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.
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References
1.
ReavenGM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes, 1988; 37:1595–1607.
LakkaHM, LaaksonenDE, LakkaTAet al.The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. J Am Med Assoc, 2002; 288:2709–2716.
5.
WeissR, DziuraJ, BurgertTSet al.Obesity and the metabolic syndrome in children and adolescents. N Engl J Med, 2004; 350:2362–2374.
6.
EbbelingCB, PawlakDB, LudwigDS. Childhood obesity: Public-health crisis, common sense cure. Lancet, 2002; 360:473–482.
7.
FordES, LiC. Defining the metabolic syndrome in children and adolescents: Will the real definition please stand up?J Pediatr, 2008; 152:160–164.
8.
GolleyRK, MagareyAM, SteinbeckKSet al.Comparison of metabolic syndrome prevalence using six different definitions in overweight pre-pubertal children enrolled in a weight management study. Int J Obesity, 2006; 30:853–860.
9.
ChiCH, WangY, WilsonDMet al.Definition of metabolic syndrome in preadolescent girls. J Pediatr, 2006; 148:788–792.
10.
TailorAM, PeetersPH, NoratTet al.An update on the prevalence of the metabolic syndrome in children and adolescents. Int J Pediatr Obesity, 2010; 5:202–213.
11.
International Diabetes Federation. The IDF consensus worldwide definition of the metabolic syndrome. www.idf.org/webdata/docs/Metabolic_syndrome_definition.pdf/. 2012 November 25.
12.
Expert Panel on Detection E, Treatment of High Blood Cholesterol in A. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). J Am Med Assoc, 2001; 285:2486–2497.
13.
AlbertiKG, ZimmetPZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med, 1998; 15:539–553.
14.
KongAP, KoGT, OzakiRet al.Metabolic syndrome by the new IDF criteria in Hong Kong Chinese adolescents and its prediction by using body mass index. Acta Paediatr, 2008; 97:1738–1742.
15.
PirkolaJ, TammelinT, BloiguAet al.Prevalence of metabolic syndrome at age 16 using the International Diabetes Federation paediatric definition. Arch Dis Child, 2008; 93:945–951.
16.
BokorS, FrelutML, VaniaAet al.Prevalence of metabolic syndrome in European obese children. Int J Pediatr Obes, 2008; 2:3–8.
17.
ReinehrT, de SousaG, ToschkeAMet al.Comparison of metabolic syndrome prevalence using eight different definitions: A critical approach. Arch Dis Child, 2007; 92:1067–1072.
18.
AlvarezMM, VieiraAC, SichieriRet al.Prevalence of metabolic syndrome and of its specific components among adolescents from Niteroi City, Rio de Janeiro State, Brazil. Arquivos Brasileiros de Endocrinologia e Metabologia, 2011; 55:164–170.
19.
Afkhami-ArdekaniM, Zahedi-AslS, RashidiMet al.Incidence and trend of a metabolic syndrome phenotype among Tehranian adolescents: Findings from the Tehran Lipid and Glucose Study, 1998–2001 to 2003–2006. Diabetes Care, 2010; 33:2110–2112.
20.
CizmeciogluFM, HatunS, KalacaS. Metabolic syndrome in obese Turkish children and adolescents: comparison of two diagnostic models. Turkish J Pediatr, 2008; 50:359–365.
21.
Al-IsaA, AkanjiAO, ThalibL. Prevalence of the metabolic syndrome among female Kuwaiti adolescents using two different criteria. Br J Nutr, 2010; 103:77–81.
22.
JolliffeCJ, JanssenI. Development of age-specific adolescent metabolic syndrome criteria that are linked to the Adult Treatment Panel III and International Diabetes Federation criteria. J Am Coll Cardiol, 2007; 49:891–898.
23.
ReinehrT, WunschR, de SousaGet al.Relationship between metabolic syndrome definitions for children and adolescents and intima-media thickness. Atherosclerosis, 2008; 199:193–200.
24.
