Prevalence of the Metabolic Syndrome in Overweight Children and Adolescents

Volume 1, Issue 1, October 2016     |     PP. 63-74      |     PDF (313 K)    |     Pub. Date: October 15, 2016
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Kobra Shiasi Arani, Research Center for Biochemistry and Nutrition in metabolic diseases, Kashan University of Medical Sciences, Kashan, I.R. Iran
Kobra Shiasi Arani, MD, Department of Pediatric Endocrinology, Kashan University of Medical Sciences Iran

Background— the prevalence of overweight and obesity among children and adolescents is increasing worldwide. Concordantly with the increase in obesity the prevalence of the metabolic syndrome is raising in children and youth. The metabolic syndrome imposes a substantial risk for type 2 diabetes mellitus and premature coronary heart disease. Methods— Metabolic syndrome is defined by the Third Report of the Adult Treatment Panel (ATP III) using criteria easily applied by clinicians and researchers for adults. There is no standard pediatric definition. We defined pediatric metabolic syndrome using criteria analogous to ATP III as 3 of the following: (1) fasting triglycerides over 95 th percentile for age and gender; (2) high density lipoprotein (HDL) cholesterol level below 5 th percentile for age and gender; (3) fasting glucose ≥6.1 mmol/L (110 mg/dL); (4) body mass index (BMI) ≥ 95 th percentile for age and gender; and (5) systolic blood pressure over 95 th percentile for age and gender. We used the Homoeostasis model assessment score (HOMA score) to detect the degree of insulin resistance. Results —The study included 484 children and adolescents aged 4 to 18 years (290 girls and 194 boys; mean age10.58 years; mean BMI: 11.11). Metabolic syndrome was present in 30.7% of overweight adolescents (BMI ≥95 th percentile) compared with 3.7% of at-risk adolescents (85 th to 95 th BMI percentile) and none of those with a BMI below the 85 th percentile (P<.001). About 36.4% of normal weight subjects, 54.5% of at risk of overweight subjects and 55.7% of overweight had at least 1 metabolic abnormality (fasting glucose≥110 mg/dl, high triglyceride, low HDL). Mean HOMA index is 2.16 in normal weight subjects, 2.60 in at risk of overweight subjects and 3.85 in overweight subjects. HOMA score =3.18 had 67% sensitivity and 60.8% specificity for predict of metabolic syndrome in overweight subjects. Conclusions—Metabolic syndrome is common in overweight Iranian children and adolescents and they have similar prevalence of metabolic derangements associated with obesity. Because childhood metabolic syndrome likely tracks into adulthood, early identification may help target interventions to improve future cardiovascular health.

metabolic syndrome _ pediatrics _ overweight _ HOMA index

Cite this paper
Kobra Shiasi Arani, Kobra Shiasi Arani, MD, Prevalence of the Metabolic Syndrome in Overweight Children and Adolescents , SCIREA Journal of Clinical Medicine. Volume 1, Issue 1, October 2016 | PP. 63-74.


