Published Online
on April 9, 2007

A more recent version of this article appeared on May 1, 2007

This Article Full Text (PDF) All Versions of this Article: 115/17/2316    most recent CIRCULATIONAHA.106.669994v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Goodman, E. Articles by Dolan, L. M. Search for Related Content PubMed PubMed Citation Articles by Goodman, E. Articles by Dolan, L. M. Pubmed/NCBI databases Medline Plus Health Information Metabolic Syndrome Related Collections Risk Factors Type 2 diabetes Epidemiology

Submitted on October 16, 2006
Accepted on February 9, 2007

Instability in the Diagnosis of Metabolic Syndrome in Adolescents

Elizabeth Goodman MD^*, Stephen R. Daniels MD, PhD, James B. Meigs MD, MPH, and Lawrence M. Dolan MD

From the Floating Hospital for Children at Tufts-New England Medical Center, Boston, Mass (E.G.); Department of Pediatrics, Denver Children’s Hospital, and University of Colorado School of Medicine, Denver (S.R.D.); Department of Medicine, General Medicine Division, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (J.B.M.); and Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio (L.M.D.).

^* To whom correspondence should be addressed. E-mail: egoodman{at}tufts-nemc.org.

Background--Factor analyses suggest that the structure underlying metabolic syndrome is similar in adolescents and adults. However, adolescence is a period of intense physiological change, and therefore stability of the underlying metabolic structure and clinical categorization based on metabolic risk is uncertain.

Methods and Results--We analyzed data from 1098 participants in the Princeton School District Study, a school-based study begun in 2001-2002, who were followed up for 3 years. We performed factor analyses of 8 metabolic risks at baseline and follow-up to assess stability of factor patterns and clinical categorization of metabolic syndrome. Metabolic syndrome was defined using the current American Heart Association/National Heart, Lung, and Blood Institute definition for adults (AHA), a modified AHA definition used in prior pediatric metabolic syndrome studies (pediatric AHA), and the International Diabetes Federation (IDF) guidelines. We found that factor structures were essentially identical at both time points. However, clinical categorization was not stable. Approximately half of adolescents with baseline metabolic syndrome lost the diagnosis at follow-up regardless of the definitions used: pediatric AHA=56% (95% confidence interval [CI], 42% to 69%), AHA=49% (95% CI, 32% to 66%), IDF=53% (95% CI, 38% to 68%). In addition to loss of the diagnosis, new cases were identified. Cumulative incidence rates were as follows: pediatric AHA=3.8% (95% CI, 2.8% to 5.2%); AHA=4.4% (95% CI, 3.3% to 5.9%); IDF=5.2% (95% CI, 4.0% to 6.8%).

Conclusions--During adolescence, metabolic risk factor clustering is consistent. However, marked instability exists in the categorical diagnosis of metabolic syndrome. This instability, which includes both gain and loss of the diagnosis, suggests that the syndrome has reduced clinical utility in adolescence and that metabolic syndrome-specific pharmacotherapy for youth may be premature.

Key words: adolescents • insulin • obesity • syndrome X

This article has been cited by other articles:

				P. Levy, M. R. Bonsignore, and J. Eckel Sleep, sleep-disordered breathing and metabolic consequences Eur. Respir. J., July 1, 2009; 34(1): 243 - 260. [Abstract] [Full Text] [PDF]

				W. D. Johnson, J. J. M. Kroon, F. L. Greenway, C. Bouchard, D. Ryan, and P. T. Katzmarzyk Prevalence of Risk Factors for Metabolic Syndrome in Adolescents: National Health and Nutrition Examination Survey (NHANES), 2001-2006 Arch Pediatr Adolesc Med, April 1, 2009; 163(4): 371 - 377. [Abstract] [Full Text] [PDF]

				R.-C. Huang, T. A. Mori, V. Burke, J. Newnham, F. J. Stanley, L. I. Landau, G. E. Kendall, W. H. Oddy, and L. J. Beilin Synergy Between Adiposity, Insulin Resistance, Metabolic Risk Factors, and Inflammation in Adolescents Diabetes Care, April 1, 2009; 32(4): 695 - 701. [Abstract] [Full Text] [PDF]

				J. Steinberger, S. R. Daniels, R. H. Eckel, L. Hayman, R. H. Lustig, B. McCrindle, and M. L. Mietus-Snyder 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, February 3, 2009; 119(4): 628 - 647. [Full Text] [PDF]

				WRITING GROUP MEMBERS, D. Lloyd-Jones, R. Adams, M. Carnethon, G. De Simone, T. B. Ferguson, K. Flegal, E. Ford, K. Furie, A. Go, et al. Heart Disease and Stroke Statistics--2009 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, January 27, 2009; 119(3): e21 - e181. [Full Text] [PDF]

				M. Chinali, G. de Simone, M. J. Roman, L. G. Best, E. T. Lee, M. Russell, B. V. Howard, and R. B. Devereux Cardiac Markers of Pre-Clinical Disease in Adolescents With the Metabolic Syndrome: The Strong Heart Study J. Am. Coll. Cardiol., September 9, 2008; 52(11): 932 - 938. [Abstract] [Full Text] [PDF]

				S. R. Daniels Metabolic Syndrome and Cardiovascular Abnormalities in Children J. Am. Coll. Cardiol., September 9, 2008; 52(11): 939 - 940. [Full Text] [PDF]

				K. A Matyka and S. Malik Management of the obese child -- Application of NICE guidelines 2006 The British Journal of Diabetes & Vascular Disease, July 1, 2008; 8(4): 178 - 182. [Abstract] [PDF]

				K. A. Matyka Type 2 diabetes in childhood: epidemiological and clinical aspects Br. Med. Bull., June 1, 2008; 86(1): 59 - 75. [Abstract] [Full Text] [PDF]

				Writing Group Members, W. Rosamond, K. Flegal, K. Furie, A. Go, K. Greenlund, N. Haase, S. M. Hailpern, M. Ho, V. Howard, et al. Heart Disease and Stroke Statistics--2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, January 29, 2008; 117(4): e25 - e146. [Full Text] [PDF]

				S. D De Ferranti and S. K Osganian Epidemiology of paediatric metabolic syndrome and type 2 diabetes mellitus Diabetes and Vascular Disease Research, December 1, 2007; 4(4): 285 - 296. [Abstract] [PDF]

				Caution on Metabolic Syndrome Diagnosis Journal Watch Pediatrics and Adolescent Medicine, June 27, 2007; 2007(627): 2 - 2. [Full Text]

				S. Cook and S. S. Gidding Modifying Cardiovascular Risk in Adolescent Obesity Circulation, May 1, 2007; 115(17): 2251 - 2253. [Full Text] [PDF]