Metabolic Syndrome In Adolescents Research Articles

0199 Circadian Misalignment, Cardiac-Autonomic and Inflammatory Pathways, and Metabolic Syndrome in Adolescents

0199 Circadian Misalignment, Cardiac-Autonomic and Inflammatory Pathways, and Metabolic Syndrome in Adolescents

Anthropometric parameters in metabolic syndrome in brazilian adolescents: confirmatory factor analysis

This study aims to identify the influence of anthropometric variables on the patterns of clustering of metabolic and hemodynamic variables in the metabolic syndrome in adolescents, being an epidemiological, cross-sectional, analytical study conducted with 635 adolescents from public schools in the municipality of Montes Claros, state of Minas Gerais, Brazil. Methods: the metabolic, hemodynamic and anthropometric parameters were evaluated and the data analysis was processed using the Statistical Package for Social Sciences for Windows software. Results: three diferente models stratified by gender were adjusted that were estimated through Confirmatory Factor Analysis by the maximum likelihood method implemented in the IBM SPSS AMOS 23.0 software. Conclusion: The profile found could contribute to the consolidation of the SM construct, allowing early identification and favoring the creation of strategies to prevent this disease, avoiding adverse clinical outcomes.

Serum Iron Levels, Dietary Iron Intake, and Supplement Use in Relation to Metabolic Syndrome in Adolescents: A Cross-Sectional Study.

The objective of this study was to investigate the potential associations between serum iron levels, dietary iron intake, and iron supplementation, and the prevalence of metabolic syndrome (MetS) in adolescents A cross-sectional analysis was conducted, utilizing data from adolescents participating in the 2003-2018 cycle of the National Health and Nutrition Examination Survey (NHANES). Odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) pertaining to serum iron, dietary iron, and iron supplementation were derived through multivariate logistic regression models. Additionally, a restricted cubic spline (RCS) regression model was applied to explore the nonlinear relationship between dietary iron and serum iron concerning MetS. The study encompassed 4858 American adolescents aged 12 to 19, among whom 413 (8.5%) manifested MetS. The study cohort exhibited an average age of 15.52years, comprising 2551 males (52.51%) and 2307 females (47.49%). Relative to individuals in the lowest serum iron quartile, those in the highest quartile for serum iron (OR = 0.33, 95% CI 0.21-0.50), the highest quartile for dietary iron (OR = 0.53, 95% CI 0.32-0.89), and those utilizing iron supplements (OR = 0.61, 95% CI 0.37-0.99) evinced a diminished prevalence of MetS, even post adjustment for potential confounding variables. A non-linear relationship was discerned between serum iron and MetS, exhibiting a statistically significant negative correlation when serum iron concentrations exceeded the inflection point (serum iron = 8.66µmol/L, P for nonlinear < 0.001). This investigation reveals that higher levels of serum iron, increased dietary iron intake, and the use of iron supplements are linked to a lower prevalence of MetS in US adolescents. These findings suggest that dietary modifications could play a role in promoting the health of adolescents.

Nonalcoholic Fatty Liver Disease and Continuous Metabolic Syndrome in Adolescents with Overweight/Obesity.

