Definition and early diagnosis of metabolic syndrome in children

Gunter Matthias Christian Flemming 4 , Sarah Bussler 1 , Antje Körner 1 , 2 , 3 ,  and Wieland Kiess 1 , 2 , 3
  • 1 Hospital for Children and Adolescents, Leipzig University, Leipzig, Germany
  • 2 LIFE-Child-Leipzig Research Centre for Civilization Diseases, Leipzig University, Leipzig, Germany
  • 3 Centre of Pediatric Research (CPL), Leipzig University, Leipzig, Germany
  • 4 Hospital for Children and Adolescents, Leipzig University, Liebigstr. 20a, Leipzig, D-04103, Germany
Gunter Matthias Christian Flemming
  • Corresponding author
  • Hospital for Children and Adolescents, Leipzig University, Liebigstr. 20a, Leipzig, D-04103, Germany
  • Email
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Sarah Bussler, Antje Körner
  • Hospital for Children and Adolescents, Leipzig University, Leipzig, Germany
  • LIFE-Child-Leipzig Research Centre for Civilization Diseases, Leipzig University, Leipzig, Germany
  • Centre of Pediatric Research (CPL), Leipzig University, Leipzig, Germany
  • Search for other articles:
  • degruyter.comGoogle Scholar
and Wieland Kiess
  • Hospital for Children and Adolescents, Leipzig University, Leipzig, Germany
  • LIFE-Child-Leipzig Research Centre for Civilization Diseases, Leipzig University, Leipzig, Germany
  • Centre of Pediatric Research (CPL), Leipzig University, Leipzig, Germany
  • Search for other articles:
  • degruyter.comGoogle Scholar

Abstract

With this review, we aim to focus the attention on some established as well as new concepts for the metabolic syndrome (MetS) in children and adolescents spanning from definition to recommendations for the diagnostic approach. Even though there is no international commonly used definition of the metabolic syndrome in children and adolescents, all definitions include obesity as precondition for the development of MetS even in children. Obesity is one of the major cardiometabolic risk factors and it is strongly linked to other metabolic diseases like hyperlipidemia, hyperinsulinemia as well as hypertension. The metabolic syndrome is commonly known as a constellation of the mentioned morbidities. Pediatricians and researchers agree that early diagnosis and early interventions of the MetS are important to improve the prevention of cardiovascular disease and type 2 diabetes in adulthood. However, this requires appropriate screening tools for children and adolescents at risk for the MetS and its comorbidities. Due to controversies regarding the definition of MetS and the lack of consensus thresholds for the single components in children and adolescents, there is no internationally accepted diagnostic pathway for MetS available. However, several consensus statements and national guidelines for the assessment of obesity and its comorbidities in children and adolescents are available. Obesity seems to be the driving factor for the development of the other risk factors of MetS. In order to avoid conflicts concerning the definition of overweight and obesity, we recommend using the WHO definition of overweight (one standard deviation body mass index for age and sex and obesity; two standard deviations body mass index for age and sex) in children and adolescents.

  • 1.

    Dietz, WH. The obesity epidemic in young children. Reduce television viewing and promote playing. BMJ 2001;322:313–4. https://doi.org/10.1136/bmj.322.7282.313.

    • Crossref
    • Export Citation
  • 2.

    Kiess, W, Penke, M, Sergeyev, E, Neef, M, Adler, M, Gausche, R, et al. Childhood obesity at the crossroads. J Pediatr Endocrinol Metab 2015;28:481–4. https://doi.org/10.1515/jpem-2015-0168.

    • PubMed
    • Export Citation
  • 3.

    Kurth, BM, Rosario, AS. Die verbreitung von übergewicht und adipositas bei kindern und jugendlichen in Deutschland. Ergebnisse des bundesweiten Kinder- und Jugendgesundheitssurveys (KiGGS). Robert Koch-Institut, Epidemiologie und Gesundheitsberichterstattung; 2007.

  • 4.

    Eckel, RH, Grundy, SM, Zimmet, PZ. The metabolic syndrome. Lancet 2005;365:1415–28. https://doi.org/10.1016/s0140-6736(05)67779-3.

