Prevalence of metabolic syndrome in children aged 5-9 years from southwest colombia: a cross-sectional study

Cardiometabolic risk factors in South American children: A systematic review and meta-analysis

BACKGROUND

Cardiometabolic risk factors (impaired fasting glucose, abdominal obesity, high blood pressure, dyslipidemia) cluster in children, may predict adult disease burden, and are inadequately characterized in South American children.

OBJECTIVES

To quantify the burden of cardiometabolic risk factors in South American children (0-21 years) and identify knowledge gaps.

METHODS

We systematically searched PubMed, Google Scholar, and the Latin American and Caribbean Health Sciences Literature via Virtual Health Library from 2000-2021 in any language. Two independent reviewers screened and extracted all data.

RESULTS

179 studies of 2,181 screened were included representing 10 countries (n = 2,975,261). 12.2% of South American children experienced obesity, 21.9% elevated waist circumference, 3.0% elevated fasting glucose, 18.1% high triglycerides, 29.6% low HDL cholesterol, and 8.6% high blood pressure. Cardiometabolic risk factor definitions varied widely. Chile exhibited the highest prevalence of obesity/overweight, low HDL, and impaired fasting glucose. Ecuador exhibited the highest prevalence of elevated blood pressure. Rural setting (vs. urban or mixed) and indigenous origin protected against most cardiometabolic risk factors.

CONCLUSIONS

South American children experience high rates of obesity, overweight, and dyslipidemia. International consensus on cardiometabolic risk factor definitions for children will lead to improved diagnosis of cardiometabolic risk factors in this population, and future research should ensure inclusion of unreported countries and increased representation of indigenous populations.

Disparities in the Prevalence of Childhood Obesity-Related Comorbidities: A Systematic Review

Background

Non-communicable diseases among children are serious consequences of childhood obesity. However, less is known about the disparities in childhood obesity comorbidities burden. This review describes the salient pattern of disparities in the prevalence of childhood obesity-related non-communicable diseases and relevant inequalities in both high- and low/medium-income countries.

Method

A systematic literature search was performed in MEDLINE, Embase, CINAHL, PsycInfo, Scopus, and Web of Science databases by two independent reviewers. Inclusion criteria were as follows: age 2–18 years; the prevalence or incidence of childhood obesity comorbidities reported; and studies published in English from January 2010 to date. No restrictions on the setting. The prevalence data were analyzed using range and median for subgroups based on the country's development status, gender, and geographical region.

Results

Our search identified 6,837 articles, out of which we examined 145 full-text articles and included 54 articles in the analysis. The median prevalence of childhood obesity-related hypertension was 35.6 vs. 12.7% among middle- and low-income countries compared with high-income countries; 37.7 vs. 32.9% among boys compared with girls; and 38.6, 25.3, and 20.1% in Asia, South America, and Europe, respectively. For metabolic syndrome, the median prevalence was 26.9 vs. 5.5% among middle- and low-income countries compared with high-income countries; 55.2 vs. 12.0% among boys compared with girls; and 40.3, 25.8, and 7.7% in South America, Asia, and Europe, respectively. The prevalence of childhood obesity-related non-alcoholic fatty liver disease was 47.5 vs. 23% among middle- and low-income countries compared with high-income countries; and 52.1, 39.7, and 23.0% in Asia, South America, and Europe, respectively. The median prevalence of dyslipidemia was 43.5 vs. 63% among middle- and low-income countries compared with high-income countries; 55.2 vs. 12.0% among boys compared to girls; and 73.7 and 49.2% in Australia and Europe, respectively.

Conclusion

There are disparities in the prevalence of childhood obesity-related hypertension, metabolic syndrome, and non-alcoholic fatty liver disease, with middle- and low-income countries, boys, and Asian region having higher prevalence. Implementing targeted interventions for childhood obesity comorbidities should consider socioeconomic disparities and strengthening of research surveillance methods for a better understanding of non-communicable disease burden in the pediatric population.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42021288607.