Nonalcoholic fatty liver disease is the leading cause of pediatric chronic liver disease. Although nonalcoholic fatty liver disease is closely associated with obesity, its relationship with metabolic syndrome in children is not fully understood. The main aim of this study was to evaluate the association between nonalcoholic fatty liver disease and a combination of cardiometabolic risk factors in adolescents with overweight/obesity, using a pediatric metabolic syndrome score (PsiMS) to predict metabolic syndrome. A retrospective cohort study was conducted. Subjects with overweight/obesity aged 10 to 17 followed at two clinical centers in Portugal (2018 - 2021) were enrolled. The independent association of nonalcoholic fatty liver disease with PsiMS, and of other potential predictors, was tested through multiple regression analyses. Receiver operator characteristic curve analysis was performed to estimate the optimal cutoff of PsiMS to discriminate metabolic syndrome. Eighty-four subjects were included (median age at baseline 11.5 years). The prevalence rate of nonalcoholic fatty liver disease was 51% and the prevalence rate of metabolic syndrome was 7%. The mean PsiMS was 2.05 ± 0.48 at the first evaluation, and 2.11 ± 0.52 at the last evaluation (mean follow-up time was 15 months). The nonalcoholic fatty liver disease group had significantly (p < 0.05) higher weight and body mass index z-scores, higher rate of severe obesity and higher waist circumference percentile. PsiMS was highly accurate in predicting metabolic syndrome (area under the curve = 0.96), with an optimal cutoff of 2.46 (sensitivity 100%, specificity 89%). In the univariate analysis, no statistically significant association was observed between nonalcoholic fatty liver disease and PsiMS. In the multiple regression analysis, female sex had a negative association with PsiMS (first and last evaluation). Independent predictors of a higher PsiMS at first evaluation were: ≥ 2 metabolic syndrome criteria, body mass index z-score, insulin resistance and dyslipidemia. At the last evaluation, independent predictors of a higher PsiMS were: nonalcoholic fatty liver disease, baseline PsiMS and body mass index increase from baseline. The results suggest a good performance of the PsiMS to assess metabolic syndrome and that nonalcoholic fatty liver disease is associated with PsiMS at follow-up.

Association between asthma, obesity, and metabolic syndrome in adolescents and young adults

Background The association of asthma and metabolic syndrome (MetS) among adolescents and young adults (AYAs) remains unclear, as well as the role of obesity in this relationship. Methods AYAs aged 12-25 years who participated in the 2011–2020 National Health and Nutrition Examination Survey were included in this cross-sectional analysis. The moderating effect of obesity (age- and sex-adjusted body mass index ≥ 95th%ile for adolescents or ≥ 30 kg/m2 for adults) on asthma and MetS were evaluated in four groups: 1) both asthma and obesity; 2) asthma and no obesity; 3) obesity and no asthma; and 4) healthy controls with no obesity/asthma. Results A total of 7,709 AYAs (53.9% aged 12–18 years, 51.1% males, and 54.4% non-Hispanic White) were included in this analysis. 3.6% (95% CI 2.8–4.3%) had obesity and asthma, 7.6% (95% CI 6.8–8.4%) had asthma and no obesity, 21.4% (95% CI 19.6-23.2%) had obesity and no asthma, and 67.4% (95% CI 65.4–69.4%) had neither obesity nor asthma. The estimated prevalence of MetS was greater among those with both obesity and asthma versus those with only asthma (4.5% [95% CI 1.7–7.3%] vs. 0.2% [95% CI 0–0.5%], p < 0.001). Compared to healthy controls, those with both obesity and asthma had ∼10 times higher odds of having MetS (aOR 10.5, 95% CI 3.9–28.1). Conclusions Our results show the association between MetS and asthma is stronger in AYAs with BMI-defined obesity. Efforts to prevent and treat obesity may reduce MetS occurrence in AYAs with asthma.

Circadian misalignment impacts the association of visceral adiposity with metabolic syndrome in adolescents.

Although insufficient sleep is a risk factor for metabolic syndrome (MetS), the circadian timing of sleep (CTS) is also involved in cardiac and metabolic regulation. We examined whether delays and deviations in the sleep midpoint (SM), a measure of CTS, modify the association between visceral adipose tissue (VAT) and MetS in adolescents. We evaluated 277 adolescents (median 16 years) who had at least 5 nights of at-home actigraphy (ACT), in-lab polysomnography (PSG), dual-energy X-ray absorptiometry (DXA) scan, and MetS score data. Sleep midpoint (SM), sleep irregularity (SI), and social jetlag (SJL) were examined as effect modifiers of the association between VAT and MetS, including waist circumference, blood pressure, insulin resistance, triglycerides, and cholesterol. Linear regression models adjusted for demographics, ACT-sleep duration, ACT-sleep variability, and PSG-apnea-hypopnea index. The association between VAT and MetS was significantly stronger (p-values for interactions < 0.001) among adolescents with a schooldays SM later than 4:00 (2.66 [0.30] points increase in MetS score), a SI higher than 1 hour (2.49 [0.30]) or a SJL greater than 1.5 hours (2.15 [0.36]), than in those with an earlier SM (<3:00; 1.76 [0.28]), lower SI (<30 minutes; 0.98 [0.70]), or optimal SJL (<30 minutes; 1.08 [0.45]). A delayed sleep phase, an irregular sleep-wake cycle, and greater social jetlag on schooldays identified adolescents in whom VAT had a stronger association with MetS. Circadian misalignment is a risk factor that enhances the impact of visceral obesity on cardiometabolic morbidity and should be a target of preventative strategies in adolescents.

