Correlation of metabolic syndrome severity with cardiovascular health markers in adolescents

Relationship between serum uric acid and estimated glomerular filtration rate in adolescents aged 12-19 years with different body mass indices: a cross-sectional study

Background

Globally, chronic kidney disease (CKD) is a growing public health concern. Serum uric acid (SUA) is an easily detectable and readily available biochemical indicator that has long been recognized as an independent risk factor for CKD. In addition, studies have indicated a potential relationship between SUA and body mass index (BMI). However, studies on the effect of SUA levels on the estimated glomerular filtration rate (eGFR) in adolescents with different BMIs are very rare.

Methods

Weighted multiple regression analysis was used to estimate the independent relationship between SUA and log-transformed eGFR. Additionally, we used a weighted generalized additive model and smooth curve fitting to describe the nonlinear relationships in the subgroup analysis.

Results

First, SUA was negatively associated with log-transformed eGFR even after adjusting for all covariates (β=-0.0177, 95% CI: -0.0203-0.0151, P<0.0001). Second, the results of the stratified analysis found that after adjusting for all covariates, the decrease in log-transformed eGFR due to changes in per SUA levels (Per 1, mg/dL increase) was elevated in female adolescents (β=-0.0177, 95% CI: -0.0216, -0.0138, P<0.0001), adolescents aged 12-15 years (β=-0.0163, 95% CI: -0.0200, -0.0125, P<0.0001) and black (β=-0.0199, 95% CI: -0.0251, -0.0148, P<0.0001) adolescents. Furthermore, we found that adolescents with a higher BMI had higher SUA levels, and the effect of SUA on eGFR was significantly higher in underweight adolescents (β=-0.0386, 95% CI: (-0.0550, -0.0223), P<0.0001).

Conclusion

SUA was negatively associated with the eGFR in adolescents aged 12-19 years. Furthermore, we found for the first time that SUA affects the eGFR differently in adolescents with different BMIs. This effect was particularly significant in underweight adolescents.

The association of sagittal abdominal diameter with metabolic syndrome risk before and after weight-loss surgery in adolescents

BACKGROUND

Metabolic syndrome (MetS) affects ∼10% of U.S. adolescents. Abdominal obesity is the most prevalent component and may indicate MetS risk in adolescents undergoing weight loss surgery.

OBJECTIVES

Assess MetS risk/severity and its association with abdominal obesity (measured by sagittal abdominal diameter, SAD) before and after weight loss surgery in adolescents to determine whether SAD predicts MetS risk in this population.

SETTING

Data were collected in the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study at 5 sites (U.S. children's hospitals) performing weight-loss surgery in adolescents. The current study is a secondary analysis of these data.

METHODS

We examined data collected presurgery through 5 years postsurgery. MetS risk/severity was defined using the MetS severity z score (MetS-z), and MetS prevalence was determined using age-appropriate criteria. Association between SAD and MetS-z was evaluated with an adjusted linear mixed model.

RESULTS

Among 228 individuals (75% female, 72% White), mean age 16.5 years and body mass index (BMI) 53 kg/m2, 79% met MetS criteria pre-urgery. MetS-z (1.5) and SAD (32cm) were correlated (r = 0.6, P < .0001) presurgery, and both improved significantly at 6 months, 1, and 5 years postsurgery, remaining highly correlated at each timepoint. SAD predicted MetS-z (β = 0.118; 95% CI, 0.109, 0.127) after adjustment for age, visit, surgery type, and caregiver education.

CONCLUSIONS

Abdominal obesity is a key MetS risk marker in youth undergoing weight loss surgery. Both SAD and Met-z measures may be useful for MetS risk assessment and tracking postsurgery changes in this population, but more research is needed to identify effective lifestyle interventions targeting abdominal obesity.