VissersD, VanroyC, De MeulenaereAet al.Metabolic syndrome in youth: A cross-sectional school-based survey. Acta Paediatr, 2007; 96:1809–1813.
Braga-TavaresH, FonsecaH. Prevalence of metabolic syndrome in a Portuguese obese adolescent population according to three different definitions. Eur J Pediatr, 2010; 169:935–940.
27.
GoodmanE, DanielsSR, MorrisonJAet al.Contrasting prevalence of and demographic disparities in the World Health Organization and National Cholesterol Education Program Adult Treatment Panel III definitions of metabolic syndrome among adolescents. J Pediatr, 2004; 145:445–451.
28.
LiC, FordES, McBridePEet al.Non-high-density lipoprotein cholesterol concentration is associated with the metabolic syndrome among US youth aged 12–19 years. J Pediatr, 2011; 158:201–207.
29.
VikramNK, MisraA, PandeyRMet al.Heterogeneous phenotypes of insulin resistance and its implications for defining metabolic syndrome in Asian Indian adolescents. Atherosclerosis, 2006; 186:193–199.
30.
XuYQ, JiCY. Cooperative Study on Childhood Obesity: Working Group on Obesity in C. Report on childhood obesity in China (7). Comparison of NCHS and WGOC. Biomed Environ Sci, 2008; 21:271–279.
31.
SekiM, MatsuoT, CarrilhoAJ. Prevalence of metabolic syndrome and associated risk factors in Brazilian schoolchildren. Pub Health Nutrit, 2009; 12:947–952.
32.
LiY, YangX, ZhaiFet al.Childhood obesity and its health consequence in China. Obes Rev, 2008; 1:82–86.
33.
HirschlerV, RoqueMI, CalcagnoMLet al.Maternal waist circumference and the prediction of children's metabolic syndrome. Arch Pediatr Adolesc Med, 2007; 161:1205–1210.
34.
Mar BibiloniM, MartinezE, LlullRet al.Metabolic syndrome in adolescents in the Balearic Islands, a Mediterranean region. Nutrit Met Cardiovascular Dis, 2011; 21:446–454.
35.
SinghR, BhansaliA, SialyRet al.Prevalence of metabolic syndrome in adolescents from a north Indian population. Diabet Med, 2007; 24:195–199.
36.
XuYQ, JiCY. Prevalence of the metabolic syndrome in secondary school adolescents in Beijing, China. Acta Paediatr, 2008; 97:348–353.
37.
PanY, PrattCA. Metabolic syndrome and its association with diet and physical activity in US adolescents. J Am Dietet Assoc, 2008; 108:276–86.
38.
RyuSY, KweonSS, ParkHCet al.Obesity and the metabolic syndrome in Korean adolescents. J Korean Med Sci, 2007; 22:513–517.
39.
SaitoI, MoriM, ShibataHet al.Prevalence of metabolic syndrome in young men in Japan. J Atheroscler Thromb, 2007; 14:27–30.
40.
EsmaillzadehA, MirmiranP, AzadbakhtLet al.High prevalence of the metabolic syndrome in Iranian adolescents. Obesity, 2006; 14:377–382.
41.
BraunschweigCL, GomezS, LiangHet al.Obesity and risk factors for the metabolic syndrome among low-income, urban, African American schoolchildren: The rule rather than the exception?Am J Clin Nutr, 2005; 81:970–975.
42.
de FerrantiSD, GauvreauK, LudwigDSet al.Prevalence of the metabolic syndrome in American adolescents: Findings from the Third National Health and Nutrition Examination Survey. Circulation, 2004; 110:2494–2497.
43.
AgirbasliM, CakirS, OzmeSet al.Metabolic syndrome in Turkish children and adolescents. Metab Clin Exp, 2006; 55:1002–1006.
44.
ParkJ, HilmersDC, MendozaJAet al.Prevalence of metabolic syndrome and obesity in adolescents aged 12 to 19 years: Comparison between the United States and Korea. J Korean Med Sci, 2010; 25:75–82.
45.
ValeryPC, MoloneyA, CotterillAet al.Prevalence of obesity and metabolic syndrome in Indigenous Australian youths. Obes Rev, 2009; 10:255–261.