Omega-3 and omega-6 fatty acids food intake and metabolic syndrome in adolescents 12 to 17 years old: A school-based cross-sectional study

Fatty acids (FAs) of the omega-3 and omega-6 family are considered essential, and adequate intake seems to be associated with lower risk of developing chronic non-communicable diseases. The objective was to evaluate the association of omega-3 and omega-6 FAs dietary intake with the prevalence of MS and its components waist circumference (WC), blood pressure (BP), fasting blood glucose, triglycerides and High Density Lipoprotein - cholesterol (HDL-c) in Brazilian adolescents aged 12-17 years. This is a school-based cross-sectional investigation, using data from the Study of Cardiovascular Risks in Adolescents (ERICA), carried out between 2013 and 2014. The following variables were collected and assessed: 1) sociodemographic (sex, age, type of school, school location whether urban or rural and region of the country); 2) food consumption was measured through a 24-h Food Recall (24hR), and a second 24hR was applied to 7% of the total sample; 3) anthropometrics (weight, height, WC), BP and biochemical (glycemia, triglycerides and HDL-c) were also assessed. Logistic regression analysis was performed according to gender and age group. A total of 36,751 adolescents participated in the study. The intake of omega-3 FAs in the total population was 1.71g/day and of omega-6 FAs, 13.56g/day, with an omega-6/omega-3 ratio of 7.93:1. It was found that higher intake of omega-3 FAs was associated with an 53% lower chance of low HDL-c. For omega-6 FAs, no significant results were found. The findings indicated an association between omega-3 FAs and HDL-c. More studies are needed to elucidate the effects of omega-6 FAs.

Cross-sectional associations between phthalates, phenols, and parabens with metabolic syndrome risk during early-to-mid adolescence among a cohort of Mexican youth

BackgroundEpidemiological studies on children and adults have linked toxicants from plastics and personal care products to metabolic disruption. Yet, the impact of endocrine-disrupting chemicals (EDCs) on adolescent metabolic syndrome (MetS) risk during early and mid-adolescence is unclear. MethodsTo examine the links between exposure to EDCs and MetS risk and its components, cross-sectional data from 344 Mexican youth in early-to-mid adolescence (10–17 years) were analyzed. Urinary biomarker concentrations of phthalates, phenol, and paraben analytes were measured from a single spot urine sample collected in 2015; study personnel obtained anthropometric and metabolic measures. We examined associations between summary phthalates and metabolites, phenol, and paraben analytes with MetS risk z-scores using linear regression, adjusted for specific gravity, sex, age, pubertal status, smoking, alcohol intake, physical activity level, and screen time. As a secondary aim, mediation analysis was conducted to evaluate the role of hormones in the association between summary phthalates with lipids and MetS risk z-scores. ResultsThe mean (SD) age was 13.2 (1.9) years, and 50.9% were female. Sex-stratified analyses revealed associations between summary phthalates and lipids ratio z-scores, including Σ DEHP [β = 0.21 (95% CI: 0.04, 0.37; p < 0.01)], phthalates from plastic sources (Σ Plastic) [β = 0.22 (95% CI: 0.05, 0.39; p < 0.01)], anti-androgenic phthalates (Σ AA) [β = 0.22 (95% CI: 0.05, 0.39; p < 0.01)], and individual phthalate metabolites (MEHHP, MEOHP, and MECPP) among males. Among females, BPA [β = 0.24 (95% CI: 0.03, 0.44; p < 0.05)] was positively associated with lipids ratio z-score and one phenol (2,5 DCP) [β = 0.09 (95% CI: 0.01, 0.18); p < 0.05)] was associated with increased waist circumference z-score. Results showed no evidence of mediation by hormone concentrations in the association between summary phthalates with lipids ratio or MetS risk z-scores. ConclusionHigher EDC exposure was positively associated with serum lipids during adolescence, particularly among males.

