Metabolic syndrome's risk factors and its association with nutritional status in schoolchildren

Metabolic syndrome and risk factors in children: a risk score proposal

INTRODUCTION/OBJECTIVE

The lack of international consensus on the definition of Metabolic Syndrome (MS) in the pediatric population makes it difficult to estimate its prevalence. In this study, we intend to identify MS prevalence and a cutoff point based on a continuous score in children aged four to seven years.

METHODS

A cross-sectional study of 402 children (4-7 years) monitored by the Lactation Support Program (PROLAC). A continuous MS risk score was assessed using Principal Component Analysis (PCA). In order to calculate the score, the following MS risk factors were considered: Waist circumference (WC), High Density Lipoprotein (HDL), Triglycerides (TG), Blood Pressure (BP) and Blood sugar. Using a Receiver Operating Characteristics (ROC) curve, the cutoff point for predicting MS risk based on continuous score was evaluated.

RESULTS

A progressive increase in MS scores was observed according to increase in the number of risk factors. This increase was also observed when comparing boys and girls (p < 0.001). In the absence of MS, the median score among the children was -0.0486 (-0.2929-0.2151). For children with MS, the median score was 0.5237 (0.2286-0.7104) (p < 0.001). The best cutoff score for predicting MS in children aged four to five years was >0.09 (100% sensitivity and specificity 72.67%). For children aged six to seven years, this value was >0.14 (100% sensitivity and 64.65% specificity).

CONCLUSION

The calculated continuous risk score can predict MS with good accuracy and high sensitivity and reasonable specificity.

Metabolic risk is associated with sociodemographic characteristics in adolescents from both rural and urban regions from southern Brazil

BACKGROUND

The prevalence of several cardiovascular metabolic disorders are increasingly cause for concern in adolescents worldwide. Given the complex interrelations between metabolic risk (MR) and sociodemographic variables, the present study aims to examine the association between the presence of MR with sociodemographic characteristics (sex, skin color, residential area, and parental socioeconomic status) in adolescents from Southern Brazil.

METHODS

Cross-sectional study conducted with 1,152 adolescents (507 males) aged between 12 and 17 years. MR was assessed using a continuous score (cMetS; sum of Z-scores of the following variables: waist circumference, systolic blood pressure (SBP), glucose, high-density lipoprotein cholesterol [HDL-C, inverse], triglycerides [TG], and estimated cardiorespiratory fitness [CRF, inverse]). Poisson regression was used to examine associations between sociodemographic variables with the dichotomized cMetS and separate metabolic variables. The results were expressed with prevalence ratios (PR) and 95% confidence intervals (CI).

RESULTS

The presence of MR (evaluated by the cMetS) was observed in 8.7% of adolescents. Higher MR was less prevalent among non-white adolescents (PR: 0.96; 95% CI: 0.93; 0.99). Adolescents living in rural areas had a lower prevalence of the following metabolic variables; low HDL-C (PR: 0.95; 95% CI: 0.94; 0.97), elevated TG (PR: 0.95; 95% CI: 0.92; 0.99), elevated glucose (PR: 0.96; 95% CI: 0.95; 0.98), and low CRF levels (PR: 0.88; 95% CI: 0.85; 0.92). Whereas, SBP was higher in those living in rural areas (PR: 1.11; 95% CI: 1.05; 1.17). In girls, there was a higher prevalence of raised TG (PR: 1.06; 95% CI: 1.02; 1.10) and lower levels of CRF (PR: 1.20; 95% CI: 1.16; 1.24), but a lower prevalence of elevated glucose (PR: 0.97; 95% CI: 0.97; 0.99).

CONCLUSION

Higher MR prevalence was lower in those self-reporting non-white skin color and selected MR factors were less prevalent in those living in rural areas. The identification of groups at higher MR is important for early prevention and monitoring strategies for both Type 2 diabetes and later cardiovascular disease. Future studies should be conducted to assess the socio-cultural aspects of the relationships between MR and socio-cultural and lifestyle variables.

Overweight and obesity associated with high blood pressure: a cross-sectional study in Brazilian students

OBJECTIVE

To verify the association among overweight, obesity and high blood pressure in Brazilian students aged between 6 and 10 years old.