46.
MirhosseiniNZ, YusoffNA, ShaharSet al.Prevalence of the metabolic syndrome and its influencing factors among adolescent girls in Mashhad, Iran. Asia Pacif J Clin Nutr, 2009; 18:131–136.
47.
NasreddineL, OuaijanK, MansourMet al.Metabolic syndrome and insulin resistance in obese prepubertal children in Lebanon: A primary health concern. Ann Nutr Metab, 2010; 57:135–142.
48.
YoshinagaM, TanakaS, ShimagoAet al.Metabolic syndrome in overweight and obese Japanese children. Obes Res, 2005; 13:1135–1140.
49.
Halley CastilloE, BorgesGet al.Body mass index and the prevalence of metabolic syndrome among children and adolescents in two Mexican populations. J Adolesc Health, 2007; 40:521–526.
50.
FordES, LiC, ZhaoGet al.Prevalence of the metabolic syndrome among U.S. adolescents using the definition from the International Diabetes Federation. Diabetes Care, 2008; 31:587–589.
51.
ParkMJ, BostonBA, OhMet al.Prevalence and trends of metabolic syndrome among Korean adolescents: From the Korean NHANES survey, 1998–2005. J Pediatr, 2009; 155:529–534.
52.
de FerrantiSD, GauvreauK, LudwigDSet al.Inflammation and changes in metabolic syndrome abnormalities in US adolescents: Findings from the 1988–1994 and 1999–2000 National Health and Nutrition Examination Surveys. Clin Chem, 2006; 52:1325–1330.
53.
SchwandtP, KelishadiR, RibeiroRQet al.A three-country study on the components of the metabolic syndrome in youths: The BIG Study. Int J Pediatr Obes, 2010; 5:334–341.
54.
van VlietM, von RosenstielIA, SchindhelmRKet al.the metabolic syndrome in obese children and adolescents: do age and definition matter?Curr Clin Pharmacol, 2009; 4:233–238.
55.
Lopez-CapapeM, AlonsoM, ColinoEet al.Frequency of the metabolic syndrome in obese Spanish pediatric population. Eur J Endocrinol, 2006; 155:313–319.
56.
MorrisonJA, FriedmanLA, HarlanWRet al.Development of the metabolic syndrome in black and white adolescent girls: A longitudinal assessment. Pediatrics, 2005; 116:1178–1182.
57.
EkelundU, AnderssenS, AndersenLBet al.Prevalence and correlates of the metabolic syndrome in a population-based sample of European youth. Am J Clin Nutr, 2009; 89:90–96.
58.
CarantiDA, LazzerS, DamasoARet al.Prevalence and risk factors of metabolic syndrome in Brazilian and Italian obese adolescents: A comparison study. Int J Clin Pract, 2008; 62:1526–1532.
59.
LafortunaCL, AdorniF, AgostiFet al.Prevalence of the metabolic syndrome among extremely obese adolescents in Italy and Germany. Diabetes Res Clin Pract, 2010; 88:14–21.
60.
LeeK. Waist circumference percentile criteria for the pediatric metabolic syndrome in Korean adolescents. Asia Pac J Clin Nutr, 2008; 17:422–428.
61.
Al-DaghriNM. Extremely high prevalence of metabolic syndrome manifestations among Arab youth: A call for early intervention. Eur J Clin Invest, 2010; 40:1063–1066.
62.
BudakN, OzturkA, MaziciogluMet al.Decreased high-density lipoprotein cholesterol and insulin resistance were the most common criteria in 12- to 19-year-old adolescents. Eur J Nutr, 2010; 49:219–225.
63.
AziziF, FarahaniZK, GhanbarianAet al.Familial aggregation of the metabolic syndrome: Tehran Lipid and Glucose Study. Ann Nut Met, 2009; 54:189–196.
64.
VenturaEE, DavisJN, AlexanderKEet al.Dietary intake and the metabolic syndrome in overweight Latino children. J Am Dietet Assoc, 2008; 108:1355–1359.
