Metabolic syndrome in youth: a cross-sectional school-based survey

Appraisal of Clinical Care Practices for Child Obesity Treatment. Part II: Comorbidities

The objective of this technical report is to provide clinicians with actionable evidence-based information upon which to make treatment decisions. In addition, this report will provide an evidence base on which to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) "What are effective clinically based treatments for obesity?" and (KQ2) "What is the risk of comorbidities among children with obesity?" See Appendix 1 for the conceptual framework and a priori Key Questions.

Diet, Physical Activity, Lifestyle Behaviors, and Prevalence of Childhood Obesity in Irish Children: The Cork Children's Lifestyle Study Protocol

Background

Childhood obesity is complex, and its aetiology is known to be multifaceted. The contribution of lifestyle behaviors, including poor diet and physical inactivity, to obesity remains unclear. Due to the current high prevalence, childhood obesity is an urgent public health priority requiring current and reliable data to further understand its aetiology.

Objective

The objective of this study is to explore the individual, family, and environmental factors associated with childhood overweight and obesity, with a specific focus on diet and physical activity. A secondary objective of the study is to determine the average salt intake and distribution of blood pressure in Irish children.

Methods

A cross-sectional survey was conducted of children 8-11 years old in primary schools in Cork, Ireland. Urban schools were selected using a probability proportionate to size sampling strategy, and a complete sample of rural schools from one area in Cork County were invited to participate. Information collected included physical measurement data (anthropometric measurements, blood pressure), early morning spot and 24 hour urine samples, a 3 day estimated food diary, and 7 days of accelerometer data. Principal- (school head) reported, parent/guardian-reported, and child-reported questionnaires collected information on lifestyle behaviors and environmental attributes. The Cork Children’s Lifestyle Study (CCLaS) was designed by the Department of Epidemiology and Public Health in University College Cork, Ireland in 2011 and 2012. Piloting and modification of study methods was undertaken. Data collection took place between April 2012 and June 2013.

Results

Overall, 27/46 schools and 1075/1641 children, of which 623 were boys, participated. Preliminary data analysis is underway. It is anticipated that the results of the CCLaS study will be available in late 2014.

Conclusions

The CCLaS study has collected in-depth data on a wide range of individual, family, social, and environmental correlates which will allow us to access multilevel influences on childhood obesity. This study will contribute to the evidence base by highlighting current knowledge and gaps regarding the predominant drivers of childhood obesity.

The prevalence of metabolic syndrome in children: a systematic review of the literature

BACKGROUND

Metabolic syndrome has been identified as a condition of childhood relatively recently. The aim in this study was to describe the prevalence of metabolic syndrome in children allowing for differences in metabolic syndrome definitions.

METHODS

This was a systematic review of the OVID, EMBASE, and CINAHL databases, capturing details of overall prevalence and prevalence within groups categorized by obesity, gender, age, and ethnicity.

RESULTS

In all, 378 studies published since 2003 were identified, and of these 85 papers were included in the present review. When all studies were considered, the median prevalence of metabolic syndrome in whole populations was 3.3% (range 0%-19.2%), in overweight children was 11.9% (range 2.8%-29.3%), and in obese populations was 29.2% (range 10%-66%). Within-study analyses confirmed higher prevalence for obese compared to overweight (P=0.012) and obese compared to nonobese, nonoverweight children (P<0.001). Within-study analyses also revealed higher median metabolic syndrome prevalence for boys compared to girls (5.1% versus 3.0%, P<0.001) and also in older compared with younger children (5.6% versus 2.9%, P=0.001). Limited evidence was found to suggest differences between ethnic groups, and there were insufficient studies to determine whether metabolic syndrome prevalence was increasing over time.

CONCLUSIONS

This is the first systematic review of all of the relevant literature. It describes the magnitude of associations between metabolic syndrome and obesity, age, and gender. We find evidence that ethnicity and geography may be important to metabolic syndrome prevalence in children and these associations require further study.

Waist circumference is a sensitive screening tool for assessment of metabolic syndrome risk in children treated with second-generation antipsychotics

OBJECTIVE

To compare the prevalence of metabolic syndrome (MetS) and its components in second-generation antipsychotic (SGA)-treated and SGA-naive children; and to explore the utility of clinical markers, such as waist circumference (WC) and body mass index (BMI), as screening tools for MetS.

METHODS

Subjects were prospectively recruited from the Psychiatry Emergency Unit at British Columbia Children's Hospital. As part of a quality-assurance project, a metabolic monitoring protocol was implemented, including collection of anthropomorphic and laboratory data.

RESULTS

From January 2008 to February 2010, there were 117 SGA-treated and 217 SGA-naive children recruited. The overall prevalence of MetS was 19.0% (16/84; median treatment duration = 14 months) in SGA-treated and 0.8% (1/127) in SGA-naive children (OR 29.7; 95% CI 3.85 to 228.40, P < 0.001), with an increased prevalence of all components except high-density lipoprotein cholesterol (HDL-C), respectively: elevated WC (40.7% and 10.1%; P < 0.001); hypertriglyceridemia (33.7% and 18.8%; P = 0.01); impaired fasting glucose (12.5% and 0.7%; P = 0.005); and elevated blood pressure (41.2% and 16.5%; P < 0.001). SGA treatment was the strongest predictor of MetS (OR 19.2; 95% CI 2.30 to 160.44, P = 0.006) followed by male sex (OR 5.7; 95% CI 1.08 to 30.62, P = 0.04). Presence of abdominal obesity was more sensitive (92.9%) than BMI (68.8%), while fasting glucose of 5.6 mmol/L or more and HDL-C of 1.03 mmol/L or less were most specific (94.1%) in correctly identifying MetS.