METHOD

Cross-sectional study carried out in the city of Macaé, RJ, in which body mass, height and blood pressure were collected. The body mass index was calculated using the Anthro Plus software and classified according to SISVAN. High systolic/diastolic blood pressure when ≥ 90th percentile by age, gender and height/age percentile (7th Brazilian Guideline on Hypertension). Logistic regression with a 95% confidence interval, using SPSS software were done.

RESULTS

A total of 911 children were evaluated and, after stratification by nutritional status, the underweight were excluded. Among the remaining 888 children, the prevalence of overweight was 17.7% and obesity 16.2%. The prevalence of high blood pressure was 34%, with no statistical difference between gender (p=0.57). Overweight was significantly associated with high blood pressure in the 8-9 year old group (OR 1.99; p=004), while obesity was associated in both groups (6-7 year old OR 2.50; p=0.004 and 8-9 year old OR 4.21 p=0.001).

CONCLUSION

The results showed that overweight and obesity significantly increased the chance of high blood pressure among children aged 6 to 10 years old.

Diet dan Sindrom Metabolik pada Remaja Obesitas

ABSTRACTBackground : The prevalence of obesity in adolescents is increasing and causes metabolic syndrome at a young age. Metabolic syndrome results from the interaction of environmental, genetic, and dietary factors. The purpose of this study was to determine the diet profile of obese adolescents suffering from metabolic syndrome.Methods: This study was a cross-sectional study of obese adolescents who visited the Pediatric Nutrition and Metabolic Disease in Dr. Soetomo General Hospital, Surabaya. The anthropometry examination (weight, height and waist circumference), blood pressure, and blood tests (HDL cholesterol, triglycerides and blood glucose levels) were measured. The diagnosis of metabolic syndrome was based on the International Diabetes Federation. Food consumption data was obtained through direct interviews using data collection sheets. Analysis of dietary differences in obese adolescents suffering from metabolic syndrome was performed by chi square using SPSS.Results and Discussions: A total of 59 obese adolescents aged 13-16 years were involved in this study. A total of 27 subjects (45.8%) suffered from metabolic syndrome and 32 subjects (54.2%) did not suffer from metabolic syndrome. The level of the consumption of fish, vegetables, and fruit in obese adolescents were still low. There was no significant difference in the diet profile between obese adolescents who suffer from metabolic syndrome or not.Conclusion: Prevention strategies through food consumption patterns are needed in obese adolescents to control metabolic stress processes and prevent metabolic syndrome in the future. Diet knowledge in obese adolescents needs to be given early to prevent further complications. Increasing foods that contain anti-oxidants, such as fruits and vegetables, is one of the strategies to prevent metabolic syndrome in obese adolescents.ABSTRAKLatar Belakang : Prevalensi obesitas pada remaja semakin meningkat dan menyebabkan sindrom metabolik di usia muda. Sindrom metabolik terjadi akibat interaksi faktor lingkungan, genetik, dan diet. Tujuan dari penelitian ini adalah mengetahui profil diet pada remaja obesitas yang menderita sindrom metabolik.Metode : Penelitian ini merupakan penelitian potong lintang pada remaja obesitas yang berkunjung di Poli Nutrisi dan Penyakit Metabolik Anak di RSUD Dr. Soetomo, Surabaya. Pada subyek dilakukan pemeriksaan antropometri (berat badan, tinggi badan, dan lingkar pinggang), pemeriksaan tekanan darah, dan pemeriksaan darah (kolesterol HDL, trigliserida, dan kadar glukosa darah). Diagnosis sindrom metabolik ditegakkan berdasarkan International Diabetes Federation. Data konsumsi makanan didapatkan melalui wawancara langsung dengan menggunakan lembar pengumpul data. Analisis perbedaan diet pada remaja obesitas yang menderita sindrom metabolik dilakukan dengan chi square menggunakan SPSS.Hasil dan Pembahasan : Sebanyak 59 remaja obesitas yang berusia 13-16 tahun terlibat dalam penelitian ini. Sebanyak 27 subyek (45,8%) menderita sindrom metabolik dan sebanyak 32 subyek (54,2%) tidak menderita sindrom metabolik. Tingkat konsumsi ikan, sayur, dan buah pada remaja obesitas masih rendah. Tidak ada perbedaan yang bermakna pada profil diet antara remaja obesitas yang menderita sindrom metabolik maupun tidak.Kesimpulan : Strategi pencegahan melalui pola konsumsi makanan diperlukan pada remaja obesitas untuk mengontrol proses stres metabolik sehingga dapat mencegah sindrom metabolik di masa datang. Pengetahuan diet pada remaja obesitas perlu diberikan sejak dini untuk mencegah komplikasi lebih lanjut. Memperbanyak makanan yang mengandung anti-oksidan, seperti buah dan sayur merupakan salah satu strategi mencegah sindrom metabolik pada remaja obesitas.