The prevalence of pediatric metabolic syndrome-a critical look on the discrepancies between definitions and its clinical importance

Introduction

The Metabolic Syndrome (MetS) describes the clustering of cardio-metabolic risk factors—including abdominal obesity, insulin resistance, elevated blood pressure, high levels of triglycerides, and low levels of high-density lipoproteins—that increase the risk for developing cardiovascular diseases and type 2 diabetes mellitus. However, a generally accepted definition of MetS in pediatric patients is still lacking.

Objectives

The aim was to summarize current prevalence data of childhood MetS as well as to discuss the continuing disagreement between different pediatric definitions and the clinical importance of such diagnosis.

Methodology

A systematic literature search on the prevalence of pediatric MetS was conducted. Articles that were published during the past 5 years (2014–2019), using at least one of four predetermined classifications (International Diabetes Federation, Cook et al., Ford et al., and de Ferranti et al.), were included.

Results

The search resulted in 1167 articles, of which 31 publications met all inclusion criteria.

Discussion

The prevalence of MetS ranged between 0.3 and 26.4%, whereby the rising number of children and adolescents with MetS partly depended on the definition used. The IDF definition generally provided the lowest prevalences (0.3–9.5%), whereas the classification of de Ferranti et al. yielded the highest (4.0–26.4%). In order to develop a more valid definition, further research on long-term consequences of childhood risk factors such as abdominal obesity, insulin resistance, hypertension, and dyslipidemia is needed. There is also a temptation to suggest one valid, globally accepted definition of metabolic syndrome for pediatric populations but we believe that it is more appropriate to suggest definitions of MetS that are specific to males vs. females, as well as being specific to race/ethnicity or geographic region. Finally, while this notion of definitions of MetS specific to certain subgroups is important, it still needs to be tested in future research.

Association of Total and High Molecular Weight Adiponectin with Components of Metabolic Syndrome in Mexican Children

OBJECTIVE

Childhood obesity linked to metabolic alterations, tend to appear simultaneously with altered adipocytokines, suggesting a role in pathogenetic development. Low circulating level of total and high molecular weight (HMW) adiponectin have been associated with components of the metabolic syndrome (MetS) and could represent an independent risk factor with potential use as a biomarker. To examine the prevalence of MetS in Mexican school children and to investigate the association of total and HMW adiponectin levels with biochemical parameters related to MetS.

METHODS

The study included a population of boys and girls, from 8 to 11 years old. Anthropometric and biochemical parameters were evaluated according to weight and MetS status. A correlation analysis was fitted to establish an association between adiponectin concentrations and metabolic indicators.

RESULTS

One-hundred and fifty five children participated (59.4% females) from 8-11 years of age. The prevalence of MetS was of 10.3%. Impaired biochemical parameters, including total and HMW adiponectin, were associated with obesity. The adiponectin level was significantly lower in MetS than in non-MetS subjects (4.5 vs. 5.4 μg/mL). Total- but not HMW adiponectin concentration was negatively correlated with blood pressure, fasting insulin, fasting blood sugar and Homeostatic Model Assessment for Insulin Resistance.

CONCLUSION

In young children, the total adiponectin level is associated with impaired biochemical parameters of carbohydrate metabolism and could be an excellent early predictor of metabolic complications.

Metabolic Syndrome and Insulin Resistance in Schoolchildren From a Developing Country

Background: Overweight and obesity are prevalent in schoolchildren due to dietary habits and lack of exercise. These children are prone to metabolic syndrome (MS) and future risk of type 2 diabetes mellitus and cardiovascular diseases.

Materials and Methods: This cross-sectional study was conducted in Bhubaneswar City, Eastern India, among schoolchildren. Obesity and overweight were determined by the Indian Academy of Pediatrics guideline. Fasting venous blood samples were taken for insulin, blood glucose, and lipid levels measurement. Blood pressure was measured as per the protocol. The International Diabetic Federation (IDF) criteria for the definition of MS were followed. Insulin resistance was determined by a homeostatic model assessment (HOMA-IR).