The association between serum copper and obesity and all-cause mortality: the NHANES 2011-2016

Excessive serum copper has multiple effects on human health, while the association between copper and obesity remains unclear. The objective of this study is to examine the associations of serum copper concentrations with obesity and adiposity measures, including body fat composition and distribution among adults in the USA. This analysis utilized data from the National Health and Nutrition Examination Survey (NHANES) (2011-2016). A total of 7285 adults aged 18 years or older who had serum copper measures were included in this cross-sectional study. Multi-linear regression and logistic regression were used to estimate the independent risky effect of copper on fat deposition and all-cause mortality. Moreover, these associations were analyzed in stratification analysis by gender, age, and physical activity (PA). Generally, we found that participants who were females, non-Hispanic Black, or with inactive PA tended to have a higher serum level of copper. In addition, we observed positive associations between serum copper and adiposity measurements. Furthermore, a serum copper level higher than 133.9 μg/dL was a risk factor for all-cause mortality, which doubled the odds ratio of all-cause mortality compared to the normal serum copper level. Serum copper was positively associated with fat deposition of whole body and regional parts, and all-cause mortality. Furthermore, the effects of copper on fat distribution were also significant and could be modified by age, gender, and PA.

BMI trajectory and inflammatory effects on metabolic syndrome in adolescents

BACKGROUND

Various life course factors can affect susceptibility to diseases during adolescence and adulthood, and those relationships are complex. However, few studies have assessed the potential mediating factors. Therefore, we assessed the mediating effects of factors related to growth and inflammation between perinatal factors and metabolic syndrome risk during adolescence.

METHODS

The study was conducted on adolescents who participated in the follow-up in the Ewha Birth and Growth Cohort. We considered the ponderal index (PI) as a perinatal factor and the continuous metabolic syndrome score (cMetS) as the outcome and confirmed the mediating effects of body mass index (BMI) trajectory pattern in childhood and inflammation levels by using the PROCESS macro for SAS.

RESULTS

Although the direct effect of BMI trajectory on the relationship between PI and cMetS was not significant (0.545), the indirect effect was significant (1.044). In addition, the indirect effect was statistically significant in the pathways mediating the BMI trajectory pattern and inflammation (β = 1.456).

CONCLUSIONS

The direct and indirect effects on the relationship between PI and cMetS suggest that childhood factors related to growth may be involved in disease susceptibility. Therefore, appropriate interventions for the management of obesity during the growth phase are necessary.

IMPACT

Unlike other existing studies, this study assessed multiple mediating effects by considering the BMI trajectory pattern and inflammatory indexes as mediating factors between the ponderal index and the continuous metabolic syndrome score during adolescence. We found significant indirect effects of the BMI trajectory between PI and cMetS, and also significant indirect effects in the pathways mediating the BMI trajectory and hs-CRP. The significant indirect mediating effects support that childhood factors related to growth may be involved in disease susceptibility.

The Presence of Hyperhomocysteinemia Does Not Aggravate the Cardiometabolic Risk Imposed by Hyperuricemia in Young Individuals: A Retrospective Analysis of a Cross-Sectional Study

BACKGROUND

Little research has been conducted into the effects of the combined manifestation of hyperuricemia and hyperhomocysteinemia on cardiometabolic risk factors and markers in young subjects.

METHODS

1298 males and 1402 females, 14-to-20-year-olds, were classified into four groups: 1/normouricemic/normohomocysteinemic, 2/normouricemic/hyperhormohomocysteinemic, 3/hyperuricemic/normohomocysteinemic, and 4/hyperuricemic/hyperhomocysteinemic. Anthropometric measures, blood pressure, plasma glucose, insulin, lipids, markers of renal function, C-reactive protein, asymmetric dimethylarginine, and blood counts were determined.

RESULTS

Hyperuricemic males (but not females) had higher odds for hyperhomocysteinemia than normouricemic ones (OR: 1.8; 95% CI: 1.4-2.3; p < 0.001). Homocysteine and uric acid levels correlated directly (males: r = 0.076, females: r = 0.120; p < 0.01, both). Two-factor analysis of variance did not reveal a significant impact of hyperhomocysteinemia on any of the investigated cardiometabolic variables in females; in males, hyperuricemia and hyperhomocysteinemia showed a synergic effect on asymmetric dimethylarginine levels. Among four groups, subjects concurrently manifesting hyperuricemia and hyperhomocysteinemia did not presented the highest continuous metabolic syndrome score-a proxy measure of cardiometabolic risk; neither the multivariate regression model indicated a concurrent significant effect of uric acid and homocysteine on continuous metabolic syndrome score in either sex.

CONCLUSION

In young healthy subjects, hyperhomocysteinemia does not aggravate the negative health effects imposed by hyperuricemia.