Concordance between five criteria of metabolic syndrome in teenagers from a Peruvian high andes region.

Motivation for the study. There are several criteria for metabolic syndrome in adolescents, each reporting different prevalence rates and not necessarily coinciding with each other. Main findings. We studied school children from the city of Cajamarca at 2750 meters above sea level. The five criteria for metabolic syndrome coincided in six of the 397 (1.5%) adolescents. The criteria generated prevalence rates ranging from 3.0% to 17.1%. The criteria with near perfect concordance were those from the American Heart Association criteria and those modified by Cook. Implications. The diagnosis of metabolic syndrome in adolescents is complex, even more so among those residing at high altitudes. . To determine the concordance between five diagnostic criteria for metabolic syndrome (MS) among teenagers from a Peruvian high Andes region. A cross-sectional study was carried out with secondary data from an intervention study in two public schools in 2019. We included 397 teenagers who lived in the city of Cajamarca, in the Andean region of Peru. We applied the criteria from the Adult Treatment Panel III (ATP-III) modified by Cook, the International Diabetes Federation (IDF), the American Heart Association (AHA), Ferranti, and the World Health Organization (WHO). The point prevalence and interval prevalence were estimated with the five criteria. The Kappa concordance coefficient with an 95% confidence interval (95%CI) was estimated. The Ferranti criterion identified 17.1% (95%CI: 13.4 to 20.8) of teenagers with MS, followed by the ATP-III criterion with 4.3% (95%CI: 2.3 to 6.3); the other criteria identified a lower frequency. The best concordance was found between the AHA and ATP-III criteria (k = 0.905); the WHO and IDF criteria had a coefficient of 0.628. The five criteria coincided in classifying six adolescents (1.5%) as MS. The AHA and ATP-III criteria modified by Cook had almost perfect concordance, which was also found for both sexes. The ATP-III, Ferranti, IDF, AHA and WHO criteria agree in less than 2% when identifying MS in the same group of adolescents.

Investigation of cardiovascular risk parameters in adolescents with metabolic syndrome.

Metabolic syndrome leading to type 2 diabetes mellitus and cardiovascular diseases is a chronic multifactorial syndrome, associated with low-grade inflammation status. In our study, we aimed at assessing the serum levels of follistatin (FST), pregnancy-associated plasma protein-A (PAPP-A), and platelet/endothelial cell adhesion molecule-1 (PECAM-1) in adolescent patients with metabolic syndrome. This study was performed in 43 (19 males, 24 females) metabolic syndrome adolescents and 37 lean controls matched for age and sex. The serum levels of FST, PECAM-1, and PAPP-A were measured by using ELISA method. Serum FST and PAPP-A levels in metabolic syndrome were significantly higher than those of controls (p < 0.005 and p < 0.05). However, there was no difference in serum PECAM-1 levels between metabolic syndrome and control groups (p = 0.927). There was a significant positive correlation between serum FST and triglyceride (r = 0.252; p < 0.05), and PAPP-A and weight, (r = 0.252; p < 0.05) in metabolic syndrome groups. Follistatin was determined statistically significant in both univariate (p = 0,008) and multivariate (p = 0,011) logistic regression analysis. Our findings indicated a significant relationship between FST and PAPP-A levels and metabolic syndrome. These findings offer the possibility of using these markers in diagnosis of metabolic syndrome in adolescents as the prevention of the future complications.

Increase of Prevalence of Obesity and Metabolic Syndrome in Children and Adolescents in Korea during the COVID-19 Pandemic: A Cross-Sectional Study Using the KNHANES.

