The Journal of Pediatrics
Volume 152, Issue 2 , Pages 165-170.e2 , February 2008

Metabolic Syndrome Rates in United States Adolescents, from the National Health and Nutrition Examination Survey, 1999–2002

  • Stephen Cook, MD

      Affiliations

    • Division of General Pediatrics and Strong Children’s Research Center, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
    • Corresponding Author InformationReprint requests: Stephen Cook, MD, University of Rochester School of Medicine and Dentistry Department of Pediatrics, 601 Elmwood Ave, Box 777, Rochester, NY 14642-3917.
  • ,
  • Peggy Auinger, MS

      Affiliations

    • Division of General Pediatrics and Strong Children’s Research Center, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
  • ,
  • Chaoyang Li, MD, PhD

      Affiliations

    • Division of Adult and Community Health and the Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
  • ,
  • Earl S. Ford, MD, MPH

      Affiliations

    • Division of Adult and Community Health and the Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.

Received 31 January 2007 ,Accepted 1 June 2007.

References 

  1. Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486–2497
  2. Grundy SM, Brewer HBJ, Cleeman JI, Smith SCJ, Lenfant C, American H, et al. Definition of metabolic syndrome: teport of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation. 2004;109:433–438
  3. Ford ES. The metabolic syndrome and mortality from cardiovascular disease and all-causes: findings from the National Health and Nutrition Examination Survey II Mortality Study. Atherosclerosis. 2004;173:309–314
  4. Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA. 2002;288:2709–2716
  5. Wilson PWF, D’Agostino RB, Parise H, Sullivan L, Meigs JB. Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation. 2005;112:3066–3072
  6. 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: executive summary. Circulation. 2005;112:e285–e290
  7. Grundy SM. Does the metabolic syndrome exist?. Diabetes Care. 2006;29:1689–1692
  8. Kahn R, Buse J, Ferrannini E, Stern M. 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;28:2289–2304
  9. Kahn R. The metabolic syndrome (emperor) wears no clothes. Diabetes Care. 2006;29:1693–1696
  10. 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;157:821–827
  11. Weiss R, Dziura J, Burgert T, Tamborlane W, Taksali S, Yeckel C, et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med. 2004;350:2362–2374
  12. Cruz ML, Weigensberg MJ, Huang TT, Ball G, Shaibi GQ, Goran MI. The metabolic syndrome in overweight Hispanic youth and the role of insulin sensitivity. J Clin Endocrinol Metab. 2004;89:108–113
  13. Goodman E, Daniels SR, Morrison J, Huang B, Dolan LM. Contrasting prevalence of and demographic disparities in the World Health Organization and National Cholesterol Education Program Adult Treatment Panel III definitions of metabolic syndrome among adolescents. J Pediatr. 2004;145:445–451
  14. Centers for Disease Control and Prevention. NHANES 1999-2000 public data release file documentaion. http://www.cdc.gov/nchs/about/major/nhanes/currentnhanes.htmAccessed Jun 1, 2004
  15. Ford ES, Ajani UA, Mokdad AH. The metabolic syndrome and concentrations of C-reactive protein among US youth. Diabetes Care. 2005;28:878–881
  16. Li C, Ford ES, Mokdad AH, Cook S. Recent trends in waist circumference and waist-height ratio among US children and adolescents. Pediatrics. 2006;118:e1390–e1398
  17. Fernandez JR, Redden DT, Pietrobelli A, Allison DB. Waist circumference percentiles in nationally representative samples of African-American, European-American, and Mexican-American children and adolescents. J Pediatr. 2004;145:439–444