Effect of Sprint Interval Training on Cardiometabolic Biomarkers and Adipokine Levels in Adolescent Boys with Obesity

This study investigated the effect of supervised sprint interval training (SIT) on different cardiometabolic risk factors and adipokines in adolescent boys with obesity. Thirty-seven boys were allocated to either a SIT group (13.1 ± 0.3 years; body mass index [BMI]: 30.3 ± 0.9 kg·m^-2) or a control group (CONT) (13.7 ± 0.4 years; BMI: 32.6 ± 1.6 kg·m^-2). The SIT group performed 4-6 × 30 s all-out cycling sprints, interspersed with 4 min rest, for 3 sessions/week, during a 12-week period, while the non-exercising CONT group maintained a habitual lifestyle. Anthropometric measurements, triglycerides, fasting insulin and glucose, total cholesterol (TC), high- (HDLc) and low-density (LDLc) cholesterol, leptin and adiponectin in blood, cardiorespiratory fitness (CRF), and a metabolic syndrome severity risk score (MSSS) were calculated before and after the 12-week period. Compared to baseline values, a significant reduction in MSSS was seen in the SIT group after intervention. LDLc showed favorable changes in SIT compared to CONT (-0.06 ± 0.1 vs. 0.19 ± 0.01 mmol·L^-1; p = 0.025). Additionally, CRF increased in the SIT group compared to the CONT group (5.2 ± 1.1 vs. -2.1 ± 1.1 mL·min^-1·kg^-1, p < 0.001). Moreover, a 12-week all-out SIT training effectively improves cardiometabolic health in adolescent boys with obesity.

Associations of Fine Particulate Matter Constituents with Metabolic Syndrome and the Mediating Role of Apolipoprotein B: A Multicenter Study in Middle-Aged and Elderly Chinese Adults

Fine particulate matter (PM_2.5) was reported to be associated with metabolic syndrome (MetS), but how PM_2.5 constituents affect MetS and the underlying mediators remains unclear. We aimed to investigate the associations of long-term exposure to 24 kinds of PM_2.5 constituents with MetS (defined by five indicators) in middle-aged and elderly adults and to further explore the potential mediating role of apolipoprotein B (ApoB). A multicenter study was conducted by recruiting subjects (n = 2045) in the Beijing-Tianjin-Hebei region from the cohort of Sub-Clinical Outcomes of Polluted Air in China (SCOPA-China Cohort). Relationships among PM_2.5 constituents, serum ApoB levels, and MetS were estimated by multiple logistic/linear regression models. Mediation analysis quantified the role of ApoB in "PM_2.5 constituents-MetS" associations. Results indicated PM_2.5 was significantly related to elevated MetS prevalence. The MetS odds increased after exposure to sulfate (SO₄^2-), calcium ion (Ca²⁺), magnesium ion (Mg²⁺), Si, Zn, Ca, Mn, Ba, Cu, As, Cr, Ni, or Se (odds ratios ranged from 1.103 to 3.025 per interquartile range increase in each constituent). PM_2.5 and some constituents (SO₄^2-, Ca²⁺, Mg²⁺, Ca, and As) were positively related to serum ApoB levels. ApoB mediated 22.10% of the association between PM_2.5 and MetS. Besides, ApoB mediated 24.59%, 50.17%, 12.70%, and 9.63% of the associations of SO₄^2-, Ca²⁺, Ca, and As with MetS, respectively. Our findings suggest that ApoB partially mediates relationships between PM_2.5 constituents and MetS risk in China.

Cardiovascular Risk Factors and Target Organ Damage in Adolescents: The SHIP AHOY Study

BACKGROUND

Development of cardiovascular disease in adults has been directly linked to an adverse metabolic phenotype. While there is evidence that development of these risk factors in childhood persists into adulthood and the development of cardiovascular disease, less is known about whether these risk factors are associated with target organ damage during adolescence.

METHODS

We collected data from 379 adolescents (mean age 15.5, 60% male) with blood pressure between the 75th and 95th percentile to determine if there is a metabolic phenotype that predicts cardiovascular changes (left ventricular mass, systolic and diastolic function, pulse wave velocity, and renal function). We determined the number of risk factors for cardiovascular disease (hypertension, dyslipidemia, obesity, and insulin resistance) present in each participant. Generalized linear models were constructed to determine if the number of cardiovascular risk factors (CVRFs) were associated with measures of target organ damage.