    • Crossref
    • PubMed
    • Export Citation
  • 5.

    Isomaa, B, Almgren, P, Tuomi, T, Forsen, B, Lahti, K, Nissen, M, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001;24:683–9. https://doi.org/10.2337/diacare.24.4.683.

    • Crossref
    • PubMed
    • Export Citation
  • 6.

    Delavari, A, Forouzanfar, MH, Alikhani, S, Sharifian, A, Kelishadi, R. First nationwide study of the prevalence of the metabolic syndrome and optimal cutoff points of waist circumference in the Middle East: the national survey of risk factors for noncommunicable diseases of Iran. Diabetes Care 2009;32:1092–7. https://doi.org/10.2337/dc08-1800.

    • Crossref
    • PubMed
    • Export Citation
  • 7.

    Johnson, WD, Kroon, JJ, Greenway, FL, Bouchard, C, Ryan, D, Katzmarzyk, PT. Prevalence of risk factors for metabolic syndrome in adolescents: National Health and Nutrition Examination Survey (NHANES), 2001-2006. Arch Pediatr Adolesc Med 2009;163:371–7. https://doi.org/10.1001/archpediatrics.2009.3.

    • Crossref
    • PubMed
    • Export Citation
  • 8.

    Urbina, EM, Kimball, TR, Khoury, PR, Daniels, SR, Dolan, LM. Increased arterial stiffness is found in adolescents with obesity or obesity-related type 2 diabetes mellitus. J Hypertens 2010;28:1692–8. https://doi.org/10.1097/hjh.0b013e32833a6132.

    • Crossref
    • PubMed
    • Export Citation
  • 9.

    Berenson, GS. Childhood risk factors predict adult risk associated with subclinical cardiovascular disease. The Bogalusa Heart Study. Am J Cardiol 2002;90:3L–7L. https://doi.org/10.1016/s0002-9149(02)02953-3.

    • Crossref
    • PubMed
    • Export Citation
  • 10.

    Reaven, GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes 1988;37:1595–607. https://doi.org/10.2337/diabetes.37.12.1595.

    • Crossref
    • PubMed
    • Export Citation
  • 11.

    Reaven, GM. Insulin resistance and compensatory hyperinsulinemia: role in hypertension, dyslipidemia, and coronary heart disease. Am Heart J 1991;121:1283–8. https://doi.org/10.1016/0002-8703(91)90434-j.

    • Crossref
    • PubMed
    • Export Citation
  • 12.

    Kaur, J. A comprehensive review on metabolic syndrome. Cardiol Res Pract 2014;2014:943162. https://doi.org/10.1155/2014/943162.

    • PubMed
    • Export Citation
  • 13.

    Ahrens, W, Moreno, LA, Marild, S, Molnar, D, Siani, A, De Henauw, S, et al. Metabolic syndrome in young children: definitions and results of the IDEFICS study. Int J Obes 2014;38 (Suppl 2):S4–14. https://doi.org/10.1038/ijo.2014.130.

    • Crossref
    • Export Citation
  • 14.

    Cook, S, Weitzman, M, Auinger, P, Nguyen, M, Dietz, WH. 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;157:821–7. https://doi.org/10.1001/archpedi.157.8.821.

    • Crossref
    • PubMed
    • Export Citation
  • 15.

    de Ferranti, SD, Gauvreau, K, Ludwig, DS, Neufeld, EJ, Newburger, JW, Rifai, N. Prevalence of the metabolic syndrome in American adolescents: findings from the Third National Health and Nutrition Examination Survey. Circulation 2004;110:2494–7. https://doi.org/10.1016/j.accreview.2004.12.160.

    • Crossref
    • PubMed
    • Export Citation
  • 16.

    Zimmet, P, Alberti, G, Kaufman, F, Tajima, N, Silink, M, Arslanian, S, et al. The metabolic syndrome in children and adolescents. Lancet 2007;369:2059–61. https://doi.org/10.1016/S0140-6736(07)60958-1.

    • Crossref
    • PubMed
    • Export Citation
  • 17.