(1) Background: The aim of this study was to evaluate the prevalence of obesity and metabolic syndrome since the COVID-19 pandemic outbreak utilizing representative data on youth aged 2-18 years from the Korean National Health and Nutrition Examination Surveys (KNHANES) conducted in 2019-2020. (2) Methods: The survey consists of three parts: health interviews, health examinations, and nutrition surveys. From the 2019 and 2020 surveys, 1371 (2-9 years = 702 and 10-18 years = 669) and 1124 (2-9 years = 543 and 10-18 years = 581) individuals were included in the analysis. (3) Results: The mean body mass index (BMI) increased significantly among youth aged 2-9 years from 16.53 kg/m2 in 2019 to 17.1 kg/m2 in 2020 (p < 0.01). In youth aged 10-18 years, the BMI was found to increase slightly from 21.25 kg/m2 in 2019 to 21.41 kg/m2 in 2020 (p = 0.64). The increasing prevalence of extreme obesity was significant in girls, especially those aged 2-9 years (p < 0.01). However, extreme obesity had increased in 10-18-year-old boys (p = 0.08). The overall prevalence of metabolic syndrome in adolescents increased from 3.79% to 7.79% during the COVID-19 pandemic (p = 0.01). (4) Conclusions: We observed that the prevalence of obesity and metabolic syndrome among children and adolescents has increased after the COVID-19 outbreak. This is believed to be associated with an increase in the rate of early comorbidities in adulthood. The prevention of the progression of pediatric obesity has recently become an urgent public health concern in Korea.

1601-P: Childhood Plasma Amino Acid Profiles Predict the 10-Year Risk of Nonalcoholic Fatty Liver Disease—The BCAMS Study

Background and Aims: Amino acid profiles have been proved a promising tool to identify novel biomarkers and insight of the mechanisms of metabolic diseases; however, date on youth was still limited, particularly nonalcoholic fatty liver disease (NAFLD). We aimed to prospectively investigate if there exist any association between childhood plasma amino acid profiles and adulthood NAFLD, and explore the early predictor and the underlying mechanism for the development of hepatic steatosis. Methods: A total of 307 subjects aged 12.1±3.0 years at baseline were enrolled in this study at 10-year follow-up, recruited from the Beijing Child and Adolescent Metabolic Syndrome (BCAMS) study cohort, including 99 NAFLD patients and 208 normal controls. Thirty-two amino acids (AAs) in fasting plasma at baseline were evaluated by liquid chromatograph-mass spectrometry. NAFLD was diagnosed by abdominal ultrasonography at follow-up. Results: Among the 32 qualified AAs, 14 AAs showed significant differences (p&amp;lt;0.05) between NAFLD and normal controls, including four AAs survived Bonferroni correction (p&amp;lt;0.0016). Adjustment for age, gender and lifestyle factors, there were 10 AAs remain significant, including alanine, asparagine, glutamine, glycine, isoleucine, tyrosine, serine and threonine etc. Further adjustment for BMI, lower levels of asparagine (OR: 0.62, 95% CI: 0.44-0.87), glutamine (OR: 0.73, 95% CI: 0.53-0.99) and serine (OR: 0.71, 95% CI: 0.51-0.98) remain significant predictors of NAFLD at the 10-year follow-up. Conclusion: Plasma amino acid profiles in childhood can predict risk of NAFLD in young adults. Plasma asparagine, glutamine and serine are likely to be early predictors of NAFLD independently of adiposity. Disclosure M.Li: None. S.Gao: None. Bcams group: n/a. Funding National High Level Hospital Clinical Research Funding (2022-PUMCH-C-014); National Natural Science Foundation of China (81970732, 82270924); Capital's Funds for Health Improvement and Research (2020-2Z-40117); CAMS Innovation Fund for Medical Sciences (C

1099-P: Plasma Amino Acid Profiles in Childhood Predict 10-Year Risk of Insulin Resistance in Adulthood—The BCAMS Study