RESULTS

The number of CVRFs present were associated with statistically significant differences in increased left ventricular mass index, increased pulse wave velocity, decreased peak longitudinal strain, urine albumin to creatine ratio and echocardiographic parameters of diastolic dysfunction. Generalized linear models showed that dyslipidemia and insulin resistance were independently associated with markers of diastolic dysfunction (P ≤ .05) while increased blood pressure was associated with all makers of target organ damage (P ≤ .03).

CONCLUSIONS

These data suggest the of the number of CVRFs present is independently associated with early changes in markers of target organ damage during adolescence.

Association of diet quality, physical activity, and abdominal obesity with metabolic syndrome z-score in black and white adolescents in the US

BACKGROUND AND AIMS

Metabolic syndrome (MetS) affects ∼10% of adolescents and is associated with cardiometabolic disease risk. The most prevalent MetS component is abdominal obesity. Healthy diet and physical activity (PA) are inversely associated with abdominal obesity and may reduce MetS risk in youth. Our aim was to examine associations of diet, activity, and abdominal obesity with MetS z-score (MetS-z).

METHODS AND RESULTS

An analysis of National Health and Nutrition Examination Survey (NHANES) 2011-2016 data in adolescents was performed. Healthy Eating Index (HEI)- 2015 scores were calculated for diet quality, PA habits were used to determine alignment with national guidelines, and abdominal obesity was assessed by sagittal abdominal diameter (SAD). MetS-z represented severity or potential risk for MetS. Multivariable regression evaluated the relationships of HEI, SAD and PA with MetS-z. Among 1214 black and white adolescents, SAD was significantly associated with MetS-z [β (95% CI) = 0.17 (0.16, 0.19); P <0.0001] while HEI-2015 components showed associations with MetS-z overall (HEI total, dairy, and sodium scores), and by sex (total, refined grains, dairy for males; added sugar, protein, whole grains for females). Mean HEI-2015 score was 47.4/100 (51.6 using the population-ratio method), and the proportion of adolescents meeting national PA guidelines was 37.6%, yet PA was not a significant predictor of MetS-z.

CONCLUSIONS

US adolescents have poor diet quality and fewer than half meet PA guidelines. Strategies for preventing MetS and related conditions in adolescence should focus on weight management - specifically, abdominal fat reduction - with individualized diet counseling.

Trajectory patterns for continuous metabolic syndrome score in childhood and the cardiovascular risk in adolescence

We explored the association between the trajectory of the continuous metabolic syndrome score (cMetS) in childhood with high-sensitivity C-reactive protein (hs-CRP) and carotid intima-media thickness (CIMT), which are known to increase cardiovascular disease risk in adolescence. The trajectory of cMetS in childhood (from 3 to 12 years of age) was identified in 833 children who participated in the Ewha Birth and Growth Study. The associations between cMetS and hs-CRP and CIMT were analyzed in 204 out of 833 children who participated in the follow-up at 13-15 years of age and measured hs-CRP and CIMT. Among the 833 children, three groups were classified: cMetS maintained at a low level (n = 198, 23.77%), middle level (n = 530, 63.63%), and at high levels (n = 105, 12.61%). The group with a stable-high cMetS trajectory showed significantly higher hs-CRP levels, and the statistical significance was maintained after adjusting for covariates. This study found that a consistently high cMetS in childhood was significantly associated with higher hs-CRP levels in adolescents, suggesting that it is necessary to intervene in metabolic risk factors early in life to reduce the risk of cardiovascular disease later in life.

Metabolic risk associated with liver enzymes, uric acid, and hemoglobin in adolescents

BACKGROUND

The associations of renal, hepatic, and hematologic markers with metabolic risk (MR) have already been shown in adolescents. However, it is still controversial which marker best predicts metabolic changes in youth. The aim of this study was to verify the association of MR with alanine aminotransferase (ALT), aspartate aminotransferase (AST), uric acid, and hemoglobin (Hb) in adolescents.

METHODS

We evaluated 1713 Brazilian adolescents aged 10 to 17 years. MR was calculated using a continuous metabolic risk score, including the sum of Z-scores of waist circumference, systolic blood pressure, fasting glucose, high-density lipoproteins, triglycerides, and cardiorespiratory fitness. Cutoff points were set for MR prediction for five metabolic components (ALT, AST, AST/ALT ratio, uric acid, and Hb).