    Alberti, KG, Zimmet, P, Shaw, J. Metabolic syndrome – a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med 2006;23:469–80. https://doi.org/10.1111/j.1464-5491.2006.01858.x.

    • Crossref
    • PubMed
    • Export Citation
  • 18.

    Barba, G, Buck, C, Bammann, K, Hadjigeorgiou, C, Hebestreit, A, Marild, S, et al. Blood pressure reference values for European non-overweight school children: the IDEFICS study. Int J Obes 2014;38 (Suppl 2):S48–56. https://doi.org/10.1038/ijo.2014.135.

    • Crossref
    • Export Citation
  • 19.

    De Henauw, S, Michels, N, Vyncke, K, Hebestreit, A, Russo, P, Intemann, T, et al. Blood lipids among young children in Europe: results from the European IDEFICS study. Int J Obes 2014;38 (Suppl 2):S67–75. https://doi.org/10.1038/ijo.2014.137.

    • Crossref
    • Export Citation
  • 20.

    Nagy, P, Kovacs, E, Moreno, LA, Veidebaum, T, Tornaritis, M, Kourides, Y, et al. Percentile reference values for anthropometric body composition indices in European children from the IDEFICS study. Int J Obes 2014;38 (Suppl 2):S15–25. https://doi.org/10.1038/ijo.2014.131.

    • Crossref
    • Export Citation
  • 21.

    Peplies, J, Jimenez-Pavon, D, Savva, SC, Buck, C, Gunther, K, Fraterman, A, et al. Percentiles of fasting serum insulin, glucose, HbA1c and HOMA-IR in pre-pubertal normal weight European children from the IDEFICS cohort. Int J Obes 2014;38 (Suppl 2):S39–47. https://doi.org/10.1038/ijo.2014.134.

    • Crossref
    • Export Citation
  • 22.

    Sinha, R, Fisch, G, Teague, B, Tamborlane, WV, Banyas, B, Allen, K, et al. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med 2002;346:802–10. https://doi.org/10.1056/nejm200205303462224.

    • Crossref
    • PubMed
    • Export Citation
  • 23.

    Olza, J, Gil-Campos, M, Leis, R, Bueno, G, Aguilera, CM, Valle, M, et al. Presence of the metabolic syndrome in obese children at prepubertal age. Ann Nutr Metab 2011;58:343–50. https://doi.org/10.1159/000331996.

    • Crossref
    • PubMed
    • Export Citation
  • 24.

    Reinehr, T, de Sousa, G, Toschke, AM, Andler, W. Comparison of metabolic syndrome prevalence using eight different definitions: a critical approach. Arch Dis Childhood 2007;92:1067–72. https://doi.org/10.1136/adc.2006.104588.

    • Crossref
    • Export Citation
  • 25.

    Retnakaran, R, Zinman, B, Connelly, PW, Harris, SB, Hanley, AJ. Nontraditional cardiovascular risk factors in pediatric metabolic syndrome. J Pediatr 2006;148:176–82. https://doi.org/10.1016/j.jpeds.2005.08.025.

    • Crossref
    • PubMed
    • Export Citation
  • 26.

    Khader, YS, Batieha, A, Jaddou, H, Batieha, Z, El-Khateeb, M, Ajlouni, K. Factor analysis of cardiometabolic risk factors clustering in children and adolescents. Metab Syndr Relat Disord 2011;9:151–6. https://doi.org/10.1089/met.2010.0097.

    • Crossref
    • PubMed
    • Export Citation
  • 27.

    Higgins, V, Adeli, K. Pediatric metabolic syndrome: pathophysiology and laboratory assessment. EJIFCC 2017;28:25–42.

    • PubMed
    • Export Citation
  • 28.

    Hajian-Tilaki, K. Comparison of competitive models of metabolic syndrome using structural equation modeling: a confirmatory factor analysis. Diabetes Metab J 2018;42:433–41. https://doi.org/10.4093/dmj.2018.0010.

    • Crossref
    • PubMed
    • Export Citation
  • 29.