65.
SellersEA, SinghGR, SayersSM. Large waist but low body mass index: The metabolic syndrome in Australian Aboriginal children. J Pediatr, 2008; 153:222–227.
66.
MoayeriH, RabbaniA, KeihanidoustZTet al.Overweight adolescents: A group at risk for metabolic syndrome (Tehran adolescent obesity study)Arch Iran Med, 2008; 11:10–15.
67.
LeeMS, WahlqvistML, YuHLet al.Hyperuricemia and metabolic syndrome in Taiwanese children. Asia Pacif J Clin Nutr, 2007; 2:594–600.
68.
GuptaR, MisraA, VikramNKet al.Younger age of escalation of cardiovascular risk factors in Asian Indian subjects. BMC Cardiovasc Disord, 2009; 9:28.
CalcaterraV, KlersyC, MuratoriTet al.Prevalence of metabolic syndrome (MS) in children and adolescents with varying degrees of obesity. Clin Endocrinol, 2008; 68:868–872.
71.
AtabekME, PirgonO, KurtogluS. Prevalence of metabolic syndrome in obese Turkish children and adolescents. Diabetes Res Clin Pract, 2006; 72:315–321.
72.
MessiahSE, ArheartKL, LukeBet al.Relationship between body mass index and metabolic syndrome risk factors among US 8- to 14-year-olds, 1999 to 2002. J Pediatr, 2008; 153:215–221.
73.
de FerrantiSD, OsganianSK. Epidemiology of paediatric metabolic syndrome and type 2 diabetes mellitus. Diabetes Vasc Dis Res, 2007; 4:285–296.
74.
CruzML, GoranMI. The metabolic syndrome in children and adolescents. Curr Diabetes Rep, 2004; 4:53–62.
75.
ZimmetP, AlbertiG, KaufmanFet al.The metabolic syndrome in children and adolescents. Lancet, 2007; 369:2059–2061.
76.
CookS, WeitzmanM, AuingerPet al.Prevalence of a metabolic syndrome phenotype in adolescents: Findings from the third National Health and Nutrition Examination Survey, 1988–1994. Arch Pediatr Adolesc Med, 2003; 157:821–827.
77.
La RosaE, Clesiau LeH, ValensiP. Metabolic syndrome and psychosocial deprivation. Data collected from a Paris suburb. Diabet Metab, 2008; 34:155–61.
78.
TanumihardjoSA, AndersonC, Kaufer-HorwitzMet al.Poverty, obesity, and malnutrition: An international perspective recognizing the paradox. J Am Dietet Assoc, 2007; 107:1966–1972.
79.
Regitz-ZagrosekV, LehmkuhlE, WeickertMO. Gender differences in the metabolic syndrome and their role for cardiovascular disease. Clin Res Cardiol, 2006; 95:136–147.
80.
GoodmanE, DanielsSR, MeigsJBet al.Instability in the diagnosis of metabolic syndrome in adolescents. Circulation, 2007; 115:2316–2322.
81.
VanhalaM, VanhalaP, KumpusaloEet al.Relation between obesity from childhood to adulthood and the metabolic syndrome: Population based study. Br Med J, 1998; 317:1.
82.
VinerRM, SegalTY, Lichtarowicz-KrynskaEet al.Prevalence of the insulin resistance syndrome in obesity. Arch Dis Child, 2005; 90:10–14.
83.
KangHT, LeeHR, ShimJYet al.Association between screen time and metabolic syndrome in children and adolescents in Korea: The 2005 Korean National Health and Nutrition Examination Survey. Diabetes Res Clin Pract, 2010; 89:72–78.
84.
AgirbasliM, AgaogluNB, OrakNet al.Sex hormones and metabolic syndrome in children and adolescents. Metabol Clin Exp, 2009; 58:1256–1262.
85.
HarrabiI, BouaouinaM, MaatougJet al.Prevalence of the metabolic syndrome among urban schoolchildren in Sousse, Tunisia. Int J Cardiol, 2009; 135:130–131.
86.