Objective Insulin resistance (IR) is the critical step in the development of type 2 diabetes. Recent cross-sectional studies in children demonstrate plasma amino acids such as branched-chain and aromatic amino acids are associated with IR, however, information is scant regarding whether these associations in childhood persist over time and predict diabetes risk in young adults. We aimed to examine whether circulating amino acids in childhood predict 10-year risk of IR in early adulthood. Research design and Methods: This was a 10-year longitudinal study from childhood to early adulthood. A total of 961 subjects aged 6-18 years at baseline participated in the Beijing Child and Adolescent Metabolic Syndrome study (BCAMS). Serum insulin was determined by in-house ELISA with no cross-reaction with proinsulin, and plasma amino acids were profiled using targeted LC-MS/MS. IR was determined by the homeostatic model assessment of insulin resistance (HOMA-IR). Results: At baseline, after adjusting for age, gender, tanner stage, diet score, exercise, residence and BMI, 17 amino acids were closely correlated with HOMA-IR and nine with impaired fasting glucose (IFG) in childhood (p &amp;lt; 0.05 for all). Among them, Isoleucine showed the strongest association with IR (OR=2.04, 95% CI 1.65-2.54, P&amp;lt;0.001), and alanine was the strongest predictor of IFG (OR =1.52, 95%CI 1.22-1.91, P&amp;lt;0.001). Prospectively, after adjusting for the covariates at baseline, four amino acids have a significant predictive effect on the risk of IR at 10-years follow-up, of which alanine was the strongest predictor [OR=1.38, 95% CI (1.02, 1.85), P=0.035]. Conclusion: Our findings suggest the changes in amino acid metabolism not only link IR in childhood, but also persist into adulthood and may heighten type 2 diabetes risk later in life. Disclosure S.Gao: None. M.Li: None. Bcams group: n/a. Funding National High Level Hospital Clinical Research Funding (2022-PUMCH-C-014); National Natural Science Foundation of China (81970732, 82270924); CAMS Innovation Fund for Medical Sciences (CIFMS 2021-I2M-1-016); Capital's Funds for Health Improvement and Research (2020-2Z-40117); Key Program of Beijing Municipal Science &amp;Technology Commission (D111100000611001, D111100000611002)

Value of waist-to-hip ratio as a predictor of metabolic syndrome in adolescents with obesity.

Metabolic syndrome is present in 7% of adolescents and 19 to 35% in obese adolescents, and the cause of this condition has not been fully understood. Early identification of the risk involved could be an initial step in preventing a metabolic syndrome. Increased waist circumference, which is a parameter of central obesity, is also risk factor for this condition. This study aims to determine the possibility cut-off value of waist-to-hip (WHR) as a predictor of metabolic syndrome. We studied 208 obese adolescents between the ages of 13 to 18 years from junior and senior high schools who living in rural dan urban areas in East Java. These obese adolescents were divided into two groups, namely with and without a metabolic syndrome. Anthropometric measurements, including waist-to-hip ratio (WHR), were carried out to analyze the cut-off values between the two groups. 208 obese adolescents (51.4% males and 48.6% females) without the metabolic syndrome and 104 obese adolescents with metabolic syndrome were evaluated. There was a significant relationship between WHR and metabolic syndrome in obese adolescents (r = 0.203, P = 0.003). Those adolescents with a high WHR value > 0.891 had twice risk to develop metabolic syndrome compared to those with lower (OR 2.033; 95% CI = 1.165-3.545). Increased waist-to-hip ratio > 0.89 in adolescents was associated with higher risk to develop metabolic syndrome and can be proposed as a predictor for metabolic syndrome in obese adolescents.

Polymorphisms of Fat Mass and Obesity-Associated Gene in the Pathogenesis of Child and Adolescent Metabolic Syndrome.

Childhood metabolic syndrome (MetS) is prevalent around the world and is associated with a high likelihood of suffering from severe diseases such as cardiovascular disease later in adulthood. MetS is associated with genetic susceptibility that involves gene polymorphisms. The fat mass and obesity-associated gene (FTO) encodes an RNA N6-methyladenosine demethylase that regulates RNA stability and molecular functions. Human FTO contains genetic variants that significantly contribute to the early onset of MetS in children and adolescents. Emerging evidence has also uncovered that FTO polymorphisms in intron 1, such as rs9939609 and rs9930506 polymorphisms, are significantly associated with the development of MetS in children and adolescents. Mechanistic studies reported that FTO polymorphisms lead to aberrant expressions of FTO and the adjacent genes that promote adipogenesis and appetite and reduce steatolysis, satiety, and energy expenditure in the carriers. The present review highlights the recent observations on the key FTO polymorphisms that are associated with child and adolescent MetS with an exploration of the molecular mechanisms underlying the development of increased waist circumference, hypertension, and hyperlipidemia in child and adolescent MetS.