    Ferguson, TF, Funkhouser, E, Roseman, J. Factor analysis of metabolic syndrome components in the Coronary Artery Risk Development in Young Adults (CARDIA) study: examination of factors by race-sex groups and across time. Ann Epidemiol 2010;20:194–200. https://doi.org/10.1016/j.annepidem.2009.11.002.

    • Crossref
    • Export Citation
  • 30.

    Pladevall, M, Singal, B, Williams, LK, Brotons, C, Guyer, H, Sadurni, J, et al. A single factor underlies the metabolic syndrome: a confirmatory factor analysis. Diabetes Care 2006;29:113–22. https://doi.org/10.2337/diacare.29.01.06.dc05-0862.

    • Crossref
    • PubMed
    • Export Citation
  • 31.

    Li, C, Ford, ES. Is there a single underlying factor for the metabolic syndrome in adolescents? A confirmatory factor analysis. Diabetes Care 2007;30:1556–61. https://doi.org/10.2337/dc06-2481.

    • Crossref
    • Export Citation
  • 32.

    Bahar, A, Hosseini Esfahani, F, Asghari Jafarabadi, M, Mehrabi, Y, Azizi, F. The structure of metabolic syndrome components across follow-up survey from childhood to adolescence. Int J Endocrinol Metab 2013;11:16–22. https://doi.org/10.5812/ijem.4477.

    • PubMed
    • Export Citation
  • 33.

    Kelishadi, R, Ardalan, G, Adeli, K, Motaghian, M, Majdzadeh, R, Mahmood-Arabi, MS, et al. Factor analysis of cardiovascular risk clustering in pediatric metabolic syndrome: CASPIAN study. Ann Nutr Metab 2007;51:208–15. https://doi.org/10.1159/000104139.

    • Crossref
    • PubMed
    • Export Citation
  • 34.

    Bussler, S, Penke, M, Flemming, G, Elhassan, YS, Kratzsch, J, Sergeyev, E, et al. Novel insights in the metabolic syndrome in childhood and adolescence. Horm Res Paediatr 2017;88:181–93. https://doi.org/10.1159/000479510.

    • Crossref
    • PubMed
    • Export Citation
  • 35.

    Clemente, MG, Mandato, C, Poeta, M, Vajro, P. Pediatric non-alcoholic fatty liver disease: recent solutions, unresolved issues, and future research directions. World J Gastroenterol 2016;22:8078–93. https://doi.org/10.3748/wjg.v22.i36.8078.

    • Crossref
    • PubMed
    • Export Citation
  • 36.

    Gupta, R, Bhangoo, A, Matthews, NA, Anhalt, H, Matta, Y, Lamichhane, B, et al. The prevalence of non-alcoholic fatty liver disease and metabolic syndrome in obese children. J Pediatr Endocrinol Metab 2011;24:907–11. https://doi.org/10.1515/jpem.2011.282.

    • PubMed
    • Export Citation
  • 37.

    Burgert, TS, Taksali, SE, Dziura, J, Goodman, TR, Yeckel, CW, Papademetris, X, et al. Alanine aminotransferase levels and fatty liver in childhood obesity: associations with insulin resistance, adiponectin, and visceral fat. J Clin Endocrinol Metab 2006;91:4287–94. https://doi.org/10.1210/jc.2006-1010.

    • Crossref
    • PubMed
    • Export Citation
  • 38.

    Graham, RC, Burke, A, Stettler, N. Ethnic and sex differences in the association between metabolic syndrome and suspected nonalcoholic fatty liver disease in a nationally representative sample of US adolescents. J Pediatr Gastroenterol Nutr 2009;49:442–9. https://doi.org/10.1097/mpg.0b013e31819f73b4.

    • Crossref
    • Export Citation
  • 39.

    Schwimmer, JB, McGreal, N, Deutsch, R, Finegold, MJ, Lavine, JE. Influence of gender, race, and ethnicity on suspected fatty liver in obese adolescents. Pediatrics 2005;115:e561–5. https://doi.org/10.1542/peds.2004-1832.

    • Crossref
    • PubMed
    • Export Citation
  • 40.