LinLY, KuoHK, HwangJJet al.Serum bilirubin is inversely associated with insulin resistance and metabolic syndrome among children and adolescents. Atherosclerosis, 2009; 203:563–568.
87.
KelishadiR, ArdalanG, GheiratmandRet al.Paediatric metabolic syndrome and associated anthropometric indices: The CASPIAN Study. Acta Paediatrica, 2006; 95:1625–1634.
88.
BoneyCM, VermaA, TuckerRet al.Metabolic syndrome in childhood: Association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics, 2005; 115:e290–e296.
89.
MoreiraC, SantosR, ValeSet al.Metabolic syndrome and physical fitness in a sample of Azorean adolescents. Metabol Synd Relat D, 2010; 8:443–449.
90.
NotoD, NiglioT, CefaluABet al.Obesity and the metabolic syndrome in a student cohort from Southern Italy. Nutrit Met Cardiovasc Dis, 2009; 19:620–625.
91.
ZorziA, WahiG, MacnabAJet al.Prevalence of impaired glucose tolerance and the components of metabolic syndrome in Canadian Tsimshian Nation youth. Can J Rural Med, 2009; 14:61–67.
92.
PanamontaO, ThamsiriN, PanamontaM. Prevalence of type II diabetes and metabolic syndrome among overweight school children in Khon Kaen, Thailand. J Med Assoc Thailand, 2010; 93:56–60.
93.
Elizondo-MontemayorL, Serrano-GonzalezM, Ugalde-CasasPAet al.Metabolic syndrome risk factors among a sample of overweight and obese Mexican children. J Clin Hypertens (Greenwich), 2010; 12:380–387.
94.
KelishadiR, CookSR, MotlaghMEet al.Metabolically obese normal weight and phenotypically obese metabolically normal youths: The CASPIAN Study. J Am Dietet Assoc, 2008; 108:82–90.
95.
SerapS, MevlutB, InancCet al.Metabolic syndrome in childhood obesity. Indian Pediatr, 2007; 44:657–662.
96.
FuJF, LiangL, ZouCCet al.Prevalence of the metabolic syndrome in Zhejiang Chinese obese children and adolescents and the effect of metformin combined with lifestyle intervention. Int J Obesity, 2007; 31:15–22.
97.
EapenV, MabroukA, YousefS. Metabolic syndrome among the young obese in the United Arab Emirates. J Tropical Med, 2010; 56:325–328.
98.
van VlietM, von RosenstielIA, SchindhelmRKet al.Ethnic differences in cardiometabolic risk profile in an overweight/obese paediatric cohort in the Netherlands: A cross-sectional study. Cardiovasc Diabetol, 2009; 8:2.
99.
QuintosJB, MuzumdarH, GeorgeMet al.The prevalence of metabolic syndrome in inner city obese African-American youth. Pediatr Endocrinol Rev, 2006; 4:571–575.
100.
CaliAM, CaprioS. Ectopic fat deposition and the metabolic syndrome in obese children and adolescents. Horm Res, 2009; 1:2–7.
101.
WangX, LiangL, JunfenFUet al.Metabolic syndrome in obese children born large for gestational age. Indian J Pediatr, 2007; 74:561–565.
102.
SantoroN, CirilloG, AmatoAet al.Insulin gene variable number of tandem repeats (INS VNTR) genotype and metabolic syndrome in childhood obesity. J Clin Endrinol Metab, 2006; 91:4641–4644.
103.
GilardiniL, McTernanPG, GirolaAet al.Adiponectin is a candidate marker of metabolic syndrome in obese children and adolescents. Atherosclerosis, 2006; 189:401–407.
104.
InvittiC, MaffeisC, GilardiniLet al.Metabolic syndrome in obese Caucasian children: Prevalence using WHO-derived criteria and association with nontraditional cardiovascular risk factors. Int J Obes, 2006; 30:627–633.
105.
AtabekME. Re: Maternal waist circumference and the prediction of children's metabolic syndrome. Arch Pediatr Adolesc Med, 2008; 162:697–698.
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