[ 1 ] Karnik S, Kanekar A. Childhood obesity: a global public health crisis. International journal of preventive medicine. 2012;3(1):1.
[ 2 ] Sen Y, Kandemir N, Alikasifoglu A, Gonc N, Ozon A. Prevalence and risk factors of metabolic syndrome in obese children and adolescents: the role of the severity of obesity. European journal of pediatrics. 2008;167(10):1183-9.
[ 3 ] Kelishadi R, Haghdoost AA, Sadeghirad B, Khajehkazemi R. Trend in the prevalence of obesity and overweight among Iranian children and adolescents: A systematic review and meta-analysis. Nutrition. 2013.
[ 4 ] Basiratnia M, Derakhshan D, Ajdari S, Saki F. Prevalence of childhood obesity and hypertension in south of Iran. Iran J Kidney Dis. 2013;7(4):282-9.
[ 5 ] Ehtisham S, Crabtree N, Clark P, Shaw N, Barrett T. Ethnic differences in insulin resistance and body composition in United Kingdom adolescents. The Journal of clinical endocrinology and metabolism. 2005;90(7):3963-9.
[ 6 ] Whincup PH, Gilg JA, Owen CG, Odoki K, Alberti KG, Cook DG. British South Asians aged 13-16 years have higher fasting glucose and insulin levels than Europeans. Diabetic medicine : a journal of the British Diabetic Association. 2005;22(9):1275-7.
[ 7 ] Jazayeri S. Overweight and obesity among school-aged children of metropolitan Tehran, Iran. Pakistan Journal of Nutrition. 2005;4(5):342-4.
[ 8 ] Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA : the journal of the American Medical Association. 2002;287(3):356-9.
[ 9 ] Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA modeling. Diabetes care. 2004;27(6):1487-95.
[ 10 ] Goodman E, Daniels SR, Morrison JA, 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. The Journal of pediatrics. 2004;145(4):445-51.
[ 11 ] Hirschler V, Aranda C, de Luján Calcagno M, Maccalini G, Jadzinsky M. Can waist circumference identify children with the metabolic syndrome? Archives of pediatrics & adolescent medicine. 2005;159(8):740-4.
[ 12 ] Association AD. Diagnosis and classification of diabetes mellitus. Diabetes care. 2010;33(Supplement 1):S62-S9.
[ 13 ] Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988-1994. Archives of pediatrics & adolescent medicine. 2003;157(8):821-7.
[ 14 ] Pollestad Kolsgaard ML, Andersen LF, Tonstad S, Brunborg C, Wangensteen T, Joner G. Ethnic differences in metabolic syndrome among overweight and obese children and adolescents: the Oslo Adiposity Intervention Study. Acta paediatrica. 2008;97(11):1557-63.
[ 15 ] Kliegman. Kliegman: Nelson Textbook of Pediatrics, 18th ed, p:589 , Table 83-13. 2007.
[ 16 ] Association AD. Type 2 diabetes in children and adolescents. Diabetes care. 2000;23(3):381-9.
[ 17 ] Rohilla R, Rajput M, Rohilla J, Malik M, Garg D, Verma M. Prevalence and correlates of overweight/obesity among adolescents in an urban city of north India. Journal of family medicine and primary care. 2014;3(4):404-8.
[ 18 ] Lloyd L, Langley-Evans S, McMullen S. Childhood obesity and risk of the adult metabolic syndrome: a systematic review. International Journal of Obesity. 2012;36(1):1-11.
[ 19 ] Grundy SM. Pre-diabetes, metabolic syndrome, and cardiovascular risk. Journal of the American College of Cardiology. 2012;59(7):635-43.
[ 20 ] Reilly J, Kelly J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. International Journal of Obesity. 2011;35(7):891-8.
[ 21 ] Bacha F. Endocrine and Metabolic Complications of Pediatric Obesity. 2015.
[ 22 ] de Ferranti SD, Gauvreau K, Ludwig DS, Neufeld EJ, Newburger JW, Rifai N. Prevalence of the metabolic syndrome in American adolescents: findings from the Third National Health and Nutrition Examination Survey. Circulation. 2004;110(16):2494-7.
[ 23 ] Katzmarzyk PT, Perusse L, Malina RM, Bergeron J, Despres JP, Bouchard C. Stability of indicators of the metabolic syndrome from childhood and adolescence to young adulthood: the Quebec Family Study. Journal of clinical epidemiology. 2001;54(2):190-5.
[ 24 ] Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, et al. Obesity and the metabolic syndrome in children and adolescents. The New England journal of medicine. 2004;350(23):2362-74.
[ 25 ] Bao W, Srinivasan SR, Berenson GS. Persistent elevation of plasma insulin levels is associated with increased cardiovascular risk in children and young adults. The Bogalusa Heart Study. Circulation. 1996;93(1):54-9.