Obesity and the metabolic syndrome in children and adolescents.

BACKGROUND The prevalence and magnitude of childhood obesity are increasing dramatically. We examined the effect of varying degrees of obesity on the prevalence of the metabolic syndrome and its relation to insulin resistance and to C-reactive protein and adiponectin levels in a large, multiethnic, multiracial cohort of children and adolescents. METHODS We administered a standard glucose-tolerance test to 439 obese, 31 overweight, and 20 nonobese children and adolescents. Baseline measurements included blood pressure and plasma lipid, C-reactive protein, and adiponectin levels. Levels of triglycerides, high-density lipoprotein cholesterol, and blood pressure were adjusted for age and sex. Because the body-mass index varies according to age, we standardized the value for age and sex with the use of conversion to a z score. RESULTS The prevalence of the metabolic syndrome increased with the severity of obesity and reached 50 percent in severely obese youngsters. Each half-unit increase in the body-mass index, converted to a z score, was associated with an increase in the risk of the metabolic syndrome among overweight and obese subjects (odds ratio, 1.55; 95 percent confidence interval, 1.16 to 2.08), as was each unit of increase in insulin resistance as assessed with the homeostatic model (odds ratio, 1.12; 95 percent confidence interval, 1.07 to 1.18 for each additional unit of insulin resistance). The prevalence of the metabolic syndrome increased significantly with increasing insulin resistance (P for trend, <0.001) after adjustment for race or ethnic group and the degree of obesity. C-reactive protein levels increased and adiponectin levels decreased with increasing obesity. CONCLUSIONS The prevalence of the metabolic syndrome is high among obese children and adolescents, and it increases with worsening obesity. Biomarkers of an increased risk of adverse cardiovascular outcomes are already present in these youngsters.

[1]  W. Tamborlane,et al.  Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. , 2002, The New England journal of medicine.

[2]  Ncep Expert Panel on Blood Cholesterol Levels in Childr Adolescents.  National Cholesterol Education Program (NCEP): highlights of the report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. , 1992, Pediatrics.

[3]  M. Goran.  Visceral fat in prepubertal children: Influence of obesity, anthropometry, ethnicity, gender, diet, and growth , 1999, American journal of human biology : the official journal of the Human Biology Council.

[4]  P. Ridker,et al.  Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. , 1997, The New England journal of medicine.

[5]  S. Kiechl,et al.  Prevalence of insulin resistance in metabolic disorders: the Bruneck Study. , 1998, Diabetes.

[6]  W. Dietz,et al.  Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988-1994. , 2003, Archives of pediatrics & adolescent medicine.

[7]  R. Turner,et al.  Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man , 1985, Diabetologia.

[8]  J. E. Jackson,et al.  Factor analysis, an applied approach , 1983 .

[9]  S. Ozanne,et al.  Early programming of glucose–insulin metabolism , 2002, Trends in Endocrinology & Metabolism.

[10]  J B Stokes,et al.  The national high blood pressure education program. , 1974, Journal of the American Pharmaceutical Association.

[11]  T. Lam,et al.  C-reactive protein predicts the deterioration of glycemia in chinese subjects with impaired glucose tolerance. , 2003, Diabetes care.

[12]  U. Müller-Ladner,et al.  Adiponectin represents an independent cardiovascular risk factor predicting serum HDL‐cholesterol levels in type 2 diabetes , 2003, FEBS letters.

[13]  M. Thun,et al.  Body-mass index and mortality in a prospective cohort of U.S. adults. , 1999, The New England journal of medicine.

[14]  Mark B Pepys,et al.  C-reactive protein: a critical update. , 2003, The Journal of clinical investigation.

[15]  G. Reaven.  Banting lecture 1988. Role of insulin resistance in human disease. , 1988, Diabetes.

[16]  B. Gower,et al.  Abdominal obesity and cardiovascular risk in children , 1998, Coronary artery disease.

[17]  W. Dietz,et al.  Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935. , 1992, The New England journal of medicine.

[18]  Tracey McLaughlin,et al.  Relationship between obesity, insulin resistance, and coronary heart disease risk. , 2002, Journal of the American College of Cardiology.

[19]  A. Döring,et al.  C-Reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men: results from the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Augsburg Cohort Study, 1984 to 1992. , 1999, Circulation.

[20]  S. Caprio.  Insulin resistance in childhood obesity. , 2002, Journal of pediatric endocrinology & metabolism : JPEM.

[21]  Douglas G. Altman,et al.  Practical statistics for medical research , 1990 .

[22]  S. Holm.  A Simple Sequentially Rejective Multiple Test Procedure , 1979 .

[23]  S. Haffner,et al.  Cardiovascular risk factors in confirmed prediabetic individuals. Does the clock for coronary heart disease start ticking before the onset of clinical diabetes? , 1990, JAMA.

[24]  H. Pollack,et al.  Epidemic increase in childhood overweight, 1986-1998. , 2001, JAMA.

[25]  G. Reaven.  Role of Insulin Resistance in Human Disease , 1988, Diabetes.

[26]  P. Zimmet,et al.  Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO Consultation , 1998, Diabetic medicine : a journal of the British Diabetic Association.

[27]  NoriyukiOuchi,et al.  Association of Hypoadiponectinemia With Coronary Artery Disease in Men , 2003 .

[28]  P. Ridker,et al.  Inflammatory bio‐markers and cardiovascular risk prediction , 2002, Journal of internal medicine.

[29]  Endy,et al.  Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults , 2000 .

[30]  S. Yanovski,et al.  Differences in body composition of black and white girls. , 1996, The American journal of clinical nutrition.

[31]  S. Arslanian.  Type 2 Diabetes in Children: Clinical Aspects and Risk Factors , 2004, Hormone Research in Paediatrics.

[32]  E. Ford.  C-Reactive Protein Concentration and Cardiovascular Disease Risk Factors in Children: Findings From the National Health and Nutrition Examination Survey 1999–2000 , 2003, Circulation.

[33]  S. Daniels,et al.  Obesity, insulin resistance, diabetes, and cardiovascular risk in children: an American Heart Association scientific statement from the Atherosclerosis, Hypertension, and Obesity in the Young Committee (Council on Cardiovascular Disease in the Young) and the Diabetes Committee (Council on Nutrition, , 2003, Circulation.

[34]  J. Tanner,et al.  Growth at adolescence : with a general consideration of the effects of hereditary and environmental factors upon growth and maturation from birth to maturity , 1962 .

[35]  E. Lambert,et al.  The foetal origins of the metabolic syndrome--a South African perspective. , 2002, Cardiovascular journal of South Africa : official journal for Southern Africa Cardiac Society [and] South African Society of Cardiac Practitioners.