Components Of Metabolic Syndrome In Children Research Articles

Abstract P375: Cardiometabolic Risk Factors and Socioeconomic Status Indices in Young Adults in Latin America: A Systematic Review and Meta-Analysis of Observational Studies

Background: Metabolic syndrome components in children and adolescents have gained attention in low- and middle-income countries due to variability in their effects and measures across socioeconomic status (SES) determinants. Socioeconomic disparities have been studied related to health, and this fact still poses a serious challenge that raises concerns, especially in low-and middle-income countries, where the classification of the population relies on different determinants from wealthier countries. We conducted a systematic review and meta-analysis to illustrate the effects of measures of metabolic syndrome components across SES in Latin American (LA) young adults. Methods: We searched PubMed/MEDLINE, Web of Science, Lilacs (Bireme), Embase and Scopus for LA studies published before September 2023. Included studies were those with participants aged 6-19 years in whom metabolic syndrome (MS) components were analyzed across SES in LA. The quality of observational studies was assessed using the adapted New Castle Ottawa quality tool. Blood pressure, abdominal obesity, body mass index, body fat, glucose levels and insulin resistance data were synthesized, and a random effect model was used to measure the collective effect of overweight/obesity and lipid profile on higher SES levels compared with middle and low SES levels. The protocol of this review was registered with the International Prospective Register of Systematic Reviews database (registration number: CRD42020222378) and was developed following PRISMA statements. Results: Sixty-three eligible articles (n=255, 521 participants) from nine LA countries were selected. SES definitions were used in 41 studies from five countries with similar criteria. Obesity and overweight (odds ratio: 1.57, 95% confidence interval: 1.18-1.96) and altered lipid profiles were significantly associated with higher SES compared to lower SES. However, high-density lipoprotein-cholesterol levels were lower in patients with a lower SES. The heterogeneity observed could be explained by age, sex, nutrition patterns, standardized cardiometabolic measures, and temporally collected data due to rapid transitions in LA countries. Conclusions: Cardiometabolic components may be associated with higher SES in LA countries. As national SES definitions have been used around LA countries to classify populations, this definition needs to be standardized around LA countries to guide national programs to intensify cardiovascular health and prevent detrimental effects in young people.

Role of cortisol in the formation of metabolic syndrome in children: literature review and own observations

Background. The issue of the pathogenetic influence of cortisol on the development of metabolic syndrome (MS) in children is considered. The above-threshold values of cortisol are proposed to be taken as a marker of MS. The purpose was to study the relationship between blood cortisol and MS components in children. Materials and methods. We have examined 44 children with MS (study group; waist circumference > 90th percentile of the distribution according to age and sex) and 14 children without signs of MS (controls). The children of the study groups did not differ in age and gender. Anthropometric parameters (body weight, height, body mass index, neck, waist, and hip circumferences, waist/hip circumference index), blood cortisol and leptin, blood lipid and carbohydrate spectrum (total cholesterol, high- and low-density lipoprotein cholesterol, triglycerides, blood glucose, and insulin, HOMA-IR and glucose/insulin indices) were evaluated. The measurement of blood pressure with the calculation of the average level was conducted three times. The diagnosis of MS was formed according to the IDF guidelines, 2007. Results. It was found that the level of blood cortisol in children with MS (362.9 (255.5–634.1) µg/l) was 37.9 % lower than in controls (р > 0.05). The frequency of the above-threshold blood cortisol values in children of both groups was 31.8 and 50.0 %, respectively (р > 0.05). The study of dependence using the Spearman’s rank correlation coefficient between blood cortisol and anthropometric parameters (rmax = 0.16; p > 0.05), lipids (rmax = 0.4; р > 0.05), carbohydrate metabolism (rmax = 0.26; р > 0.05), and blood leptin (r = 0.19; р > 0.05) did not reveal any significance. A significant correlation was found between cortisol and systolic blood pressure. Conclusions. In children with MS, there was no significant difference in the level of blood cortisol compared to those without MS criteria. The association of blood cortisol and MS criteria other than systolic blood pressure has not been found. Although cortisol is important in the formation of systolic blood pressure, it cannot serve as a marker of MS in children since it is not a criterion-forming sign of MS.

Retail food outlets and metabolic syndrome: a systematic review of longitudinal studies.