Results: A total of 1,930 children were screened, of which 545 (28.2%) were overweight and obese. The male to female ratio was 1.27. The overall prevalence of MS was 21.8% (11% in 6 to ≤10 years old and 30.6% in 11 to 16 years old). A history of cardiovascular disease, diabetes, obesity, and hypertension in the family was present in 42.7%. Acanthosis nigricans was present in 46.4%. A history of exclusive breast feeding for 6 months was present in 68.1%. The mean HOMA-IR in children with MS was 5.46 compared to 2.18 in those without MS (insulin resistance was more common in children with MS).

Conclusions: The present study found a higher prevalence of MS and insulin resistance in schoolchildren from Eastern India who are overweight/obese.

Prevalence of Metabolic Syndrome and Its Association with Sociodemographic Characteristics in Participants of a Public Chronic Disease Control Program in Medellin, Colombia, in 2018

BACKGROUND

Metabolic syndrome has increased to epidemic levels in low- and middle-income countries. The knowledge on metabolic syndrome and its related diseases constitutes a clinical, epidemiological, and economic challenge of great relevance. The frequency of metabolic syndrome may vary between populations depending on age, sex, lifestyle, and culture; however, in Colombia, there is only little research, and the available studies focus on small populations that do not allow estimating their prevalence and distribution in different sociodemographic groups. We aimed to estimate the prevalence of metabolic syndrome and its association with sociodemographic characteristics in participants attending public chronic disease control programs in Medellin, Colombia, in the year 2018.

METHODS

We conducted a cross-sectional study in all patients who participated in a public chronic disease control program. Involved in this study were 68,288 individuals who attended at 10 hospital units and were strategically distributed in the city. The diagnostic criteria of the metabolic syndrome and its components were based on the consensus of the Latin American Diabetes Association. The data on age, sex, blood pressure, weight, height, physical activity, medications, lipid profile, and glycemic and glycosylated hemoglobin levels were obtained for clinical records. The prevalence, Pearson's chi-square test, prevalence ratios (Kato-Katz method), and odds ratios (Woolf method) were estimated with 95% confidence intervals. A multivariate adjustment model was used with a logistic regression model to identify potential confounders using Epidat 4.2 and SPSS^® 25.0.

RESULTS

The prevalence of the syndrome was 35.4%, with abdominal obesity in 82.3% individuals, hypertension in 48.6%, glucose intolerance in 25.5%, and hypertriglyceridemia in 22%. The prevalence of the syndrome exhibited statistical differences according to the area of residence. It was 15% higher in women; 31% and 59% higher in young and older adults, respectively, than in individuals aged <25 years; 11% and 13% higher in the illiterate population and population with primary studies than in individuals with higher education; and approximately 200 times higher than those who are sedentary.

CONCLUSION

A high prevalence of the syndrome and its constitutive factors in the study population demonstrated the importance of controlling it and increasing community-based prevention strategies, prioritizing the identified groups that are at the highest risk.

Metabolic syndrome among children and adolescents in low and middle income countries: a systematic review and meta-analysis

BACKGROUND

Metabolic syndrome (MetS) is a clustering of cardiovascular risk factors, which is rising in the low and middle income countries (LMICs). There are various studies with inconsistent findings that are inconclusive for policy makers and program planners. Thus, this systematic review and meta-analysis aimed at estimating the pooled prevalence of MetS and its components in LMICs.

METHODS

Electronic searches were conducted in international databases including PubMed, Web of Science, EMBASE (Elsevier), Scopus, CINAHL (EBSCOhost), Science direct (Elsevier), Food Science and Technology Abstracts (FSTA), Global Health and Medline, and other sources (World Cat, Google Scholar, and Google). The pooled estimates were computed in the random effect model. The pooled prevalence was computed using the three diagnostic methods (IDF, ATP III and de Ferranti). Publication bias was verified using funnel plot and Egger's regression test. Subgroup and sensitivity analysis were performed to identify the possible sources of heterogeneity among the included studies.