    Belei, O, Olariu, L, Dobrescu, A, Marcovici, T, Marginean, O. The relationship between non-alcoholic fatty liver disease and small intestinal bacterial overgrowth among overweight and obese children and adolescents. J Pediatr Endocrinol Metab 2017;30:1161–8. https://doi.org/10.1515/jpem-2017-0252.

    • PubMed
    • Export Citation
  • 41.

    Bussler, S, Vogel, M, Pietzner, D, Harms, K, Buzek, T, Penke, M, et al. New pediatric percentiles of liver enzyme serum levels (alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase): effects of age, sex, body mass index, and pubertal stage. Hepatology 2018;68:1319–30. https://doi.org/10.1002/hep.29542.

    • Crossref
    • PubMed
    • Export Citation
  • 42.

    Sinha, S, Jhaveri, R, Banga, A. Sleep disturbances and behavioral disturbances in children and adolescents. Psychiatr Clin North Am 2015;38:705–21. https://doi.org/10.1016/j.psc.2015.07.009.

    • Crossref
    • PubMed
    • Export Citation
  • 43.

    Rocha, E, Vogel, M, Stanik, J, Pietzner, D, Willenberg, A, Korner, A, et al. Serum uric acid levels as an indicator for metabolically unhealthy obesity in children and adolescents. Horm Res Paediatr 2018;90:19–27. https://doi.org/10.1159/000490113.

    • Crossref
    • PubMed
    • Export Citation
  • 44.

    Nehus, E. Obesity and chronic kidney disease. Curr Opin Pediatr 2018;30:241–6. https://doi.org/10.1159/000095315.

    • Crossref
    • Export Citation
  • 45.

    Chen, J, Muntner, P, Hamm, LL, Jones, DW, Batuman, V, Fonseca, V, et al. The metabolic syndrome and chronic kidney disease in U.S. adults. Ann Int Med 2004;140:167–74. https://doi.org/10.7326/0003-4819-140-3-200402030-00002.

    • Crossref
    • Export Citation
  • 46.

    Patel, HP, Saland, JM, Ng, DK, Jiang, S, Warady, BA, Furth, SL, et al. Waist circumference and body mass index in children with chronic kidney disease and metabolic, cardiovascular, and renal outcomes. J Pediatr 2017;191:133–9. https://doi.org/10.1016/j.jpeds.2017.08.047.

    • Crossref
    • PubMed
    • Export Citation
  • 47.

    Kamboj, MK, Bonny, AE. Polycystic ovary syndrome in adolescence: diagnostic and therapeutic strategies. Transl Pediatr 2017;6:248–55. https://doi.org/10.21037/tp.2017.09.11.

    • Crossref
    • PubMed
    • Export Citation
  • 48.

    Rosenfield, RL. The diagnosis of polycystic ovary syndrome in adolescents. Pediatrics 2015;136:1154–65. https://doi.org/10.1542/peds.2015-1430.

    • Crossref
    • Export Citation
  • 49.

    Bluher, M. The distinction of metabolically ‘healthy’ from ‘unhealthy’ obese individuals. Curr Opin Lipidol 2010;21:38–43. https://doi.org/10.1097/mol.0b013e3283346ccc.

    • Crossref
    • PubMed
    • Export Citation
  • 50.

    Heinzle, S, Ball, GD, Kuk, JL. Variations in the prevalence and predictors of prevalent metabolically healthy obesity in adolescents. Pediatr Obes 2016;11:425–33. https://doi.org/10.1111/ijpo.12083.

    • Crossref
    • PubMed
    • Export Citation
  • 51.

    Damanhoury, S, Newton, AS, Rashid, M, Hartling, L, Byrne, JLS, Ball, GDC. Defining metabolically healthy obesity in children: a scoping review. Obes Rev 2018;19:1476–91. https://doi.org/10.1111/obr.12721.

    • Crossref
    • PubMed
    • Export Citation
  • 52.

    Bluher, S, Schwarz, P. Metabolically healthy obesity from childhood to adulthood—does weight status alone matter? Metabolism 2014;63:1084–92. https://doi.org/10.1016/j.metabol.2014.06.009.

    • Crossref
    • PubMed
    • Export Citation
  • 53.