The community food environment covers the type, quantity, density, location, and access to retail food outlets, and its influence on eating behavior, obesity, and metabolic syndrome has been investigated. To evaluate the evidence on longitudinal associations between objectively measured retail food outlets and metabolic syndrome components in children, adolescents, and adults. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality and risk of bias were assessed with the Newcastle-Ottawa Scale. The Scopus, Embase, Web of Science, Scielo, PubMed, MEDLINE, and Lilacs databases were searched without any restriction on publication dates. Of the 18 longitudinal studies included, significant associations were reported in 9 between retail food outlets and metabolic syndrome components in adults (6 positive associations, 2 negative, and 1 both positive and negative), and in 3 studies of children and adolescents (2 negative associations and 1 both positive and negative). Six studies with adults found no association. Limited evidence was found for longitudinal associations between retail food outlets and metabolic syndrome components. In future studies, researchers should consider the use of standardized retail food outlet measurements and accurate analysis to better understand the influence of the community food environment on metabolic syndrome. PROSPERO registration no: CRD42020177137.

Muscle-to-Fat Ratio for Predicting Metabolic Syndrome Components in Children with Overweight and Obesity.

Background: Pediatric obesity has been linked to the components of metabolic syndrome (MetS: abdominal obesity, atherogenic dyslipidemia, elevated blood pressure, and insulin resistance). Data on the role of muscle mass in the development of MetS are sparse. We explored the interaction between the muscle-to-fat ratio (MFR) and MetS components in children with overweight or obesity. Methods: An observational study of 210 pediatric subjects (88 boys, mean age [±standard deviation (SD)] 11.9 ± 3.1 years, BMI z-score range 1.036-3.140) from January 2018 to January 2021. Body composition was measured by bioelectrical impedance analysis (Tanita MC-780 MA and GMON Professional Software), and MFR z-scores were calculated. Results: The 148 subjects (70%) who had MetS components were older (p = 0.008), had lower socioeconomic positions, higher triglyceride/high-density lipoprotein-cholesterol ratios, fat percentages (FATP), truncal FATPs (TRFATPs), and lower MFR z-scores (p < 0.001 for all parameters) than those without MetS components. The correlation between the MFR z-score and the BMI z-score was stronger in subjects with obesity than in subjects with overweight (r = -0.556 vs. r = -0.440, p < 0.001 for both). The risk for MetS components increased by 1.4 for every 3% increase in FATP or TRFATP [odds ratio (OR) = 1.4, confidence interval ([CI] 1.20, 1.64), p < 0.001]. The risk for MetS components was tripled for every 1 SD decrease in MFR z-scores [OR = 3.3, CI (1.74, 6.27), p < 0.001]. Conclusions: Given the strong predictive value of the MFR z-score in the development of early-onset MetS components, preventive strategies should apply interventions for improving the body composition parameters of both adiposity and muscle.

Poor adherence to the Mediterranean diet is associated with increased likelihood of metabolic syndrome components in children: the Healthy Growth Study.

To examine the associations between the level of adherence to the Mediterranean diet (MedDiet) with obesity, insulin resistance (IR), metabolic syndrome (MetS) and its components in schoolchildren. The Healthy Growth Study was a large epidemiological cross-sectional study. School children who were enrolled in primary schools in four counties covering the northern, southern, western and central part of Greece were invited to participate. The study was conducted with a representative sample of 9-13-year-old schoolchildren (n 1972) with complete data. This study applied the KIDMed score to determine 'poor' (≤3), 'medium' (4-7) and 'high' (≥8) adherence of children to the MedDiet. The research hypothesis was examined using multivariate logistic regression models, controlling for potential confounders. The percentage of children with 'poor', 'medium' and 'high' adherence to the MedDiet was 64·8 %, 34·2 % and 1 %, respectively. Furthermore, the prevalence of obesity, IR and MetS was 11·6 %, 28·8 % and 3·4 %, respectively. Logistic regression analyses revealed that 'poor' adherence to the MedDiet was associated with an increased likelihood for central obesity (OR 1·31; 95 % CI 1·01, 1·73), hypertriglyceridaemia (OR 2·80; 95 % CI 1·05, 7·46) and IR (OR 1·31; 95 % CI 1·05, 1·64), even after adjusting for several potential confounders. The present study showed that approximately two-thirds of the examined sample of schoolchildren in Greece have 'poor' adherence to the MedDiet, which also increases the likelihood for central obesity, hypertriglyceridaemia and IR. Prospective studies are needed to confirm whether these are cause-effect associations.

