Metabolic Syndrome in Obese Children and Adolescents: Dichotomous or Continuous?

Abstract

Defining and detecting the metabolic syndrome in children and adolescents is difficult because of ongoing discussion of components and thresholds. The aim of this work was to highlight the limitations of a dichotomous definition of the metabolic syndrome, leading to considerable overlap between those with and without the metabolic syndrome, by computing different continuous scores. A total of 50 children and adolescents ages 6-16 years were studied. Height and weight were measured; body mass index (BMI) was calculated, and obesity was defined by age- and sex-specific 97(th) percentiles of French reference values. Metabolic syndrome prevalence was based on the criteria reported by Chen et al. in 2006 and compared with five scores reflecting specific metabolic syndrome components (MetScores): Fat mass, waist circumference, BMI, homeostasis model assessment (HOMA), and systolic blood pressure. Using a standard clinical definition, 48% of obese children and adolescents were diagnosed with metabolic syndrome. The prevalence of metabolic syndrome in the sample was much higher using specific MetScores: Fat mass, 92%; waist circumference, 94%; BMI, 94%; HOMA, 98%; and systolic blood pressure, 84%. Insulin resistance (IR), assessed as a high HOMA index, was present in 68% of the sample, and was the metabolic syndrome component with the highest prevalence. The use of a continuous indicator of the metabolic syndrome, such as MetScores, may help to overcome limitations imposed by dichotomous definitions, particularly among obese children and adolescents. A high prevalence of IR indicates the relevance of HOMA in detection of the metabolic syndrome.