    Di Bonito, P, Pacifico, L, Chiesa, C, Valerio, G, Miraglia Del Giudice, E, Maffeis, C, et al. Impaired fasting glucose and impaired glucose tolerance in children and adolescents with overweight/obesity. J Endocrinol Invest 2017;40:409–16. https://doi.org/10.1007/s40618-016-0576-8.

    • Crossref
    • PubMed
    • Export Citation
  • 54.

    Li, S, Chen, W, Srinivasan, SR, Xu, J, Berenson, GS. Relation of childhood obesity/cardiometabolic phenotypes to adult cardiometabolic profile: the Bogalusa Heart Study. Am J Epidemiol 2012;176 (Suppl 7):S142–9. https://doi.org/10.1093/aje/kws236.

    • Crossref
    • PubMed
    • Export Citation
  • 55.

    Di Bonito, P, Miraglia Del Giudice, E, Chiesa, C, Licenziati, MR, Manco, M, Franco, F, et al. Preclinical signs of liver and cardiac damage in youth with metabolically healthy obese phenotype. Nutr Metab Cardiovasc Dis 2018;28:1230–6. https://doi.org/10.1016/j.numecd.2018.08.007.

    • Crossref
    • PubMed
    • Export Citation
  • 56.

    Shaharyar, S, Roberson, LL, Jamal, O, Younus, A, Blaha, MJ, Ali, SS, et al. Obesity and metabolic phenotypes (metabolically healthy and unhealthy variants) are significantly associated with prevalence of elevated C-reactive protein and hepatic steatosis in a large healthy Brazilian population. J Obes 2015;2015:178526. https://doi.org/10.1155/2015/178526.

  • 57.

    Steinberger, J, Daniels, SR, Eckel, RH, Hayman, L, Lustig, RH, McCrindle, B, et al. Progress and challenges in metabolic syndrome in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular Nursing; and Council on Nutrition, Physical Activity, and Metabolism. Circulation 2009;119:628–47. https://doi.org/10.1161/circulationaha.108.191394.

  • 58.

    Magge, SN, Goodman, E, Armstrong, SC, Committee on Nutrition; Section on Endocrinology; Section on Obesity. The metabolic syndrome in children and adolescents: shifting the focus to cardiometabolic risk factor clustering. Pediatrics 2017;140. https://doi.org/10.1542/peds.2017-1603.

    • PubMed
    • Export Citation
  • 59.

    Kahn, R, Buse, J, Ferrannini, E, Stern, M, American Diabetes, A, American Diabetes Association; European Association for the Study of Diabetes. The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2005;28:2289–304. https://doi.org/10.1542/peds.2017-1603.

    • Crossref
    • Export Citation
  • 60.

    Alves Junior, CA, Silva, DA, Gonçalves, ECA, Trindade, EB, Mocellin, MC. Anthropometric indicators as body fat discriminators in children and adolescents: a systematic review and meta-analysis. Adv Nutr 2017;8:718–27. https://doi.org/10.3945/an.117.015446.

    • Crossref
    • PubMed
    • Export Citation
  • 61.

    Magalhaes, EI, Sant’Ana, LF, Priore, SE, Franceschini Sdo, C. [Waist circumference, waist/height ratio, and neck circumference as parameters of central obesity assessment in children]. Rev Paul Pediatr 2014;32:273–81. https://doi.org/10.1590/0103-0582201432320.

    • PubMed
    • Export Citation
  • 62.

    Ronnecke, E, Vogel, M, Bussler, S, Grafe, N, Jurkutat, A, Schlingmann, M, et al. Age- and sex-related percentiles of skinfold thickness, waist and hip circumference, waist-to-hip ratio and waist-to-height ratio: results from a population-based Pediatric Cohort in Germany (LIFE Child). Obesity Facts 2019;12:25–39. https://doi.org/10.1159/000494767.

    • Crossref
    • PubMed
    • Export Citation
  • 63.

    Brambilla, P, Bedogni, G, Moreno, LA, Goran, MI, Gutin, B, Fox, KR, et al. Crossvalidation of anthropometry against magnetic resonance imaging for the assessment of visceral and subcutaneous adipose tissue in children. Int J Obes 2006;30:23–30. https://doi.org/10.1038/sj.ijo.0803163.