RESULTS

MR was strongly associated with increased uric acid (odds ratio [OR]: 2.50; 95% confidence interval [CI]: 1.74-3.59), ALT (OR: 2.64; 95% CI: 1.63-4.27), and AST levels (OR: 2.53; 95% CI: 1.24-5.18). Uric acid was shown to be the best predictor for MR (sensitivity: 55.79%; specificity: 61.35%; area under the curve: 0.616).

CONCLUSION

Elevated hepatic, renal, and hematological markers were associated with MR in adolescents, especially ALT, AST, and uric acid levels.

IMPACT

Elevated hepatic, renal, and hematological markers were associated with metabolic risk in adolescents, especially ALT, AST, and uric acid levels. It is still controversial which marker best predicts metabolic changes in adolescents. In addition, association of Hb with metabolic risk is under-studied in this population. It is important to further investigate the relationship between elevated Hb and hepatic markers, since there are key aspects not addressed yet. Our results highlight the importance of creating public health policies aimed to child and adolescent population, to prevention of metabolic disorders from an early age.

Asymptomatic Hyperuricemia Associates with Cardiometabolic Risk Indicators in Overweight/Obese but Not in Lean Adolescents

PURPOSE

In overweight/obese adolescents, asymptomatic hyperuricemia is associated with increased prevalence of metabolic syndrome, its components, and a higher cardiometabolic risk. Whether similar associations exist in lean hyperuricemic adolescents is unknown.

SUBJECTS AND METHODS

In 2424 adolescents (51.9% females) aged 16-19 years, anthropometric variables, blood pressure, uric acid, glucose, insulin, lipid profile, inflammatory markers, and renal function were determined. Continuous cardiometabolic score was calculated. Normouricemic vs hyperuricemic subjects were compared among lean and overweight/obese individuals of both sexes.

RESULTS

Females (5.4%) and males (13.3%) presented with hyperuricemia; among them 63% of females and 53% of males were lean. In both sexes, hyperuricemic lean and hyperuricemic overweight/obese adolescents displayed similar uric acid concentrations (eg, males: 455±30 vs 461±32 µmol/L, respectively, p=0.933). Lean normouricemic adolescents manifested significantly lower uric acid levels than their overweight/obese peers (eg, males: 333±46 vs 357±41 µmol/L, respectively, p<0.001). Lean normouricemic and hyperuricemic subjects presented similar cardiometabolic score (eg, males: 2.60±0.67 vs 2.64±0.60, respectively, p=0.998); among overweight/obese adolescents those with hyperuricemia displayed higher scores compared with their normouricemic counterparts (eg, males: 3.36±1.04 vs 4.21±1.65, respectively, p<0.001). A decision-tree model revealed phenotypes associated with higher uricemia, however, distribution of individuals with hyperuricemia among phenotypes was random.

CONCLUSION

In lean adolescents, hyperuricemia is not associated with cardiometabolic profile indicating an increased risk. Existence of this rather prevalent phenotype remains undetected unless lean and overweight/obese subjects are analyzed separately. Longitudinal studies are needed to elucidate the potential clinical consequences of asymptomatic hyperuricemia in lean subjects in later life.

Food Insecurity Is Associated with Prediabetes Risk Among U.S. Adolescents, NHANES 2003-2014

Objective: Food insecurity has been linked to adverse health consequences. We sought to determine if food insecurity was related to obesity and prediabetes risk in U.S. adolescents. We also investigated if Supplemental Nutrition Assistance Program (SNAP) utilization mitigated any observed risks. Materials and Methods: We used linear and logistic regression analysis of cross-sectional data from a nationally representative sample of U.S. adolescents aged 12-19 years participating in the National Health And Nutrition Examination Survey 2003-2014 who had an income:poverty ratio of <5.0 and had complete data regarding metabolic laboratory assessments, food security, and socioeconomic status (n = 2662). Results: Food insecurity was present in 18.40% (95% confidence interval (CI): 16.47-20.37) among U.S. adolescents meeting inclusion criteria. Food insecurity was associated with increased odds of elevated blood pressure (adjusted odds ratio [aOR] = 1.57, 95% CI: 1.11-2.22) and prediabetes (aOR = 1.94, 95% CI: 1.16-3.25). SNAP usage was associated with higher body mass index z-score (e.g., mean: 0.80 vs. 0.59, P = 0.02), increased insulin resistance, and increased prediabetes odds among food-secure adolescents relative to nonusage. Conclusions: Food insecurity is relatively prevalent among U.S. adolescents with an income:poverty ratio of <5.0. Food insecurity is related to laboratory abnormalities and corresponding adverse health outcomes among U.S. adolescents in this relatively large sample. SNAP usage was associated with adverse health observations among food-secure adolescents. Ongoing efforts are still needed toward food assistance as important public health efforts aimed at mitigating the adverse outcomes related to food insecurity.