  18. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114:555–576
  19. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care. 2003;26:3160–3167
  20. Shah BV, Barnwell BG, Bieler GS. SUDAAN user’s manual, release 8.0. Research Triangle Park, NC: Research Triangle Institute; 2001;
  21. Bao W, Srinivasan SR, Wattigney WA, Berenson GS. Persistence of multiple cardiovascular risk clustering related to syndrome X from childhood to young adulthood (The Bogalusa Heart Study). Arch Intern Med. 1994;154:1842–1847
  22. Hardin DS, Hebert JD, Bayden T, Dehart M, Mazur L. Treatment of childhood syndrome X. Pediatrics. 1997;100:e5
  23. Arslanian S, Suprasongsin C. Insulin sensitivity, lipids, and body composition in childhood: is “syndrome X” present?. J Clin Endocrinol Metab. 1996;81:1058–1062
  24. Sinaiko AR, Jacobs D, Steinberger J, Moran A, Luepker R, Rocchini AP, et al. Insulin resistance syndrome in childhood: associations of the euglycemic insulin clamp and fasting insulin with fatness and other risk factors. J Pediatr. 2001;139:700–707
  25. Chen W, Srinivasan SR, Elkasabany A, Berenson GS. Cardiovascular risk factors clustering features of insulin resistance syndrome (syndrome X) in a biracial (black-white) population of children, adolescents, and young adults: the Bogalusa Heart Study. Am J Epidemiol. 1999;150:667–674
  26. Goodman E, Dolan LM, Morrison JA, Daniels SR. Factor analysis of clustered cardiovascular risks in adolescence: obesity is the predominant correlate of risk among youth. Circulation. 2005;111:1970–1977
  27. Berenson GS, Srinivasan SR, Bao W, Newman WP, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults (The Bogalusa Heart Study). N Engl J Med. 1998;338:1650–1656
  28. McGill HC, McMahan CA, Herderick EE, Zieske AW, Malcom GT, Tracy RE, et al. Obesity accelerates the progression of coronary atherosclerosis in young men. Circulation. 2002;105:2712–2718
  29. Raitakari OT, Porkka KV, Rasanen L, Ronnemaa T, Viikari JS. Clustering and six-year cluster-tracking of serum total cholesterol, HDL-cholesterol, and diastolic blood pressure in children and young adults. J Clin Epidemiol. 1994;47:1085–1093
  30. Eisenmann JC, Welk GJ, Wickel EE, Blair SN. Stability of variables associated with the metabolic syndrome from adolescence to adulthood: the Aerobics Center Longitudinal Study. Am J Hum Biol. 2004;16:690–696
  31. Chen W, Srinivasan SR, Elkasabany A, Berenson GS. The association of cardiovascular risk factor clustering related to insulin resistance syndrome (syndrome X) between young parents and their offspring: the Bogalusa Heart Study. Atherosclerosis. 1999;145:197–205
  32. Chen W, Bao W, Begum S, Elkasabany A, Srinivasan SR, Berenson GS. Age-related patterns of the clustering of cardiovascular risk variables of syndrome X from childhood to young adulthood in a population made up of black and white subjects: the Bogalusa Heart Study. Diabetes. 2000;49:1042–1048
  33. Katzmarzyk PT, Perusse L, Malina RM, Bergeron J, Despres JP, Bouchard C. Stability of indicators of the metabolic syndrome from childhood and adolescence to young adulthood: the Quebec Family Study. J Clin Epidemiol. 2001;54:190–195
  34. Rexrode KM, Carey VJ, Hennekens CH, Walker EA, Colditz GA, Stampfer MJ, et al. Abdominal adiposity and coronary heart disease in women. JAMA. 1998;280:1843–1848
  35. Pouliot MC, Despres JP, Nadeau A, Moorjani S, Prud’homme D, Lupien PJ, et al. Visceral obesity in men: associations with glucose tolerance, plasma insulin, and lipoprotein levels. Diabetes. 1992;41:826–834