    • Crossref
    • Export Citation
  • 64.

    Reinehr, T. Metabolic syndrome in children and adolescents: a critical approach considering the interaction between pubertal stage and insulin resistance. Curr Diab Rep 2016;16:8. https://doi.org/10.1007/s11892-015-0695-1.

    • Crossref
    • PubMed
    • Export Citation
  • 65.

    Goodman, E, Daniels, SR, Meigs, JB, Dolan, LM. Instability in the diagnosis of metabolic syndrome in adolescents. Circulation 2007;115:2316–22. https://doi.org/10.1161/circulationaha.106.669994.

    • Crossref
    • Export Citation
  • 66.

    Gustafson, JK, Yanoff, LB, Easter, BD, Brady, SM, Keil, MF, Roberts, MD, et al. The stability of metabolic syndrome in children and adolescents. J Clin Endocrinol Metab 2009;94:4828–34. https://doi.org/10.1210/jc.2008-2665.

    • Crossref
    • PubMed
    • Export Citation
  • 67.

    Stanley, TL, Chen, ML, Goodman, E. The typology of metabolic syndrome in the transition to adulthood. J Clin Endocrinol Metab 2014;99:1044–52. https://doi.org/10.1210/jc.2013-3531.

    • Crossref
    • PubMed
    • Export Citation
  • 68.

    Zierk, J, Arzideh, F, Rechenauer, T, Haeckel, R, Rascher, W, Metzler, M, et al. Age- and sex-specific dynamics in 22 hematologic and biochemical analytes from birth to adolescence. Clin Chem 2015;61:964–73. https://doi.org/10.1373/clinchem.2015.239731.

    • Crossref
    • PubMed
    • Export Citation
  • 69.

    Grundy, SM, Cleeman, JI, Daniels, SR, Donato, KA, Eckel, RH, Franklin, BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005;112:2735–52. https://doi.org/10.1016/s0084-3741(08)70316-0.

    • Crossref
    • PubMed
    • Export Citation
  • 70.

    Medina-Vera, I, Serralde-Zuniga, AE, Islas-Ortega, L, Jimenez-Rolland, E, Jimenez-Chanes, KD, Guevara-Cruz, M. Diagnosis of metabolic syndrome in children as a potential indicator of technical ability in medical and nutritional care. Nutr Hosp 2015;32:2105–10. https://doi.org/10.3305/nh.2015.32.5.9703.

    • PubMed
    • Export Citation
  • 71.

    Fadzlina, AA, Harun, F, Nurul Haniza, MY, Al Sadat, N, Murray, L, Cantwell, MM, et al. Metabolic syndrome among 13-year old adolescents: prevalence and risk factors. BMC Public Health 2014;14 (Suppl 3):S7. https://doi.org/10.1186/1471-2458-14-s3-s7.

    • Crossref
    • PubMed
    • Export Citation
  • 72.

    Farber, HJ, Groner, J, Walley, S, Nelson, K, Section on Tobacco Control. Protecting children from tobacco, nicotine, and tobacco smoke. Pediatrics 2015;136:e1439–67. https://doi.org/10.1542/peds.2015-3110.

    • Crossref
    • PubMed
    • Export Citation
  • 73.

    US Preventive Services Task Force, Grossman, DC, Bibbins-Domingo, K, Curry, SJ, Barry, MJ, Davidson, KW, et al. Screening for obesity in children and adolescents: us preventive services task force recommendation statement. JAMA 2017;317:2417–26. https://doi.org/10.1542/peds.2009-2037.

    • Crossref
    • PubMed
    • Export Citation
  • 74.

    Higgins, A, McCarville, M, Kurowski, J, McEwen, S, Tanz, RR. Diagnosis and screening of overweight and obese children in a resident continuity clinic. Glob Pediatr Health 2014;1:2333794X14559396. https://doi.org/10.1177/2333794x14559396.

  • 75.

