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The Stability of Metabolic Syndrome in Children and Adolescents

Unit on Growth and Obesity (J.K.G., L.B.Y., B.D.E., S.M.B., M.F.K., M.D.R., J.C.H., S.Z.Y., J.A.Y.), Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Nutrition Department (N.G.S.), Hatfield Clinical Research Center; and Division of Digestive Diseases and Nutrition (S.Z.Y.), National Institute of Diabetes and Digestive Kidney Diseases; and Division of Nutrition Research Coordination (V.S.H.), National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland 20892

Address all correspondence and requests for reprints to: Jack A. Yanovski, M.D., Ph.D., Unit on Growth and Obesity, National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), 9000 Rockville Pike, Hatfield Clinical Research Center, Room 1E-3330, MSC 1103, Bethesda, Maryland 20892-1103. E-mail: jy15i{at}nih.gov.

Context: Some studies suggest the presence of metabolic syndrome before adulthood may identify those at high risk for later cardiovascular morbidity, but there are few data examining the reliability of pediatric metabolic syndrome.

Objective: To examine the short- and long-term stability of pediatric metabolic syndrome.

Design: Metabolic syndrome was defined as having at least three of the following: waist circumference, blood pressure, and fasting serum triglycerides in the 90th or higher percentile for age/sex; high-density lipoprotein-cholesterol 10th or lower percentile for age/sex; and fasting serum glucose of at least 100 mg/dl. Short-term metabolic syndrome stability (repeated measurements within 60 d) was assessed in obese youth ages 6–17 yr. Long-term metabolic syndrome stability (repeated measurements more than 1.5 yr apart) was studied in 146 obese and nonobese children age 6–12 yr at baseline.

Patients and Setting: Convenience samples of obese and nonobese youth ages 6–17 yr participating in research studies were collected at a clinical research hospital.

Results: Short-term metabolic syndrome stability (repeat measurements performed 19.7 ± 13.1 d apart) was assessed in 220 children. The diagnosis of metabolic syndrome was unstable in 31.6% of cases. At their short-term follow-up visit, incidence of metabolic syndrome among participants who did not have metabolic syndrome at baseline was 24%. In the long term (repeat measurements performed 5.6 ± 1.9 yr apart), the diagnosis of metabolic syndrome was unstable in 45.5% of cases.

Conclusions: Cutoff-point-based definitions for pediatric metabolic syndrome have substantial instability in the short and long term. The value of making a cutoff-point-based diagnosis of metabolic syndrome during childhood or adolescence remains in question.

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