RESULT

In this study, 142,142 children and adolescents from 76 eligible articles were included to compute the pooled prevalence of MetS and its components in LMCIs. MeTs among overweight and obese population was computed from 20 articles with the pooled prevalence of 24.09%, 36.5%, and 56.32% in IDF, ATP III and de Ferranti criteria, respectively. Similarly, a total of 56 articles were eligible to compute the pooled prevalence of MetS in the general population of children and adolescents. Hence, Mets was found in 3.98% (IDF), 6.71% (ATP III) and 8.91% (de Ferranti) of study subjects. Regarding the components of MetS, abdominal obesity was the major component in overweight and obese population and low HDL-C was the most common component in the general population. This study also revealed that males were highly affected by MetS than females.

CONCLUSION

This study illustrates that MetS among children and adolescents is an emerging public health challenge in LMICs, where the prevalence of obesity is on the move. Preventive strategies such as community and school based intervention need to be designed. Promoting physical activities and healthy eating behaviors could avert this problem.

Early evaluation of the metabolic syndrome in Bucaramanga, Colombia

BACKGROUND

Metabolic syndrome (MS) is one of the conditions that increase the risk of developing cardiovascular diseases (CVD) and type-2 diabetes in the early future if it appears during childhood or adolescence. The purpose of the study to compare the MS prevalence of MS estimated in a representative sample of school-age population in Bucaramanga, Colombia, and the MS prevalence estimated in a subsample from the same population in the adolescent stage.

METHODS

An analytical cross-sectional survey (in the adolescent stage) (n=494) was carried out, nested in a population-based cohort assembled when children were of school age (n=1,282). Selection employed a bi-stage randomized sampling per neighborhoods and houses across the city. Sociodemographic and anthropometric variables, as well as cardiometabolic factors were analyzed in accordance with their distribution, and statistical significance tests were applied according to each case. MS was determined using the Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) criteria.

RESULTS

Estimated MS prevalence in school age according to the ATP III criteria was 9.5% (95% CI: 8.0-11.3%) and according to the IDF criteria it was 8.0% (95% CI: 6.6-9.7%). At the time of follow up the prevalence of MS was 13.2% and 14.8% according to the ATP III and IDF criteria, respectively.

CONCLUSIONS

MS prevalence of MS increased in 4% from the school age (9.5%) to the adolescence (13.1%).

Association of elective cesarean delivery with metabolic measures in childhood: A prospective cohort study in China

BACKGROUND AND AIMS

Cesarean delivery may increase the risk of childhood obesity, a precursor of metabolic syndrome (MetS). We aimed to investigate the association of elective cesarean delivery (ElCD) with MetS and its components in a Chinese birth cohort.

METHODS AND RESULTS

This cohort included 1467 children (737 delivered by ElCD and 730 by spontaneous vaginal delivery [SVD]) who were followed up at the age of 4-7 years in 2013. MetS was defined as the presence of ≥3 components: central obesity, hypertriglyceridemia, low high-density lipoprotein (HDL), high fasting glucose, and hypertension. Of the 1467 children, 93 (6.3%) were categorized as having MetS: 50 (6.8%) delivered by ElCD and 43 (5.9%) by SVD. After multivariable adjustment, ElCD was not associated with MetS (adjusted odds ratio [AOR] 1.15, 95% confidence interval [CI] 0.74, 1.78) or certain components including hypertriglyceridemia, low HDL, and high fasting glucose but was associated with central obesity (AOR 1.33, 95% CI 1.02, 1.72) and hypertension (AOR 1.50, 95% CI 1.15, 1.96), as well as higher levels of total cholesterol (3.43 vs. 3.04 mmol/L; P < 0.001), low-density lipoprotein-cholesterol (1.77 vs. 1.67 mmol/L, P = 0.002), fasting glucose (5.08 vs. 5.02 mmol/L, P = 0.022), systolic (97.57 vs. 94.69 mmHg, P < 0.001)/diastolic blood pressure (63.72 vs. 62.24 mmHg, P < 0.001), and BMI (15.46 vs. 14.83 kg/m², P < 0.001) than SVD.

CONCLUSIONS

ElCD is not associated with MetS in early to middle childhood but is associated with its components including central obesity and hypertension, as well as various continuous indices.

