Continuous Metabolic Syndrome Score in Children: How Useful is it?

cMetS Based on Z-Scores as an Accurate and Efficient Scoring System to Determine Metabolic Syndrome in Spanish Adolescents

The definition of metabolic syndrome (MetS) based on dichotomous cut-off points is efficient in the adult population. However, to date, there is no international consensus on how to define MetS in the pediatric population. For that reason, a continuous MetS score (cMetS) has been proposed for the pediatric population. However, despite multiple attempts, cMetS has not been fully validated as there is no agreement about the most accurate score to calculate it. The purpose of the present study was to compare the validity of different scores (three siMS scores, z-score, principal components analysis (PCA), the sum of PCA, and confirmatory factor analysis) to calculate cMetS and determine MetS in Spanish adolescents. There were 981 subjects, ranging 11-16 years old, recruited for this cross-sectional study. Seven different approaches to pediatric cMetS scores were calculated. All cMetS scores calculated strongly correlated with each other, especially siMS scores. The area under the curve obtained from receiving operating characteristic curves was particularly elevated for z-scores 0.81 (95% CI: 0.784-0.838), showing a specificity of 64.4%. Our study shows that cMetS based on z-scores is accurate and efficient to be used for research instead of the dichotomized definition of MetS in adolescents; and cMetS based on siMS scores is useful for clinical practice.

Uric acid versus metabolic syndrome as markers of fatty liver disease in young people with overweight/obesity

AIMS

To compare the association of high serum uric acid (HUA) or metabolic syndrome (MetS) with fatty liver disease (FLD) in youths with overweight/obesity (OW/OB).

MATERIALS AND METHODS

Cross-sectional study of anthropometrics, biochemical variables, and liver ultrasound of 3104 individuals with OW/OB (age 5-17 years). Metabolic syndrome was defined by ≥ 3 criteria among (1) high waist circumference; (2) high triglycerides; (3) low high-density lipoproteins; (4) fasting glucose ≥100 mg/dl; (5) blood pressure ≥95^th percentile in children, and ≥130/80 mmHg in adolescents. High serum uric acid was defined as serum UA value ≥ 75^th percentile adjusted for sex. Fatty liver disease was determined by echography.

RESULTS

The sample was stratified in four categories: (1) no HUA, no MetS (reference category); (2) MetS; (3) HUA; (4) HUA and MetS (HUA + MetS). The prevalence of FLD increased across the four categories from 29.9%, 44.0%, 52.2%, to 67.1%, respectively (p < 0.0001). The ORs for the categorical variables were 1.33 (1.06-1.68) for MetS (p = 0.02), 3.19 (2.51-4.05) for HUA (p < 0.0001) and 3.72 (2.65-5.21) for HUA + MetS (p < 0.0001), versus the reference category regardless of the body mass index.

CONCLUSIONS

HUA represents a useful marker of FLD in youths with OW/OB, given its greater ability to identify those at increased risk of the disease compared to MetS. The ability of both to predict incident FLD must be investigated in longitudinal study.

A considerable proportion of metabolic syndrome-free adults from Bratislava Region, Slovakia, display an increased cardiometabolic burden

Although the dichotomous classification of metabolic syndrome (MS) enables the classification of individuals as MS-free or presenting MS, it is inconvenient for assessing cardiometabolic risk in MS-free individuals. Continuous MS score allows for estimation of cardiometabolic burden even in MS-free subjects. We used the scores to estimate the proportion of MS-free subjects on high cardiometabolic risk. A total of 876 subjects (62% females) of Central European descent, aged 20-81 years, were included. International Diabetes Federation (IDF) criteria were employed to classify MS. Continuous scores were calculated. We used the receiver operating characteristics (ROC) analysis to estimate the cutoff value to determine the proportion of MS-free subjects on increased risk. Using the waist circumference, 38% of males and 23% of females presented MS. ROC area under the curves (90%-98%) showed an acceptable performance of both scores to classify the presence of MS. Up to 18% of MS-free males and up to 10% of females displayed continuous score ≥ the relevant cutoff point. The waist-to-height ratio performed similar results. Both continuous scores were proven credible for assessing cardiometabolic risk in MS-free subjects. Clinically, this is important for earlier intervention. Despite minor differences between waist circumference and waist-to-height ratio, it would be appropriate to objectify it using reference population. Novelty: The first study using Z-MSS/siMSS (population-specific Z-score/continuous score of MS) to estimate cardiometabolic risk in Slovak adults. A proportion of MS-free Slovak adults is on high cardiometabolic risk. Difference between using waist circumference and the waist-to-height ratio does not seem to be major in our cohort.