A proposed simplified definition of metabolic syndrome in children and adolescents: a global perspective

Xin'nan Zong; Roya Kelishadi; Hae Soon Kim; Peter Schwandt; Tandi E Matsha; Jose G Mill; Carmelo Antonio Caserta; Carla Campos Muniz Medeiros; Anastasios Kollias; Peter H Whincup; Lucia Pacifico; Abel López-Bermejo; Min Zhao; Miaobing Zheng; Bo Xi

doi:10.1186/s12916-024-03406-y

A proposed simplified definition of metabolic syndrome in children and adolescents: a global perspective

BMC Med. 2024 May 7;22(1):190. doi: 10.1186/s12916-024-03406-y.

Authors

Xin'nan Zong^#^{1

2}, Roya Kelishadi^#³, Hae Soon Kim^#⁴, Peter Schwandt^#⁵, Tandi E Matsha^#⁶, Jose G Mill^#⁷, Carmelo Antonio Caserta^#⁸, Carla Campos Muniz Medeiros^#⁹, Anastasios Kollias^#¹⁰, Peter H Whincup¹¹, Lucia Pacifico¹², Abel López-Bermejo^{13

14

15}, Min Zhao¹⁶, Miaobing Zheng¹⁷, Bo Xi¹⁸

Affiliations

¹ Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China.
² Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
³ Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
⁴ Department of Pediatrics, Ewha Womans University College of Medicine, Seoul, Korea.
⁵ Atherosclerosis Prevention Institute, Munich-Nuremberg, Munich, Germany.
⁶ Department of Biomedical Sciences, Faculty of Health & Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa.
⁷ Department of Physiological Sciences, Center of Health Sciences, Federal University of Espírito Santo, Vitória, Brazil.
⁸ Associazione Calabrese Di Epatologia - Medicina Solidale - A.C.E. ETS, Reggio Calabria, Italy.
⁹ Department of Public Health, State University of Paraiba, Campina Grande, Brazil.
¹⁰ Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece.
¹¹ Population Health Research Institute, St George's, University of London, London, UK.
¹² Department of Maternal and Child Health, Sapienza University of Rome, Rome, Italy.
¹³ Pediatric Endocrinology Research Group, Girona Biomedical Research Institute (IDIBGI), Salt, Spain.
¹⁴ Department of Pediatrics, Hospital Dr. Josep Trueta, Girona, Spain.
¹⁵ Department of Medical Sciences, University of Girona, Girona, Spain.
¹⁶ Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China. zhaomin1986zm@126.com.
¹⁷ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
¹⁸ Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China. xibo2007@126.com.

^# Contributed equally.

Abstract

Metabolic syndrome (MetS) is becoming prevalent in the pediatric population. The existing pediatric MetS definitions (e.g., the International Diabetes Federation (IDF) definition and the modified National Cholesterol Education Program (NCEP) definition) involve complex cut-offs, precluding fast risk assessment in clinical practice.We proposed a simplified definition for assessing MetS risk in youths aged 6-17 years, and compared its performance with two existing widely used pediatric definitions (the IDF definition, and the NCEP definition) in 10 pediatric populations from 9 countries globally (n = 19,426) using the receiver operating characteristic (ROC) curve analyses. In general, the total MetS prevalence of 6.2% based on the simplified definition was roughly halfway between that of 4.2% and 7.7% estimated from the IDF and NCEP definitions, respectively. The ROC curve analyses showed a good agreement between the simplified definition and two existing definitions: the total area under the curve (95% confidence interval) of the proposed simplified definition for identifying MetS risk achieved 0.91 (0.89-0.92) and 0.79 (0.78-0.81) when using the IDF or NCEP definition as the gold standard, respectively.The proposed simplified definition may be useful for pediatricians to quickly identify MetS risk and cardiometabolic risk factors (CMRFs) clustering in clinical practice, and allow direct comparison of pediatric MetS prevalence across different populations, facilitating consistent pediatric MetS risk monitoring and the development of evidence-based pediatric MetS prevention strategies globally.

Keywords: Adolescent; Cardiovascular risk factors; Central obesity; Child; Hypertension; Metabolic syndrome; Waist-to-height ratio.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Child
Female
Global Health
Humans
Male
Metabolic Syndrome* / diagnosis
Metabolic Syndrome* / epidemiology
Prevalence
ROC Curve
Risk Assessment / methods
Risk Factors

Abstract

Publication types

MeSH terms

Grants and funding