Goodman E, Daniels S, Morrison J, Huang B, Dolan LM. Contrasting prevalence of and demographic disparities in the World Health Organization and National Cholesterol Education Program Adult Treatment Panel III definitions of metabolic syndrome among adolescents

Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts 02454, USA. <>
Journal of Pediatrics (Impact Factor: 3.79). 11/2004; 145(4):445-51. DOI: 10.1016/j.jpeds.2004.04.059
Source: PubMed


To determine prevalence of metabolic syndrome (MS) among adolescents by using definitions from the National Cholesterol Education Program Adult Treatment Panel III (NCEP) and World Health Organization (WHO) guidelines and to compare the populations identified by these definitions.
School-based, cross-sectional study of 1513 black, white, and Hispanic teens who had a fasting morning blood sample drawn and a physical examination.
Overall, the prevalence of NCEP-defined MS was 4.2% and of WHO-defined MS was 8.4%. MS was found almost exclusively among obese teens, for whom prevalence of NCEP-defined MS was 19.5% and prevalence of WHO-defined MS was 38.9%. Agreement between definitions was poor (kappa statistic=0.41). No race or sex differences were present for NCEP-defined MS. However, nonwhite teens were more likely to have MS by WHO criteria (RR, 1.40; 95% CI, 1.04, 1.87), and MS was more common among girls if the WHO-based definition was used (RR, 1.26; 95% CI, 1.08, 1.88).
Among adolescents, obesity is a powerful risk for MS. Important demographic and clinical differences exist in the typology of MS, depending on the definition. Such discrepancies suggest that the concept of a common pathologic syndrome or etiologic mechanism underlying MS as defined by these guidelines may be flawed.

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Available from: Elizabeth Goodman, Feb 24, 2014
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    • "The major problem to diagnose MetS in both childhood and adulthood periods is unavailability of an accepted global definition of this phenomenon as well as different cutoff values for each component so that applying different definitive criteria including Cook [19], de Ferranti [20], Goodman [21], Weiss [22], Cruz [23], Ford [24], and IDF [25] has led to reporting various range of the prevalence rates from different societies. In this survey, we adopted IDF definition to determine the prevalence and distribution of metabolic syndrome among Iranian middle and high school students based on its convenience in epidemiological research and clinical practice, using de Ferranti's definition as a supplement. "
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    ABSTRACT: Aim . The present population-based study aimed to assess prevalence of metabolic syndrome and itsrelated components in Iranian youth in the different sex, age, and residential subgroups. Method . Overall, 1039 junior high school and 953 high school students were selected using multistage random sampling. Fasting blood sugar, total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels were determined. Trained individuals measured waist circumference and blood pressure. Subjects with MetS were selected according to two definitions provided by the IDF and de Ferranti. Results . Among girls in intervention area, hypertriglyceridemia was more prevalent in rural than in urban areas using IDF definition. Significant differences were observed between boys in rural and urban areas regarding some components of metabolic syndrome including hypertriglyceridemia and high waist circumference. Besides, boys who are residents in urban areas had higher blood pressure, as well as higher waist circumference, than boys in rural areas. Conclusion . Our youth population is at significant risk of developing metabolic syndrome, and the pattern of this phenomenon seems to be discrepant in boys as well as in rural and urban areas probably due to the different lifestyle aspects, genetic factors, and racial differences.
    Journal of Diabetes Research 05/2013; 2013(4):738485. DOI:10.1155/2013/738485 · 2.16 Impact Factor
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    • "The IDF definition underestimated metabolic syndrome compared to the De Ferranti's definition in overweight, obese, normal weight and overall children. Our results are consistent with previous studies [25,30]. "
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    ABSTRACT: China has experienced an increase in the prevalence of childhood overweight/obesity over the last decades. The purpose of this study was to examine the prevalence of obesity and metabolic syndrome among Chinese school children and determine if there is a significant association between childhood obesity and metabolic syndrome. A cross-sectional study was conducted among 1844 children (938 males and 906 females) in six elementary schools at Guangzhou city from April to June 2009. The body mass index (BMI), waist circumference, blood pressure, Tanner stage, lipids, insulin and glucose levels were determined. Criteria analogous to ATPIII were used for diagnosis of metabolic syndrome in children. Among 1844 children aged 7-14 years, 205 (11.1%) were overweight, and 133 (7.2%) were obese. The prevalence of metabolic syndrome was 6.6% overall, 33.1% in obese, 20.5% in overweight and 2.3% in normal weight children. Multiple logistic regression analysis showed that BMI (3rd quartile)(OR 3.28; 95%CI 0.35-30.56), BMI (4th quartile)(OR 17.98; 95%CI 1.75-184.34), homeostasis model assessment (HOMA-IR) (2nd quartile) (OR2.36; 95% CI 0.46-12.09), HOMA-IR (3rd quartile) (OR 2.46; 95% CI 0.48-12.66), HOMA-IR (4th quartile) (OR3.87; 95% CI 0.72-20.71) were significantly associated with metabolic syndrome. The current epidemic of obesity with subsequent increasing cardiovascular risk factors has constituted a threat to the health of school children in China. HOMA-IR and BMI were strong predictors of metabolic syndrome in children. Therefore, rigorous obesity prevention programs should be implemented among them.
    BMC Public Health 12/2010; 10(article 780):780. DOI:10.1186/1471-2458-10-780 · 2.26 Impact Factor
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    • "In fact, risk factors in growing children can be delimited only by age/gender related, percentile-based thresholds, that often do not correspond to adult thresholds , particularly in overlapping ranges of age between adolescents and adults [12]. Consequently, very different MS prevalence rates are obtained according to the chosen MS criteria [13]. Several studies have investigated the clustering of the risk factors included in the MS definition by statistical methods, mainly by the principal component analysis, an exploratory analysis that clusters the MS risk factors in fewer highly intercorrelated factors [14] [15]. "
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    ABSTRACT: Cardiovascular (CV) risk factors present in childhood predict future CV events. Few data regarding the metabolic syndrome (MS) prevalence are available in adolescents from Mediterranean areas where obesity is becoming a social emergency. This study presents data of MS prevalence in a student cohort from southern Italy. 1629 students between 7 and 14 years of age underwent anthropometric measurements and a blood sample was obtained to assess biochemical parameters. MS risk factors were calculated based on age and gender adjusted percentiles of parameter distributions. MS prevalence rate was 0.022 using paediatric, age-adjusted criteria; the rate increased to 0.029 using a 90th percentile criteria for fasting blood glucose instead of >100mg/dL. Using the criteria issued by the International Diabetes Federation the MS prevalence rate dropped to 0.005. The exploratory factor analysis identified four factors: age/fat related, lipids, blood pressure and blood glucose. Family history of type 2 diabetes mellitus was associated with triglyceride [OR=1.55 (1.0-2.3)] and BMI [OR=1.71 (1.2-2.4)] but not to blood glucose by logistic regression analysis. In a student cohort from Southern Italy, obesity is associated with the features of MS.
    Nutrition, metabolism, and cardiovascular diseases: NMCD 03/2009; 19(9):620-5. DOI:10.1016/j.numecd.2008.12.003 · 3.32 Impact Factor
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