Early Diagnosis of Overweight and Obesity by Prediction of Metabolic Syndrome Components in Children

Early Diagnosis of Overweight and Obesity by Prediction of Metabolic Syndrome Components in Children

Association of Vitamin D receptor gene polymorphisms with metabolic syndrome components in children and adolescents

The Vitamin D receptor (VDR) gene encodes the VDR protein, which is essential for the effective realization of the physiological function of vitamin D. Low vitamin D levels in children and adolescents increase the risk of obesity, insulin resistance, high blood pressure or dyslipidemia.However, the mechanisms are still unclear.It was found that VDR gene single nucleotide polymorphisms (SNP), especially BsmI, affect the level of vitamin D in children and adolescents.Some common SNP, such as BsmI, ApaI, TaqI, Cdx2, are associated with the occurrence of obesity and metabolic syndrome(MS). However, these associations are not significant in some studies, especially in obese group or with rare SNP.This review focuses on the relationship between VDR gene polymorphisms and MS components in children and adolescents, in order to provide direction for early diagnosis and intervention of MS and even the necessity and effectiveness of vitamin D replacement therapy. Key words: Vitamin D receptor gene; Obesity; Metabolic syndrome; Child

Prevalence of overweight, obesity and metabolic syndrome components in children, adolescents and young adults with type 1 diabetes mellitus.

We aimed to determine the prevalence of overweight and obesity among children, adolescents and young adults with type 1 diabetes mellitus (T1DM), and to assess the prevalence of the metabolic syndrome and its components. The study cohort comprised 326 (168 women) consecutive patients aged 5 to 30 years diagnosed with T1DM and followed up in the Juvenile Diabetes Clinic, Maccabi Health Care Services. Anthropometric measurements, blood pressure, presence of additional diseases, other medications, HbA1c , triglycerides and high density lipoprotein cholesterol levels were obtained. The mean age in the study group was 18.5 ± 6.0 years, and the mean diabetes duration was 8.7 ± 5.0 years. Mean HbA1c level was 8.1 ± 1.3%. Nineteen per cent of the study population was overweight (85th > body mass index < 95th percentile) and 5.2% was obese (body mass index ≥ 95th percentile). Female patients aged 15 ≤ 18 and 18 ≤ 25 years were significantly overweight compared with healthy Israeli women in the same age groups, 33.3% versus 12.7% and 26.3% versus 7.8%, respectively, p < 0001. There were no obese female patients in the 15 ≤ 18 age group. Among the men in all age groups, there was no difference in the prevalence of overweight and obesity compared with healthy men in the general population. There was no difference in the age of onset, disease duration, HbA1c levels, treatment with anti-depressants and associated morbidities between the normal weight, overweight and obese groups. Obese patients had lower levels of HDL and increased prevalence of hypertension and metabolic syndrome. Overweight but not obesity was more prevalent in women with T1DM. Metabolic syndrome and its components were more prevalent among overweight and obese individuals with T1DM than among normal weight individuals.

Metabolic syndrome among children and adolescents from Southern Italy: Contribution from the Calabrian Sierras Community Study (CSCS)

Among 1657 children and adolescents aged 6 to 14years (787, 47% girls and 870, 53% boys) from primary and secondary schools in a 14-town Southern Italian community, HDL cholesterol (54±15mg/dl), triglycerides (61±29mg/dl), blood glucose (78±10mg/dl), systolic (101±11mmHg) and diastolic (62±10mmHg) blood pressures, waist circumference (WC) (66±10cm) and WC/height (0.46±0.006) and triglycerides/HDL cholesterol (1.31±0.99) ratios were measured. The distributions were similar in both genders. Age did not affect triglycerides/HDL cholesterol ratio, whereas there was a slightly positive correlation (p<0.00001) between WC/height and triglycerides/HDL cholesterol ratios. We present individual gender and age specific percentile distributions (as Supplementary materials). Using percentile cut-offs (≤10th for HDL cholesterol and ≥90th for the other components), there were 183 (11%) children or adolescents with low HDL cholesterol, 162 (9.77%) with high triglycerides, 178 (10.74%) with high blood glucose, 178 (10.74%) with high WC, 244 (20.76%) with high systolic or diastolic BP and 126 (7.6%) with high systolic and diastolic BP. Abnormally high BP was seen in 470 (28.36%) children or adolescents. Using abnormal percentile values of 3 of 5 of its components, metabolic syndrome (MS) was diagnosed in 70 (4.2%) subjects, similarly in both genders.To assess out-of-limit distributions of all 5 individual MS components in children and adolescents gender- and age-distributions derived from local epidemiological data should be used: these distributions are presented and they might now be used both for comparative and applicative purposes at least in Southern Europe.