  36. Kissebah AH, Vydelingum N, Murray R, Evans DJ, Hartz AJ, Kalkhoff RK, et al. Relation of body fat distribution to metabolic complications of obesity. J Clin Endocrinol Metab. 1982;54:254–260
  37. Despres JP, Moorjani S, Lupien PJ, Tremblay A, Nadeau A, Bouchard C. Regional distribution of body fat, plasma lipoproteins, and cardiovascular disease. Arterioscler Thromb Vasc Biol. 1990;10:497–511
  38. Yusuf S, Hawken S, Ounpuu S, Bautista L, Franzosi MG, Commerford P, et al. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study. Lancet. 2005;366:1640–1649
  39. Zhu S, Wang Z, Heshka S, Heo M, Faith MS, Heymsfield SB. Waist circumference and obesity-associated risk factors among whites in the third National Health and Nutrition Examination Survey: clinical action thresholds. Am J Clin Nutr. 2002;76:743
  40. Moreno LA, Pineda I, Rodriguez G, Fleta J, Sarria A, Bueno M. Waist circumference for the screening of the metabolic syndrome in children. Acta Paediatr. 2002;91:1307–1312
  41. Lee S, Bacha F, Gungor N, Arslanian SA. Waist circumference is an independent predictor of insulin resistance in black and white youths. J Pediatr. 2006;148:188–194
  42. 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 Relat Metab Disord. 2006;30:23–30
  43. Ford ES, Mokdad AH, Ajani UA. Trends in risk factors for cardiovascular disease among children and adolescents in the United States. Pediatrics. 2004;114:1534–1544
  44. McCarthy HD, Ellis SM, Cole TJ. Central overweight and obesity in British youth aged 11-16 years: cross-sectional surveys of waist circumference. BMJ. 2003;326:624
  45. McCarthy HD, Ashwell M. A study of central fatness using waist-to-height ratios in UK children and adolescents over two decades supports the simple message. Int J Obes. 2006;30:988–992
  46. Moreno LA, Sarria A, Fleta J, Marcos A, Bueno M. Secular trends in waist circumference in Spanish adolescents, 1995 to 2000-02. Arch Dis Child. 2005;90:818–819
  47. National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report. Obes Res. 1998;6(Suppl 2):51–209S
  48. McCarthy HD. Body fat measurements in children as predictors for the metabolic syndrome: focus on waist circumference. Proc Nutr Soc. 2006;65:385–392
  49. Daniels SR. Should pediatricians be measuring waist circumference?. J Pediatr. 2006;149:A1
  50. Williams DE, Cadwell BL, Cheng YJ, Cowie CC, Gregg EW, Geiss LS, et al. Prevalence of impaired fasting glucose and its relationship with cardiovascular disease risk factors in US adolescents, 1999-2000. Pediatrics. 2005;116:1122–1126
  51. Duncan GE. Prevalence of diabetes and impaired fasting glucose levels among US adolescents: National Health and Nutrition Examination Survey, 1999-2002. Arch Pediatr Adolesc Med. 2006;160:523–528
  52. Duncan GE, Li SM, Zhou XH. Prevalence and trends of a metabolic syndrome phenotype among US adolescents, 1999-2000. Diabetes Care. 2004;27:2438–2443
  53. Grandone A, Amato A, del Giudice EM, Perrone L. Low prevalence of impaired fasting glucose in obese adolescents from Southern Europe. Pediatrics. 2006;118:2603
  54. Love-Osborne K, Butler N, Gao D, Zeitler P. Elevated fasting triglycerides predict impaired glucose tolerance in adolescents at risk for type 2 diabetes. Pediatr Diabetes. 2006;7:205–210
  55. The STOP Type 2 Study Group. Presence of diabetes risk factors in a large US eighth-grade cohort. Diabetes Care. 2006;29:212–217
  56. Dolan LM, Bean J, D’Alessio D, Cohen RM, Morrison JA, Goodman E, et al. Frequency of abnormal carbohydrate metabolism and diabetes in a population-based screening of adolescents. J Pediatr. 2005;146:751–758