Cardiovascular Risk Factors in Children and Adolescents With Obesity: Sex-Related Differences and Effect of Puberty

Objectives: To evaluate the effect of gender and puberty on cardiovascular risk factors (CVRF) in obese children and adolescents. Methods: One thousand four hundred and nine obese patients [age 9.7 (2.2-17.9) y; 646 Male] were studied. Subjects were stratified according to Tanner pubertal staging and age into prepubertal ≤ and >6 ys (G1 and G2), pubertal stage 2-3 (G3), and pubertal stage 4-5 (G4). Waist circumference (WC), systolic and diastolic blood pressure (SP, DP), fasting plasma glucose, insulin, post Oral Glucose Tolerance Test glucose and insulin, and lipids were evaluated. Insulin resistance was evaluated by HOMA index. Patients with no CVRF were considered metabolically healthy (MHO). Results: The percentage of MHO patients was 59.8% in G1 while was consistently around 30% in the other groups. WC was more frequently abnormal in G2 males. Pubertal progression was associated with a decrease in WC abnormalities. SP was more frequently abnormal in G4 males and pubertal progression was associated with higher prevalence of abnormal SP in males. Pubertal progression was associated with an increase in hypertension rate in both sexes. HOMA was more frequently abnormal in G2 and G3 females. HDL, LDL, and TG were more frequently abnormal in G2 females. Dyslipidemia rate was higher in G2 females. Pubertal progression was associated with higher prevalence of abnormal HDL in males. Conclusions: Sex and pubertal status influence the frequency of abnormalities of CVRF in obese children and adolescents. CVRF are already present in prepubertal age. Identifying patients with higher risk of metabolic complications is important to design targeted and effective prevention strategies.

Relation between circulating oxidized-LDL and metabolic syndrome in children with obesity: the role of hypertriglyceridemic waist phenotype

BACKGROUND

The association between oxidative stress (OS) and metabolic syndrome (MetS) has been reported in adults. We analyzed the relation between circulating oxidized low-density lipoproteins (Ox-LDL) and MetS in pediatric ages in order to define whether plasma Ox-LDL levels are correlated to obesity and whether oxidative damage, using serum Ox-LDL levels as a proxy, are associated with MetS.

METHODS

We enrolled 178 children (11.8±2.6 years). On the basis of a body mass index (BMI) threshold, the subjects were classified as: normal weight BMI <75th percentile; overweight BMI 75-97th percentile; obese BMI >97th percentile. Patients were classified as having MetS if they met three or more of the following criteria for age and sex: BMI >97th percentile, triglyceride levels >95th percentile, high-density lipoprotein (HDL) cholesterol level <5th percentile, systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) >95th percentile and impaired glucose tolerance.

RESULTS

Obese children showed increased MetS prevalence (p=0.001) and higher Ox-LDL levels compared to normal- and overweight subjects (p<0.05), with a limited relation between Ox-LDL and MetS (p=0.06). Waist-to-height ratio (W/HtR) (p=0.02), triglycerides (TG) (p=0.001) and LDL-cholesterol (p<0.001) resulted independent predictors of increased plasma Ox-LDL levels.

CONCLUSIONS

Oxidative damage was correlated with a hypertriglyceridemic waist phenotype and can be a precocious marker of MetS and cardiometabolic risk in obese children.