Serum apolipoprotein B is associated with increased risk of metabolic syndrome among middle-aged and elderly Chinese: A cross-sectional and prospective cohort study

BACKGROUND

Serum apolipoprotein (apo) B has been associated with an increased risk of atherosclerotic cardiovascular diseases. However, findings on the association between apoB and the risk of metabolic syndrome (MetS) are inconsistent. The purpose of this study was to investigate the association between serum apoB and MetS risk in Chinese population.

METHODS

A baseline survey was conducted in a population-based cohort of 10 340 adults aged ≥40 years in Shanghai, China, in 2010. A follow-up visit was conducted to assess incident diabetes in 2015.

RESULTS

At baseline, 2794 of 10 340 participants (27.02%) had MetS. Serum apoB was significantly associated with an increased risk of prevalent MetS. Multivariable-adjusted odds ratios and 95% confidence intervals (CIs) for quintiles 2-5 compared with quintile 1 (reference) were 1.29 (1.02-1.63), 1.47 (1.18-1.84), 1.32 (1.06-1.65), and 2.02 (1.61-2.51), respectively (P_trend  < 0.05). During an average of 5.1 years follow-up, 4627 individuals without MetS at baseline showed a significant association between apoB and the risk of incident MetS. Multivariable-adjusted risk ratios (95% CIs) for subjects in apoB quintiles 2-5 compared with the reference were 1.43 (1.13-1.82), 1.57 (1.25-1.98), 1.74 (1.38-2.18), and 2.07 (1.66-2.58), respectively (P_trend  < 0.05). Stratified analysis suggested that the above association was much stronger among normal weight individuals than in those who were overweight or obese.

CONCLUSION

These cross-sectional and prospective studies provide evidence that serum apoB is associated with existing MetS and is a possible predictor of the risk of MetS, especially among normal weight individuals.

Metabolic syndrome severity and lifestyle factors among adolescents

The continued rise of pediatric obesity globally has raised concerns for related sequalae. One marker of risk is the metabolic syndrome, a cluster of cardiovascular risk factors that is associated with future cardiovascular disease and type 2 diabetes. MetS has at its core visceral adipocytes exhibiting dysfunction as a result of excess fat content. MetS in children and adolescents is linked to unhealthy lifestyle practices such as sedentary lifestyles and excess consumption calories. As such, the optimal means of addressing MetS is targeting a decrease in adiposity through lifestyle modification, a decrease in MetS following increases in physical activity and improvements in the quality and content of food intake. Efforts remain needed in increasing motivation to these changes and maintaining adherence to avoid long-term sequelae.

Longitudinal Associations of Metabolic Syndrome Severity Between Childhood and Young Adulthood: The Bogalusa Heart Study

BACKGROUND

Childhood metabolic syndrome (MetS) is associated with insulin resistance and increased risk for later development of type 2 diabetes (T2DM) and cardiovascular disease (CVD). In using MetS severity z-scores, our objective was to assess longitudinal associations in MetS severity, fasting insulin levels as a sign of insulin resistance and risk for T2DM, and uric acid levels as a biomarker of oxidative stress leading to CVD.

METHODS

We used linear regression to analyze longitudinal data from 285 white and black participants from the Bogalusa Heart Study evaluated at baseline at ages 5-19 and as young adults after a mean of 12.0 years follow-up. We assessed correlations between childhood MetS severity and young-adult MetS severity, fasting insulin, and uric acid levels, both overall and by sex- and racial subgroups.

RESULTS

Overall, childhood MetS z-scores were positively associated with young-adult MetS z-scores (r = 0.52), insulin (r = 0.34), and uric acid (r = 0.28) (all P < 0.001). These associations were consistent across all sex- and racial subgroups, except for young adult uric acid in white males in which childhood MetS-z was not associated (r = 0.15, P = 0.243). There was a strong cross-sectional association of young-adult MetS z-scores with insulin (r = 0.70) and uric acid (r = 0.57) (both P < 0.001), which was consistent for all sex- and racial subgroups.