  57. Chi CH, Wang Y, Wilson DM, Robinson TN. Definition of metabolic syndrome in preadolescent girls. J Pediatr. 2006;148:788–792
  58. Coviello AD, Legro RS, Dunaif A. Adolescent girls with polycystic ovary syndrome have an increased risk of the metabolic syndrome associated with increasing androgen levels independent of obesity and insulin resistance. J Clin Endocrinol Metab. 2006;91:492–497
  59. Whincup PH, Gilg JA, Donald AE, Katterhorn M, Oliver C, Cook DG, et al. Arterial distensibility in adolescents: the influence of adiposity, the metabolic syndrome, and classic risk factors. Circulation. 2005;112:1789–1797
  60. Weitzman M, Cook S, Auinger P, Florin TA, Daniels S, Nguyen M, et al. Tobacco smoke exposure is associated with the metabolic syndrome in adolescents. Circulation. 2005;112:862–869
  61. Iannuzzi A, Licenziati MR, Acampora C, Renis M, Agrusta M, Romano L, et al. Carotid artery stiffness in obese children with the metabolic syndrome. Am J Cardiol. 2006;97:528–531
  62. Ventura AK, Loken E, Birch LL. Risk profiles for metabolic syndrome in a nonclinical sample of adolescent girls. Pediatrics. 2006;118:2434–2442
  63. Esmaillzadeh A, Mirmiran P, Azadbakht L, Etemadi A, Azizi F. High prevalence of the metabolic syndrome in Iranian adolescents. Obes Res. 2006;14:377–382
  64. Park HS, Han JH, Choi KM, Kim SM. Relation between elevated serum alanine aminotransferase and metabolic syndrome in Korean adolescents. Am J Clin Nutr. 2005;82:1046–1051
  65. Waters KA, Sitha S, O’Brien LM, Bibby S, de Torres C, Vella S, et al. Follow-up on metabolic markers in children treated for obstructive sleep apnea. Am J Respir Crit Care Med. 2006;174:455–460
  66. Rodriguez-Moran M, Salazar-Vazquez B, Violante R, Guerrero-Romero F. Metabolic syndrome among children and adolescents aged 10-18 years. Diabetes Care. 2004;27:2516–2517
  67. Pankow JS, Jacobs DR, Steinberger J, Moran A, Sinaiko AR. Insulin resistance and cardiovascular disease risk factors in children of parents with the insulin resistance (metabolic) syndrome. Diabetes Care. 2004;27:775–780
  68. Reis EC, Kip KE, Marroquin OC, Kiesau M, Hipps L, Peters RE, et al. Screening children to identify families at increased risk for cardiovascular disease. Pediatrics. 2006;118:e1789–e1797
  69. The SEARCH Study Group. SEARCH for Diabetes in Youth: a multicenter study of the prevalence, incidence and classification of diabetes mellitus in youth. Control Clin Trials. 2004;25:458–471
  70. Monzavi R, Dreimane D, Geffner ME, Braun S, Conrad B, Klier M, et al. Improvement in risk factors for metabolic syndrome and insulin resistance in overweight youth who are treated with lifestyle intervention. Pediatrics 2006;eds.
  71. Morrison JA, Friedman LA, Harlan WR, Harlan LC, Barton BA, Schreiber GB, et al. Development of the metabolic syndrome in black and white adolescent girls: a longitudinal assessment. Pediatrics. 2005;116:1178–1182
  72. Alberti KG, Zimmet P, Shaw J. The metabolic syndrome—a new worldwide definition. Lancet. 2005;366:1059–1062
  73. Thompson DR, Obarzanek E, Franko DL, Barton BA, Morrison J, Biro FM, et al. Childhood overweight and cardiovascular disease risk factors: the National Heart, Lung, and Blood Institute Growth and Health Study. J Pediatr. 2007;150:18–25
  74. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006;295:1549–1555

PII: S0022-3476(07)00562-8

doi: 10.1016/j.jpeds.2007.06.004

The Journal of Pediatrics
Volume 152, Issue 2 , Pages 165-170.e2 , February 2008