Article

The metabolic syndrome: Antecedent of adult cardiovascular disease in pediatrics

Journal of Pediatrics (Impact Factor: 3.74). 11/2004; 145(4):427-30. DOI: 10.1016/j.jpeds.2004.07.021
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    • "Based on the modified ATPIII criteria (Cook 2004), estimated prevalence of MetS among obese adolescents varied between 18% in Spain (Lopez-Capape et al., 2006) and 42% in the US (Dhuper et al., 2007). Limited data for random and representative population-based samples suggest a prevalence of MetS that varies between 3–12% in youth (Cook, 2004; Duncan et al., 2004; Johnson et al., 2009; Jolliffe & Janssen, 2007). The lack of a universal definition of MetS limits the generalizability of comparisons across countries and also the diagnostic and clinical utility of MetS for potential therapeutic intervention. "
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    ABSTRACT: Abstract Background: Although the prevalence of metabolic syndrome (MetS) has increased in youth, the potential independent contribution of cardiorespiratory fitness (CRF) to the clustering of metabolic risk factors has received relatively little attention. Aim: This study evaluated associations between the clustering of metabolic risk factors and CRF in a sample of youth. Subjects and methods: Height, weight, BMI, fasting glucose, insulin, HDL-cholesterol, triglycerides and blood pressures were measured in a cross-sectional sample of 924 youth (402 males, 522 females) of 11-17 years. CRF was assessed using the 20-metre shuttle run test. Physical activity (PA) was measured with a 3-day diary. Outcome variables were statistically normalized and expressed as Z-scores. A MetS risk score was computed as the mean of the Z-scores. Multiple linear regression was used to test associations between CRF and metabolic risk, adjusted for age, sex, BMI, PA and parental education. Results: CRF was inversely associated with MetS after adjustment for potential confounders. After adjusting for BMI, the relationship between CRF and metabolic risk has substantially improved. Conclusion: CRF was independently associated with the clustering of metabolic risk factors in youth of 11-17 years of age.
    Annals of Human Biology 05/2014; 41(3):271-6. DOI:10.3109/03014460.2013.856471 · 1.15 Impact Factor
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    • "The pathological accumulation of body fat in childhood and youth has medium-and long-term consequences , including dyslipidaemia, diabetes, the metabolic syndrome, arterial hypertension, fatty liver, biliary disease and orthopaedic disorders, as well as respiratory and psychological problems. These comorbidities, once characteristic of adult disease, are being detected in children with increasing frequency and at noticeably earlier ages (Cook, 2004; Baker et al., 2005; Aggoun, 2007). Metabolic comorbidities of obesity are strongly associated with insulin resistance. "
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    ABSTRACT: To compare the association between metabolic and vascular comorbidities and the body mass (BMI)-for-age cut-off criteria from three growth standards [Centers for Disease Control and Prevention (CDC), 2000; World Health Organization (WHO), 2007; Spanish Reference Criteria (Carrascosa Lezcano et al., 2008)] that are used to define being overweight and obese in childhood. A prospective study was conducted in 137 children (aged 8-16 years). Based on BMI-for-age Z-scores according to WHO cut-offs, 59 participants were obese, 35 were overweight and 43 were normal-weight. All participating children were subsequently reclassified applying the CDC and Spanish Reference Criteria. Blood pressure (BP), biochemical variables and vascular parameters (stiffness and intima-media thickness) were analysed. According to WHO and CDC references, 48% and 43% of the children, respectively, were categorised as obese, whereas 16% were considered as obese using the Spanish Reference Criteria. Applying WHO criteria, obese children showed significantly higher levels of insulin, homeostasis model assessment index and most vascular parameters, as well as lower high-density lipoprotein (HDL)-cholesterol than overweight children. Moreover, overweight children showed higher BP, insulin and uric acid, and lower HDL-cholesterol than normal weight children. The CDC criteria yielded similar results, although with fewer differences between obese and overweight children. Applying Spanish criteria, the differences between obese and overweight children disappeared. WHO and CDC BMI-for-age references and cut-offs are useful for defining obesity and being overweight in children because they clearly identify metabolic and vascular comorbidities. The Spanish Reference Criteria underdiagnose obesity because overweight children show comorbidities typical of the obese.
    Journal of Human Nutrition and Dietetics 06/2013; 27. DOI:10.1111/jhn.12140 · 2.07 Impact Factor
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    • "The pathological accumulation of body fat in childhood and youth has medium-and long-term consequences , including dyslipidaemia, diabetes, the metabolic syndrome, arterial hypertension, fatty liver, biliary disease and orthopaedic disorders, as well as respiratory and psychological problems. These comorbidities, once characteristic of adult disease, are being detected in children with increasing frequency and at noticeably earlier ages (Cook, 2004; Baker et al., 2005; Aggoun, 2007). Metabolic comorbidities of obesity are strongly associated with insulin resistance. "
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    ABSTRACT: OBJECTIVE: To examine the association between cardiovascular risk and childhood overweight and obesity using the BMI cut-offs recommended by the WHO. DESIGN: Children were classified as normal weight, overweight and obese according to the WHO BMI-for-age reference. Blood pressure, lipids, glucose, insulin, homeostasis model assessment-insulin resistance (HOMA-IR) and uric acid levels were compared across BMI groups. ANOVA and tests of linearity were used to assess overall mean differences across groups. Crude and adjusted odds ratios were calculated for adverse plasma levels of biochemical variables. SETTING: Paediatric care centres. SUBJECTS: Children (n 149) aged 8-18 years. RESULTS: About 37 %, 22 % and 41 % of children were classified respectively as normal weight, overweight and obese. There were significant linear mean differences between BMI groups in systolic blood pressure, HDL-cholesterol, TAG, insulin, HOMA-IR and uric acid. Obese children were 10·6 times more likely than normal-weight children to have hypertension; OR for other associations were 60·2 (high insulin), 39·5 (HOMA-IR), 27·9 (TAG), 16·0 (HDL-cholesterol), 4·3 (LDL-cholesterol) and 3·6 (uric acid). Overweight children were more likely than normal-weight children to have hypertension (OR = 3·5), high insulin (OR = 28·2), high HOMA-IR (OR = 23·3) and high TAG (OR = 16·1). Nearly 92 % and 57 % of the obese and overweight children, respectively, had one or more risk factor. CONCLUSIONS: Obesity and overweight defined using the WHO BMI-for-age cut-offs identified children with higher metabolic and vascular risk. These results emphasize the importance of prevention of overweight and obesity in childhood to reduce cardiovascular risk.
    Public Health Nutrition 10/2012; 16(4):1-6. DOI:10.1017/S1368980012004776 · 2.48 Impact Factor
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