Comparison between different criteria for metabolic syndrome in schoolchildren from southern Brazil

The metabolic syndrome (MetS), although more frequent in adults, is already evident in the infant-juvenile population. On the other hand, there are different criteria for the diagnosis, without a consensus of which is the best to be used in this population. The aim of this study was to evaluate the agreement between different criteria for diagnosis of MetS in adolescents from southern Brazil. A cross-sectional study consisting of a sample of 1200 subjects, 679 females, aged between 12 and 17 years. MetS was assessed by three different criteria: Cook (2003), Ferranti (2004), and International Diabetes Federation - IDF (2007). The agreement between the criteria was evaluated by the Kappa index. Low prevalence of MetS was found among schoolchildren (1.9% for Cook, 5.0% for Ferranti, and 2.1% for IDF). Regular (Ferranti - IDF: Kappa 0.382; p < 0.001) and moderate (Cook - Ferranti: Kappa 0.542; p < 0.001; Cook - IDF: Kappa 0.532; p < 0.001) agreement was demonstrated between the criteria. Elevated blood pressure was the most frequent condition in all the criteria, and the least frequent condition was in the glycemia (Cook and Ferranti) and high-density lipoprotein cholesterol levels.

CONCLUSION

The low prevalence of MetS and the low agreement among the existing criteria suggest the elaboration of new criteria for the diagnosis of MetS in the child and adolescent population. What is Known: • There are different criteria for the diagnosis of the metabolic syndrome (MetS), without a consensus of which is the best to be used in the infant-juvenile population. What is New: • Low prevalence of MetS identified among schoolchildren and the low agreement among the existing criteria suggest the elaboration of new criteria for the diagnosis of MetS in the child and adolescent population.

Metabolic syndrome and atherogenic indices in school children: A worrying panorama in Brazil

BACKGROUND

Metabolic Syndrome (MS) is defined as the combination of a cluster of cardiovascular risk factors. The use of cardiovascular indices such as the ratios TC/HDL-c, LDL-c/HDL-c and TG/HDL-c may help in the assessment of cardiovascular risk. Investigation of cardio-metabolic risks in the pre-adolescent stage is essential to characterize possible patterns for MS in the earliest stages of the life avoiding further irreversible consequences.

AIMS

This work aimed to investigate the presence of MS and cardiovascular indices in a group of children aged 6-10 years.

METHODS

We included 150 children from a city in Brazil. Anthropometric (Body Mass Index and Waist Circumference) and biochemical parameters (glycaemia, total cholesterol, LDL-c, HDL-c, and triglycerides) were evaluated in order to identify the presence of MS. Atherogenic Indices were also calculated (TC/HDL-c, LDL-c/HDL-c and TG/HDL-c).

RESULTS

Our results showed that there are high percentages of children with altered values for biochemical and anthropometric parameters and in the atherogenic indices. MS was identified in 17.8% of the children. The main parameters related to alterations in the atherogenic indices were waist circumference, body mass index and the presence of MS.

CONCLUSION

The high prevalence of MS and alterations in the atherogenic indices in schoolchildren is a worrying panorama. We suggest the performance of more studies focusing on identification, intervention and prevention programs in order to reduce the risk factors of this syndrome in childhood and to reduce future cardiovascular deaths.

The Prevalence of Metabolic Syndrome and Cardiovascular Risk Factors in Obese Children and Adolescents in Dalmatia: A Hospital Based Study

Obesity and metabolic syndrome (MS) are one of the biggest public health issues in child and adolescent population. To the best of the authors' knowledge, this hospital based study is the first report on the prevalence of MS in obese children and adolescents in Dalmatia, the Mediterranean part of Croatia. The objectives of this study were to determine the prevalence of individual cardiovascular risk factors and MS. Between January 2009 and June 2014, 201 obese subjects aged 6 to 18 were analyzed retrospectively from our Pediatric Endocrine Unit database. The subjects were then classified in two groups of obesity; subjects with BMI z score 2.0-3.0 were classified as moderately obese and subjects with BMI z score > 3.0 were classified as severely obese. The overall prevalence of MS using the modified IDF criteria was 30.3%. The most common component of MS in both groups was arterial hypertension, while impaired fasting glucose was the least common component of MS. Our finding of high prevalence of MS underlines the importance of early childhood obesity treatment.