CONCLUSIONS

SGA treatment confers a significantly increased risk for MetS over the long term. WC measurement is a simple and sensitive screening tool for determining MetS risk in SGA-treated children. These data highlight the dangers of SGA treatment and the importance of standardized metabolic monitoring using sex- and age-adjusted tables in this population.

Prevalence of abdominal obesity in adolescents: a systematic review

The objectives of this study were to (i) review extant literature on the prevalence of abdominal obesity (AO) in adolescents of both sex (10-19 years old); (ii) analyse the cut-off points used for the diagnosis of AO and (iii) compare its prevalence between developed and developing countries. The search was carried out using online databases (MEDLINE, Web of Science, EMBASE, SPORTDiscus, SCIELO and BioMed Central), references cited by retrieved articles and by contact with the authors, considering articles published from the establishment of the databanks until 19 October 2009. Only original articles and those using waist circumference in the diagnosis were considered. Twenty-nine studies met the inclusion criteria. Fourteen of these studies were performed in developed countries. The prevalence of AO varied from 3.8% to 51.7% in adolescents from developing countries. The range of results was smaller among developed countries; with values from 8.7% to 33.2%. Eighteen different cut-off points were used. It was concluded the AO prevalence is high among adolescents, but is not clear what sex has a higher proportion and it is greater in adolescents from developing countries; however, there is no consensus in the literature about the criteria to be used.

Prevalence of the metabolic syndrome among female Kuwaiti adolescents using two different criteria

Overweight and obesity are highly prevalent in Kuwait and they are associated with the metabolic syndrome (MS). The present study aims to assess the prevalence of the MS among Kuwaiti female adolescents aged 10-19 years. A cross-sectional random sample of 431, apparently healthy, Kuwaiti female adolescents drawn from several randomly selected schools was studied for the prevalence of the MS using the International Diabetes Federation (IDF) and the National Cholesterol Education Program Third Adult Treatment Panel (ATP III) modified for age diagnostic criteria. Clinical assessment included measurements of waist circumference, blood pressure, fasting blood glucose, HDL and TAG. Whichever criteria are used, the prevalence of the MS among female Kuwaiti adolescents was found to be high, which indicates an urgent need for intervention programmes to prevent increased CVD and type 2 diabetes mellitus. The IDF criteria tend to give higher values for the prevalence of the MS in comparison with the modified ATP III criteria (14.8 v. 9.1 %). There have been no diagnostic criteria specific for the MS for the Gulf Arab population as yet.

Impact of different metabolic syndrome classifications on the metabolic syndrome prevalence in a young Middle Eastern population

The metabolic syndrome (MetS) prevalence in a young Middle Eastern population has never been studied. We studied this prevalence in a randomly selected population of Lebanese students using different MetS classifications. Three hundred eighty-one subjects aged 18 to 30 years were included in the study. Anthropometric and biological parameters (waist circumference [WC], systolic and diastolic blood pressures, fasting plasma glucose, triglycerides, total cholesterol, high-density lipoprotein cholesterol, and homeostasis model assessment [HOMA] index to assess insulin resistance) were measured. Receiver operating characteristic (ROC) curves were generated to determine population-specific cutoff values for MetS parameters and HOMA index. The MetS prevalence was calculated using the National Cholesterol Education Program's Adult Treatment Panel III (ATP-III), the actualized ATP-III, and our cutoffs, either with or without HOMA index as an extra risk factor. The MetS prevalence using the ATP-III and the actualized ATP-III was, respectively, 5.25% and 5.28%. It increased to 9.19% when using our cutoff values and to 12.64% when HOMA index was added. This increase was significant only in men. The identified cutoff values are, for WC, 91 cm in women and 99.5 cm in men and, for HOMA index, 2.32. Among the MetS components, WC was the best MetS predictor, whereas fasting plasma glucose was the poorest. Our study shows that the MetS prevalence in Lebanon is comparable with other countries. In addition, we identified in our population new cutoff points for MetS parameters and HOMA index that allow the detection of a higher number of subjects with the MetS, mainly in the male population.

Waist circumference in relation to body perception reported by Finnish adolescent girls and their mothers

AIM

To study how waist circumference (WC) relates to body perception in adolescent girls and to maternal perception of the girl's body size.

METHODS

Three hundred and four girls, 11-18 years, were measured for height, weight and WC. 294 girls provided self-report data on weight, height and body image before anthropometric measurements. Paired data from 237 girls and mothers on perception of the girls' body size were collected.

RESULTS

In girls, self-reported weight indicated awareness of actual body size. The girls' body perception showed an overestimation of body size relative to international reference values for body mass index (BMI) (p < 0.05), but not for WC. Girls' body perception exceeded that of their mothers (p < 0.05). Maternal perception agreed better than the girls' perception with international reference values for BMI (p < 0.05). No significant difference between mothers and girls were found concerning agreement of body perception with international reference values for WC.

CONCLUSION

WC rather than BMI agrees with perception of body size, possibly due to its relation to abdominal fat at different ages. For effective prevention and treatment programmes for weight-related health problems among adolescent girls, we recommend measuring WC to diminish the discrepancy between measured and perceived body size.