    National Clinical Guideline Centre (UK). Obesity—identification, assessment and management of overweight and obesity in children, young people and adults 2014 [cited 2018 16.12.2018]. Available from: https://www.nice.org.uk/guidance/cg189/evidence/obesity-update-full-guideline-pdf-193342429.

  • 76.

    Wabitsch, M, Kunze, D. Konsensbasierte (S2) Leitlinie zur Diagnostik, Therapie und Prävention von Übergewicht und Adipositas im Kindes- und Jugendalter 2014 [cited 2018 17.12.]. Available from: https://www.adipositas-gesellschaft.de/fileadmin/PDF/Leitlinien/AGA_S2_Leitlinie_2014.pdf.

  • 77.

    Korner, A, Kratzsch, J, Gausche, R, Schaab, M, Erbs, S, Kiess, W. New predictors of the metabolic syndrome in children—role of adipocytokines. Pediatric research 2007;61:640–5. https://doi.org/10.1203/01.pdr.0000262638.48304.ef.

    • Crossref
    • PubMed
    • Export Citation
  • 78.

    Koerner, A, Kratzsch, J, Kiess, W. Adipocytokines: leptin—the classical, resistin—the controversical, adiponectin—the promising, and more to come. Best Pract Res Clin Endocrinol Metab 2005;19:525–46. https://doi.org/10.1016/j.beem.2005.07.008.

    • Crossref
    • Export Citation
  • 79.

    Fu, J, Li, Y, Esangbedo, IC, Li, G, Feng, D, Li, L, et al. Circulating osteonectin and adipokine profiles in relation to metabolically healthy obesity in chinese children: findings from BCAMS. J Am Heart Assoc 2018;7:e009169. https://doi.org/10.1161/jaha.118.009169.

    • PubMed
    • Export Citation
  • 80.

    Liu, Y, Ji, Y, Li, M, Wang, M, Yi, X, Yin, C, et al. Integrated analysis of long noncoding RNA and mRNA expression profile in children with obesity by microarray analysis. Sci Rep 2018;8:8750. https://doi.org/10.1038/s41598-018-27113-w.

    • Crossref
    • PubMed
    • Export Citation
  • 81.

    Marzano, F, Faienza, MF, Caratozzolo, MF, Brunetti, G, Chiara, M, Horner, DS, et al. Pilot study on circulating miRNA signature in children with obesity born small for gestational age and appropriate for gestational age. Pediatr Obes 2018;13:803–11. https://doi.org/10.1111/ijpo.12439.

    • Crossref
    • PubMed
    • Export Citation
  • 82.

    Ford, ES. Prevalence of the metabolic syndrome defined by the International Diabetes Federation among adults in the U.S. Diabetes Care 2005;28:2745–9. https://doi.org/10.2337/diacare.28.11.2745.

    • Crossref
    • PubMed
    • Export Citation
  • 83.

    Cruz, ML, Goran, MI. The metabolic syndrome in children and adolescents. Curr Diab Rep 2004;4:53–62. https://doi.org/10.1016/S0140-6736(07)60958-1.

    • Crossref
    • PubMed
    • Export Citation
  • 84.

    Weiss, R, Dziura, J, Burgert, TS, Tamborlane, WV, Taksali, SE, Yeckel, CW, et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 2004;350:2362–74. https://doi.org/10.1056/nejm200409093511119.

    • Crossref
    • PubMed
    • Export Citation
  • 85.

    Viner, RM, Segal, TY, Lichtarowicz-Krynska, E, Hindmarsh, P. Prevalence of the insulin resistance syndrome in obesity. Arch Dis Childhood 2005;90:10–4. https://doi.org/10.1136/adc.2003.036467.

    • Crossref
    • Export Citation
Purchase article
Get instant unlimited access to the article.
$42.00
Log in
Already have access? Please log in.


or
Log in with your institution

Journal + Issues

The Journal of Pediatric Endocrinology and Metabolism (JPEM) is the only international journal dedicated exclusively to endocrinology in the neonatal, pediatric and adolescent age groups, and publishes the results of clinical investigations in pediatric endocrinology and basic research. JPEM publishes Review Articles, Original Research, Case Reports, Short Communications and Letters to the Editor.

Search