CONCLUSIONS

These positive longitudinal correlations between childhood MetS z-scores and markers of later insulin resistance and oxidative stress suggest long-term durability of risk for CVD and T2DM. This suggests potential for MetS severity to serve as an indicator to monitor for future risk of T2DM and CVD.

Use of BMI as the marker of adiposity in a metabolic syndrome severity score: Derivation and validation in predicting long-term disease outcomes

BACKGROUND

Estimates of adiposity in evaluating the metabolic syndrome (MetS) have traditionally utilized measures of waist circumference (WC), whereas body mass index (BMI) is more commonly used clinically. Our objective was to determine if a MetS severity Z-score employing BMI as its measure of adiposity (MetS-Z-BMI) would perform similarly to a WC-based score (MetS-Z-WC) in predicting future disease.

METHODS

To formulate the MetS-Z-BMI, we performed confirmatory factor analysis on a sex- and race/ethnicity-specific basis on MetS-related data for 6870 adult participants of the National Health and Nutrition Survey 1999-2010. We then validated this score and compared it to MetS-Z-WC in assessing correlations with future coronary heart disease (CHD) and Type 2 diabetes mellitus (T2DM) using Cox proportional hazard analysis of 13,094 participants of the Atherosclerosis Risk in Communities study and Jackson Heart Study.

RESULTS

Loading factors, which represent the relative contribution of each component to the latent MetS factor, were lower for BMI than for WC in formulating the two respective scores (MetS-Z-BMI and MetS-Z-WC). Nevertheless, MetS-Z-BMI and MetS-Z-WC exhibited similar hazard ratios (HR) toward future disease. For each one standard-deviation-unit increase in MetS-Z-BMI, HR for CHD was 1.76 (95% confidence interval [CI]: 1.65, 1.88) and HR for T2DM was 3.39 (CI 3.16, 3.63) (both p < 0.0001). There were no meaningful differences between the MetS-Z-WC and MetS-Z-BMI scores in their associations with future CHD and T2DM.

CONCLUSIONS

A MetS severity Z-score utilizing BMI as its measure of adiposity operated similarly to a WC-based score in predicting future CHD and T2DM, suggesting overall similarity in MetS-based risk as estimated by both measures of adiposity. This indicates potential clinical usefulness of MetS-Z-BMI in assessing and following MetS-related risk over time.

The Effect of Nutrition and Sleep Habits on Predisposition for Metabolic Syndrome in Greek Children

PURPOSE

To investigate the effect of lifestyle habits in childhood Metabolic Syndrome (MTS).

DESIGN AND METHODS

Descriptive correlation study with 480 participants (5-12 years old) using a specially designed questionnaire was conducted. Anthropometric and biochemical analyses were performed.

RESULTS

Fifteen percent of children exhibited predisposition for MTS. Regarding sleep habits, logistic regression analysis (LRA) showed that hour of sleep -before 22:00- was associated with decreased waist circumference (WC%) (p = .026). Midday siesta was negatively correlated with systolic (SBP) (p = .001) and diastolic blood pressure (DBP) (p = .046). In children without MTS, lack of sleep and night time sleep was positively correlated with DBP (p = .044) and fasting blood glucose (FBG) (p = .005). Regarding nutrition habits, fast food consumption was positively correlated with SBP (p = .006) and meat consumption was positively correlated with both Body Mass Index% (BMI%) (p = .038) and WC% (p = .023). LRA showed that fruit (p = .001) and legume (p = .040) consumption was associated with decreased FBG; fish consumption with decreased Low Density Lipoprotein (LDL) cholesterol (p = .031), vegetable (p = .054) and cereal consumption (p = .012) with decreased DBP. In children with MTS, fruits were associated with increased FBG (p = .034). In children without MTS, meat consumption was associated with increased LDL (p = .024), cereal with increased WC% (p = .002) and olive products with increased High Density Lipoprotein (HDL) cholesterol and BMI% (p = .037).

CONCLUSIONS

The adoption of both balanced diet and sleep habits seemed to be crucial for the prevention of MTS.

PRACTICE IMPLICATIONS

Clinical health nurses could develop and implement preventive intervention programs in order to avoid metabolic complications in adulthood.