Challenges and Opportunities in Diagnosis and Management of Cardiometabolic Risk in Adolescents.

This review aims to elucidate the limitations of diagnosing metabolic syndrome in adolescents as well as challenges and opportunities in the identification and reduction of cardiometabolic risk in this population. There are multiple criticisms of how we define and approach obesity in clinical practice and scientific research, and weight stigma further complicates the process of making and communicating weight-related diagnoses. While the goal of diagnosing and managing metabolic syndrome in adolescents would be to identify individuals at elevated future cardiometabolic risk and intervene to reduce the modifiable component of this risk, there is evidence that identifying cardiometabolic risk factor clustering may be more useful in adolescents than establishing a cutoff-based diagnosis of metabolic syndrome. It has also become clear that many heritable factors and social and structural determinants of health contribute more to weight and body mass index than do individual behavioral choices about nutrition and physical activity. Promoting cardiometabolic health equity requires that we intervene on the obesogenic environment and mitigate the compounding effects of weight stigma and systemic racism. The existing options to diagnose and manage future cardiometabolic risk in children and adolescents are flawed and limited. While striving to improve population health through policy and societal interventions, there are opportunities to intervene at all levels of the socioecological model in order to decrease future morbidity and mortality from the chronic cardiometabolic diseases associated with central adiposity in both children and adults. More research is needed to identify the most effective interventions.

Prevalence of metabolic syndrome in adolescents based on three diagnostic definitions: a cross-sectional study.

There is no consensus as to the best criterion for the evaluation of metabolic syndrome (MS), impairing the estimation of its prevalence. This study aims to compare MS estimates using three recommended definitions for adolescents based on a cross-sectional study nested in the Consortium of Brazilian Birth Cohorts in São Luís, Maranhão. A total of 2,515 adolescents aged between 18 and 19 years were evaluated. The criteria of International Diabetes Federation (IDF) and National Cholesterol Education Program Panel III (NCEP-ATP) modified by Cook and cols. (2003) and De Ferranti and cols. (2004) defined SM. To compare the estimates of MS prevalence, the chi-square, Fisher´s exact and Cohen´s Kappa index tests were used. Among the 2,064 participants evaluated in the final sample. The prevalence of MS ranged from 4.2% (95% CI: 3.3-5.1) to 10.2% (95% CI: 8.8-11.4). When comparing the estimates of MS prevalence in the total sample and by sex, a statistically significant difference was observed. The agreement between the criteria ranged from 0.42 (CI 95%: 0.35-0.49) to 0.55 (CI 95%: 0.48-0.62) in the total sample, 0.33 (CI 95%: 0.24-0.42) to 0.59 (95%CI: 0.47-0.71) among boys and 0.39 (95% CI: 0.26-0.52) to 0.54 (95% CI: 0.44-0.64) among girls. Different criteria provide different estimates for the prevalence of MS in adolescents, reflecting the importance of establishing a consensus.

