metabolic syndrome prevalence data in children and adolescents with overweight and obes-ity, and publications in Portuguese, English, Spanish and French. The exclusion criteria were review articles and short communications, investigations enrolling participants with genetic, endocrine and immunologic diseases, primary hy-pertension, and acanthosis nigricans. DATA SYNTHESIS: The review afforded 1.226 abstracts, being 65 selected to be read, 46 of them matched the afore-mentioned selection criteria and could be retrieved. They were published between 2003 and 2009 and represented five geographic regions: North America (33%), South America (20%), Central America (4%), Asia (30%) and Europe (13%). The metabolic syndrome reported prevalence ranged from 2.1 to 58.3%. The adopted criteria diverged among the studies, 26 of them used the same components (neutral fat, HDL, glucose, waist circumference and blood pressure), with a median prevalence of 31.2%, without agreement on the chosen cut-off points. In the remaining studies, metabolic syndrome definition included glucose oral tolerance, body mass index, serum cholesterol, and HOMA-IR index. CONCLUSIONS: The metabolic syndrome prevalence among children and adolescents with obesity or overweight reported in the literature showed a wide variability. There was heterogeneity, regarding born the variables chosen to define the presence of metabolic syndrome and their respective cut-off points.
    Revista Paulista de Pediatria 06/2011; 29(2):277-288. DOI:10.1590/S0103-05822011000200021
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    • "In adults, obesity is associated with increases in systemic inflammatory markers, as evidenced by studies documenting the association of BMI and visceral obesity with circulating levels of cytokines and acute-phase reactants [9] [10] [11]. In children, the presence of obesity also appears to be associated with increased levels of high-sensitivity CRP (hsCRP) [12], as well as other inflammatory mediators [13] [14] [15] [16] [17], that promote the development of endothelial and metabolic dysfunction [18] [19] [20] [21]. A recent review on this topic [22] concluded that although there appears to be sufficient evidence to support the existence of an association between obesity and increased hsCRP along with decreased adiponectin levels, the circulating levels found in the majority of the studies published in the literature are generally within the normative range, and could therefore underestimate the concentrations of these mediators at the tissue level. "
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    ABSTRACT: The impact of obesity as a systemic low-grade inflammatory process has only partially been explored. To this effect, 704 community-based school-aged children (354 obese children and 350 age-, gender-, and ethnicity-matched controls) were recruited and underwent assessment of plasma levels of fasting insulin and glucose, lipids, and a variety of proinflammatory mediators that are associated with cardiometabolic dysfunction. Obese children were at higher risk for abnormal HOMA and cholesterol levels. Furthermore, BMI z score, HOMA, and LDL/HDL ratio strongly correlated with levels of certain inflammatory mediators. Taken together, obesity in children is not only associated with insulin resistance and hyperlipidemia, but is accompanied by increased, yet variable, expression of markers of systemic inflammation. Future community-based intervention and phenotype correlational studies on childhood obesity will require inclusion of expanded panels of inflammatory biomarkers to provide a comprehensive assessment of risk on specific obesity-related morbidities.
    International Journal of Pediatrics 01/2010; 2010(1687-9740):846098. DOI:10.1155/2010/846098
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