Cardiometabolic Risk in Adolescents: Associations with Physical Activity, Fitness, and Sleep—In Response to Kawada

We [1] recently reported the results of a structural model supporting the view that decreased physical activity and sleep duration, poor sleep quality, and fatigue were associated with increased risk of metabolic syndrome and inflammation possibly through reduced cardiorespiratory fitness in a sample of predominantly minority adolescents at risk for cardiovascular disease. Dr. Kawada’s letter raises two concerns which we address below: (a) operationalization of the metabolic syndrome and (b) significance of aerobic fitness and its interpretation. To date, there remain no universally accepted pediatric guidelines to define the metabolic syndrome. Factor analyses of metabolic syndrome components in children and adolescents have yielded conflicting results [2, 3]. Our measurement model was based on theoretical and empirical evidence of a unified syndrome composed of aggregated traits [4]. This model yielded findings consistent with current adult definitional guidelines set by national and international expert panels (e.g., American Heart Association/National Heart, Lung, and Blood Institute [5]). Because the associations among the determinants of cardiometabolic risk are complex and our data were cross sectional, alternative models that address associations among sleep, physical activity, metabolic syndrome components, and inflammation are plausible. We tested a specific conceptual model treating aerobic fitness as a potential mediator of the association of sleep and physical activity with metabolic syndrome and inflammation. This model was based on findings from literature on adults [6]. We found support for the notion that aerobic fitness plays a role in those associations, possibly a mediating role. Though the magnitude of the indirect effects was small, they were statistically significant and should not be dismissed. The partial correlation between metabolic syndrome and inflammation, controlling for fitness, sleep, and physical activity, indicates that additional mechanisms need to be examined to fully understand the link between metabolic syndrome and inflammation. We maintain this is fertile ground for research, while acknowledging the role of fitness. We support the need for additional epidemiologic evidence to confirm and extend the findings of the current study (e.g., causal models using longitudinal design). Kawada’s [7] report that habitual exercise did not predict the risk of metabolic syndrome is of interest in light of our findings for aerobic fitness. There are several differences between the two studies, including sampling and measurement. Ours was an ethnically diverse sample of adolescents with elevated blood pressure, while Kawada’s was a sample of Japanese male autoworkers. Also, Kawada used a self-report measure, and we used an objective [1] index. It may be that disruptions in sleep represent a marker of health status, indexed by poor cardiorespiratory fitness rather than a causal factor of cardiometabolic risk. Theoretical evidence and our findings suggest a cascade of negative physiological and behavioral events generated by the combination of sleep loss and poor cardiorespiratory fitness likely increasing the risk of metabolic syndrome and inflammation

Subclinical atheroesclerosis and metabolic syndrome in children

Metabolic syndrome (MS) in children has been associated to subclinical atherosclerosis as estimated by carotid intima-media thickness (CIMT). We aim to ascertain the influence of MS, insulin resistance (IR) and nutritional status on CIMT. Percentiles with an increased risk of CIMT were also explored. A cross-sectional study of 447 children attending public schools in Santiago, Chile, was performed during years 2009-2011. This sample was selected considering the presence of one or more MS component and IR. Anthropometry and BP were assessed. A blood sample for determination of glycemia, insulinemia and lipids was taken. CIMT was assessed using high resolution ultrasonography with automated software. Pearson correlation, Student's t-test, Chisquared test, and stepwise logistic regression were computed. Mean age was 11.5 ± 1.0 years old (range 10- 14); 59% girls; 93% pubertal; 72% excess weight; 24% MS; and 15% IR. Mean values of MS components in children with CIMT ≥ percentile 75 versus < percentile 75 had differences for systolic BP or diastolic BP ≥ percentile 90 (BP ≥ percentile 90) and high density lipoproteins cholesterol ≤ 40 mg/dL (CHDL ≤ 40 mg/dL). The logistic regression for CIMT ≥ percentile 75 only selected BP ≥ percentile 90 and CHDL ≤ 40 mg/dL. The logistic regression for CIMT ≥ percentile 90 did not select independent variables. In this group of children BP ≥ percentile 90 and CHDL ≤ 40 mg/dL values were associated to CIMT ≥ percentile 75. Influences of IR and nutritional status on CIMT were not found.