Updated Causes of Primary Amenorrhea [ID: 1381195

INTRODUCTION: Pubertal progression within a normal cadence is an important marker of natal female health. Data regarding causes of primary amenorrhea in a United States' adolescent population have not been published since 1981. We hypothesize that hyperandrogenism/polycystic ovarian syndrome (PCOS) is an increasingly common cause of primary amenorrhea. METHODS: A retrospective chart review was performed to identify patients with primary amenorrhea. A total of 1,785 charts were identified, of which 1,052 charts have been reviewed. Patients with hyperandrogenism/PCOS were classified by meeting any recommended diagnostic criteria for PCOS in adolescents or an elevated total or free testosterone based on Tanner staging with all other conditions ruled out. Other diagnoses for primary amenorrhea were classified per the American Society for Reproductive Medicine guidelines. RESULTS: Of the 1,052 charts reviewed so far, 263 patients met criteria for primary amenorrhea. Causes in order of prevalence were as follows: 85 hyperandrogenism/PCOS (32.3%), 71 hypothalamic hypogonadism (27%), 36 physiologic delay (13.7%), 19 primary hypogonadism (7.2%), 15 other endocrine causes (5.7%), 8 pituitary (3%), and 4 anatomic (1.5%). Twenty-five (9.5%) patients were unable to be classified. Of the 71 patients with hypothalamic hypogonadism, 27 (38%) had relative energy deficiency in sport (RED-S) making it the most common diagnosis of patients in this categorization. CONCLUSION: Polycystic ovarian syndrome/hyperandrogenism and RED-S are among the top three causes of primary amenorrhea. Proposed reasons for the shift in causes of primary amenorrhea over time include increasing obesity rates and metabolic syndrome in adolescents on one hand as well as increasing access to high-level athletics on the other.

Sleep duration is associated with metabolic syndrome in adolescents and children: a systematic review and meta-analysis.

Studies on the associations between sleep duration and metabolic syndrome in adolescents and children have reported mixed results. To shed more light on this issue, we conducted this meta-analysis by synthesizing the results of previous studies. Studies were retrieved from PubMed, Ovid, Cochrane, and Embase from inception to October 2021. Fixed-effects models and random-effects models were used to analyze the effects of sleep time on metabolic syndrome in adolescents. Data from 7 studies, including 13,305 adolescents and children, were meta-analyzed. Compared with the control group, short sleep durations were not associated with a high prevalence of metabolic syndrome in adolescents and children using a random-effects model (odds ratio = 0.92, 95% confidence interval = 0.48-1.37, I2 = 56.5%, P = .378). Using a fixed-effects model on long sleep duration, this association was statistically significant (odds ratio = 0.57, 95% confidence interval = 0.38-0.76, I2 = 0.0%, P < .001) as a protective factor compared with shorter sleep duration. Long sleep duration, instead of short sleep duration, was significantly associated with a lower prevalence of metabolic syndrome among adolescents and children. Xu Y, Hua J, Wang J, Shen Y. Sleep duration is associated with metabolic syndrome in adolescents and children: a systematic review and meta-analysis. J Clin Sleep Med. 2023;19(10):1835-1843.

The associations of adipokines with hypertension in youth with cardiometabolic risk and the mediation role of insulin resistance: The BCAMS study.

The mechanisms link obesity and hypertension are not well understood. One possibility is the alterations in adipose-derived adipokines that modulate insulin resistance (IR) and cardiovascular homeostasis. We aimed to assess the associations between hypertension and four adipokine levels in Chinese youth, and to examine to what extent the associations are mediated by IR. We utilized cross-sectional data from the Beijing Children and Adolescents Metabolic Syndrome (BCAMS) Study Cohort (n = 559, mean age = 20.2 years). Plasma leptin, adiponectin, retinol binding protein 4 (RBP4) and fibroblast growth factor 21 (FGF21) levels were assayed. The relationships between adipokines and hypertension and the possible mediation effect of IR were evaluated. Youth with hypertension have lower adiponectin and higher leptin, FGF21 (all P < 0.001) and RBP4 levels (p = 0.06) compared to their counterparts. Moreover, the co-existence of these two or more adipokine abnormalities in youth leads to a 9-fold increased risk for hypertension (OR: 9.19; 95% CI, 4.01-21.08) compared with these without abnormalities. However, in the fully adjusted and BMI-adjusted analyses, only FGF21 was a significant predictor of hypertension (OR: 2.12; 95% CI, 1.34-3.36). Mediation analysis revealed that the associations between leptin, adiponectin, RBP4 and hypertension are totally mediated by IR (proportion: 63.9%, 65.4%, and 31.6%, respectively), while BMI and IR partly mediated the association between FGF21 and hypertension (proportion: 30.6%, 21.2%). Our findings suggest that dysregulation of adipokines might result in hypertension in youth. Leptin, adiponectin and RBP4 may exert their functions in hypertension through adiposity-related IR, whereas FGF21 might be used as an independent marker of hypertension in youth.