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: 3.79). 03/2008; 152(2):177-84. DOI: 10.1016/j.jpeds.2007.07.053
Source: PubMed


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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    • "It is the most abundant adipokine in serum and interestingly, studies in adults have demonstrated an inverse correlation between hormone secretion and adipose tissue hypertrophy as the serum adiponectin concentration decreases with increasing fat tissue [2] [3]. Recently, adiponectin has gained increasing attention in pediatrics as a serum biomarker due to its correlation to various metabolic risk factors such as insulin resistance, dyslipidemia, metabolic syndrome, and also cardiovascular disease [4] [5] [6] [7]. "
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    ABSTRACT: Adiponectin is an abundant adipocyte-secreted hormone that modulates a number of metabolic processes and is correlated to various metabolic disorders. Pediatric reference levels are needed for the risk stratification and interpretation of individual serum adiponectin levels. A total of 1193 healthy, non-obese Danish schoolchildren (730 girls, 463 boys) aged 6-18 years (median 11.9) were examined by trained medical staff. Total serum adiponectin concentrations in venous fasting blood samples were quantitated by a DuoSet® ELISA human Adiponectin/Acrp30 (R&D Systems) following optimization. In a generalized linear model adjusted for BMI SDS, total serum adiponectin concentrations were correlated to age in girls (p<0.0001) and boys (p=<0.0001) and for both sexes combined (p<0.0001). No significant difference between sexes was found. Reference intervals were calculated using age as a continuous variable. The best fitted reference curve for both sexes was: 50th percentile: Y=-0.1478X+6.046; 2.5th percentile: Y=-0.06256*X+2.34; 97.5th percentile: Y=-0.4086*X+22.39, where y= adiponectin in μg/mL and x= years of age (from 6-18 yr). We developed a pediatric reference levels for total serum adiponection in a sample of 1193 Danish children and adolescents aged 6-18 years. A correlation with age was demonstrated in children, but no significant difference was seen between the sexes. Copyright © 2015. Published by Elsevier B.V.
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    Full-text · Article · Apr 2014 · Cardiovascular Diabetology
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    • "We decided to use the OGTT instead of IVGTT because OGTT describes the post-meal dynamics which is of interest for the GH physiology being GH a hormone that principally acts in the post-absorptive phase [1]. Moreover, we chose the OGTT-derived indices of insulin sensitivity and secretion because they correlate well with clamp measures in children [44], [45], are easily calculated in epidemiological or intervention studies, and DI calculated by the OGTT has been demonstrated to predict diabetes development in adults [24]. Furthermore, the OGTT is the test that is classically performed in the clinical practice during rhGH treatment being simpler and cheaper than IVGTT. "
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    Full-text · Article · Jan 2014 · PLoS ONE
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