Liquid and solid sources of added sugar and their associations with body weight and metabolic syndrome components in children

Limited evidence exists in children relating added sugar (ASug) from solid‐food sources with obesity and metabolic syndrome (MetSyn) in contrast to considerable data on sugar‐sweetened beverages (SSB). Our aim was to examine dietary sources of ASug and their relationship with body weight indicators and MetSyn components. Exposure data were three 24‐hour dietary recalls from 613 Caucasian children (8–10 y) in the QUebec Adiposity and Lifestyle InvesTigation in Youth (QUALITY) study (2008–2010). Outcome measurements included body mass index (BMI), waist circumference (WC), waist‐to‐height ratio (WHR), triglyceride, HDL‐C, systolic blood pressure (SBP) and HOMA‐IR. Multivariate regressions were used with covariates of age, sex, fat mass index (fat mass by dual‐energy absorptiometry) and physical activity (7‐day accelerometer). On average, 12% of energy intake (204 kcal) came from ASug. Four top sources of ASug were sweets (contributed 28% of ASug), baked products (25.9%), SSB (17.1%) and ready‐to‐eat cereal (5.6%). No associations were found with overweight or metabolic indicators with solid‐food sources of ASug. This was in contrast to the association of ASug from SSB with BMI, WC, WHR and SBP. Although children consumed more ASug from sweets and baked products than from SSB, these solid sources of ASug were not associated with health indicators.Grant Funding Source: Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada and Fonds de la recherche en sante du Quebec.

Comparison of Anthropometric Indices in Predicting Metabolic Syndrome Components in Children

The International Diabetes Federation (IDF) defines metabolic syndrome among children. In addition to the abdominal obesity (waist circumference ≥90 percentile of locally representative sample), the risk criteria for metabolic syndrome includes elevated blood pressure, hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL-C) levels, and elevated fasting glucose. In this study, we compared the association of anthropometric indices with metabolic syndrome risk criteria in 9-year-old children. A cross-sectional study of 9-year-old children (n=1,194) was performed in 2007-2008. Using the international cutoff points and percentiles, we determined subjects with elevated blood pressure, hypertriglyceridemia (≥90 percentile), low HDL-C (≤ 10 percentile), and elevated fasting glucose (≥100 mg/dL). We compared several anthropometric indices [triceps skin-fold thickness (SFT), waist circumference, hip circumference, waist-to-hip ratio, body mass index (BMI) and waist-to-height ratio] and their association with metabolic syndrome risk criteria other than waist circumference among 9-year-old children. Metabolic syndrome risk criteria were commonly observed among 9-year-old children: 244 students (20.4%) had hypertriglyceridemia and/or low HDL-C, 362 students (30.3%) had elevated blood pressure, and 254 (21.3%) students were overweight or obese. Among covariates of SFT, BMI, waist circumference, waist-to-hip, or waist-to-height ratio categories, the BMI category was the only significant predictor of having two or more metabolic syndrome risk variables [odds ratio (OR)=3.5, 95% confidence interval (CI) 1.69-7.41, P=0.001 for boys and OR=4.7, 95% CI 1.61-13.55, P=0.005 for girls]. Assessing anthropometric indices is crucial for early detection and prevention of metabolic syndrome among children and adolescents. Age- and sex-specific cutoff points of BMI can be used to screen for the metabolic syndrome and related risk criteria among 9-year-old children.

Factor Analysis of Cardiometabolic Risk Factors Clustering in Children and Adolescents

Research on the clustering and relative importance of the metabolic syndrome components in children and adolescents is scarce. This study was conducted to explore the factor structure of the central metabolic syndrome variables in Jordanian children and adolescents using exploratory factor analysis. This study included 665 children and adolescents who were identified in a national population-based household survey in Jordan. Their anthropometric and laboratory measurements were obtained. Factor analysis was performed on standardized variables to produce the minimum number of factors that retains as much of the total variance in the original data as possible. Factor analysis showed that one common factor is not sufficient to underlie metabolic syndrome. Four factors were extracted in the exploratory factor analysis-adiposity factor, blood pressure factor, lipids factor, and blood glucose factor. The cumulative percent of variance accounted for by the four factors together was 78.7% in male children, 86.9% in female children, 82.5% in male adolescents, and 83.4% in female adolescents. The adiposity factor accounted for the largest proportion of the total variance in the four groups. The factor analysis of cardiovascular risk clustering in Jordanian children and adolescents suggests that multiple factors account for the clustering of the metabolic syndrome components. Obesity accounts for the maximum variance in clustering and appears to be a more powerful correlate of cardiovascular risk in children and adolescents.

Understanding the Nature of Metabolic Syndrome Components in Children and What They Can and Cannot Do to Predict Adult Disease

Understanding the Nature of Metabolic Syndrome Components in Children and What They Can and Cannot Do to Predict Adult Disease

Early markers for atherosclerosis and metabolic syndrome in children

The high prevalence of obesity in children favors the appearance of metabolic syndrome (MS), increasing their cardiovascular risk. To evaluate components of MS in children and to correlate them with surrogate markers of atherosclerosis and subclinical inflammation. We studied 209 children aged 11.5 +/- 2 years (50% girls, 30% prepuberal). Fifty percent had normal weight, 18% were overweight, 29% were obese and 3% were undernourished. A fasting blood sample was obtained to measure lipid levels, glucose, insulin, adiponectin and ultrasensitive C-reactive protein (usCRP). Subclinical atherosclerosis was evaluated using flow mediated dilatation of brachial artery (FMD) and carotid intima-media thickness (IMT). For diagnosis of MS we adapted Cook's criteria. Five percent of all children and 18% of those with overweight had MS. Children with more components had significantly higher fasting insulin and Homeostasis Model Assessment (HOMA) values. Clustering of MS components was also associated to higher values of usCRP and non significantly to lower adiponectin levels. We did not find differences in FMD. In obese children there was a tendency towards a higher IMT with clustering of MS components, although not significant. Children with overweight presented a higher risk of a clustering of MS components, which was also associated with insulin resistance and increase in ultrasensitive C reactive protein.

Marcadores de aterosclerosis temprana y síndrome metabólico en niños

The high prevalence of obesity in children favors the appearance of metabolic syndrome (MS), increasing their cardiovascular risk.To evaluate components of MS in children and to correlate them with surrogate markers of atherosclerosis and subclinical inflammation.We studied 209 children aged 11.5 +/- 2 years (50% girls, 30% prepuberal). Fifty percent had normal weight, 18% were overweight, 29% were obese and 3% were undernourished. A fasting blood sample was obtained to measure lipid levels, glucose, insulin, adiponectin and ultrasensitive C-reactive protein (usCRP). Subclinical atherosclerosis was evaluated using flow mediated dilatation of brachial artery (FMD) and carotid intima-media thickness (IMT). For diagnosis of MS we adapted Cook's criteria.Five percent of all children and 18% of those with overweight had MS. Children with more components had significantly higher fasting insulin and Homeostasis Model Assessment (HOMA) values. Clustering of MS components was also associated to higher values of usCRP and non significantly to lower adiponectin levels. We did not find differences in FMD. In obese children there was a tendency towards a higher IMT with clustering of MS components, although not significant.Children with overweight presented a higher risk of a clustering of MS components, which was also associated with insulin resistance and increase in ultrasensitive C reactive protein.

Serum Retinol-Binding Protein 4 Concentration and Its Ratio to Serum Retinol Are Associated with Obesity and Metabolic Syndrome Components in Children

Although retinol-binding protein (RBP)-4 concentrations are elevated in animal models of obesity and insulin resistance (IR), the link between RBP4 and IR in humans is less clear. There are few published data on RBP4 levels in overweight children, and most previous studies did not control for vitamin A (VA) status and/or subclinical inflammation. The objective of the study was to measure serum RBP4, serum retinol (SR), the RBP4-to-SR molar ratio, and dietary VA intakes in normal-weight and overweight children and investigate the relationship of these variables to IR, subclinical inflammation, and the metabolic syndrome in this age group. This was a cross-sectional study. The study was conducted in Northern Switzerland. Patients included 6- to 14-yr-old normal-weight, overweight, and obese children (n = 79). Body mass index, body fat percentage, waist-to-hip ratio, dietary VA intakes, serum RBP4, and SR were determined. IR was assessed using fasting insulin and the quantitative insulin sensitivity check index, and components of the metabolic syndrome and indices of subclinical inflammation were measured. Only 3% of children had low VA status. Independent of age, VA intakes, and C-reactive protein, body mass index, body fat percentage, and waist-to-hip ratio were significant predictors of RBP4, SR, and RBP4/SR. Independent of adiposity, RBP4 and RBP4/SR were significantly correlated with serum triglycerides, and RBP4/SR was correlated with fasting insulin. The RBP4-to-SR ratio more strongly correlated with components of the metabolic syndrome than serum RBP4. Independent of subclinical inflammation and vitamin A intakes, serum RBP4 and the RBP4-to-SR ratio are correlated with obesity, central obesity, and components of the metabolic syndrome in prepubertal and early pubertal children.