The Journal of Pediatrics
Volume 152, Issue 2 , Pages 158-159.e1, February 2008

Finding Thresholds of Risk for Components of the Pediatric Metabolic Syndrome

  • Terry T.-K. Huang, PhD, MPH

      Affiliations

    • Corresponding Author InformationReprint requests: Dr Terry Huang, Health Scientist Administrator and Program Director, Pediatric Obesity and Metabolic Syndrome, National Institute of Child Health and Human Development, 6100 Executive Blvd, 4B11, Rockville, MD 20852.

From the Endocrinology, Nutrition and Growth Branch Center for Research for Mothers and Children, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.

Received 31 January 2007; received in revised form 7 September 2007; accepted 17 September 2007.

Article Outline

Abbreviations: PMSWG, Pediatric Metabolic Syndrome Working Group

 

In light of the lack of a common definition for the metabolic syndrome in children and adolescents, the National Institute of Child Health and Human Development, with co-sponsorship from the National Institute of Diabetes and Digestive and Kidney Diseases, the National Heart, Lung, and Blood Institute, and the National Institutes of Health Office of Rare Diseases, invited a panel of experts to form the Pediatric Metabolic Syndrome Working Group (PMSWG) to determine the potential to create a common pediatric research threshold for each of the 5 traditional risk components in the metabolic syndrome. The PMSWG was not designed to issue consensus guidelines; rather, members of the PMSWG were invited to assist the sponsoring organizations to move the science forward. The term metabolic syndrome is used simply for convenience to indicate the clustering of the 5 common risk factors: obesity, hypertension, impaired fasting glucose, hypertriglyceridemia, and reduced high-density lipoprotein cholesterol. The goal of the PMSWG was neither to endorse the terminology of metabolic syndrome nor to engage in the ongoing debate about its meaningfulness and validity. Rather, PMSWG was convened to examine the possibility of identifying thresholds of risk in each of the 5 risk components with the hope of providing a standard frame of comparison across research studies. This effort fully acknowledges the deficiencies of the metabolic syndrome as a construct, particularly in the clinical setting, and the value of considering other risk factors, such as smoking, family history, and other biomarkers, beyond the 5 commonly considered components.1, 2, 3

See related articles, p 160, p 165, p 171, p 177, p 185, p 191, p 201, and p 207

Members of the PMSWG participated in an initial workshop in July 2006 to evaluate results from a series of new analyses with existing data sets, which were designed to examine different cutoff points of components of the metabolic syndrome in childhood in relation to 1) corresponding adult components, 2) adult metabolic syndrome (using the jointly-published definition by the American Heart Association and the National Heart, Lung, and Blood Institute),1 and 3) clinical precursors of disease that were precisely measured in childhood. Data presented and discussed also examined different sets of the metabolic syndrome component cutoff points in relation to adult metabolic syndrome. This issue of The Journal includes a collection of 7 papers that were presented at the July 2006 workshop. Contents of this group submission include reviews of existing pediatric metabolic syndrome definitions and their impact on prevalence estimates (Ford et al4 and Cook et al5) and the predictive usefulness of each risk component at a given cutoff value in relation to clinical precursors of disease in childhood (Shaibi et al6 and Lee et al7) or adult metabolic syndrome (Huang et al8 and Sun et al9). In addition, a seventh paper appearing in this issue shows that metabolic syndrome in childhood confers a significant, independent risk for type 2 diabetes mellitus in adulthood (Morrison et al10). These papers represent summaries of the current state of knowledge for factors related to the metabolic syndrome. Although this collection of articles was meant to disseminate the work of some members of the PMSWG to date to the larger scientific community, each paper was evaluated independently in The Journal review process and should not be construed as representing the consensus view of the PMSWG.

Work of the PMSWG is ongoing. At the conclusion of the July 2006 workshop, the PMSWG recommended additional analyses of existing data to: 1) examine pediatric metabolic components in relation to adult incident type 2 diabetes mellitus and cardiovascular disease in long-term population-based cohorts, with the possibility of combining some data sets for analysis; 2) examine the stability of metabolic phenotypes with time in childhood and adolescence; 3) apply the statistical algorithm used in the international pediatric obesity definition11 to waist circumference by using data from the National Health and Nutrition Examination Surveys; and 4) examine the role of different anthropometric indices of body composition in relation to adult type 2 diabetes mellitus and cardiovascular disease. These analyses are underway and will be presented and evaluated at the next PMSWG meeting in 2008.

In brief, dichotomizing metabolic risk factors may be useful for identifying obese children who are metabolically at risk. We acknowledge that the development and clinical application of a definition of the metabolic syndrome in childhood may not capture most individuals in whom type 2 diabetes or cardiovascular disease eventually develops. More important, however, by examining potential thresholds of risk in each component in relation to adult disease by using existing longitudinal data, the PMSWG hopes to provide a baseline of reference across pediatric studies that involve the 5 common components of the syndrome.

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Acknowledgments available at www.jpeds.com.

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Acknowledgments 

*Members of the PMSWG (in alphabetical order): Silva Arslanian, MD, Children’s Hospital of Pittsburgh; Gerald Berenson, MD, Tulane University; Sonia Caprio, MD, Yale University; Stephen Cook, MD, University of Rochester; Martha Cruz, D.Phil., University of Texas at El Paso; Stephen Daniels, MD, PhD (co-chair), The Children’s Hospital of Denver; James Dziura, PhD, Yale University; Earl Ford, MD, MPH, Centers for Disease Control and Prevention; Elizabeth Goodman, MD, New England Medical Center and Tufts University; Michael Goran, PhD, University of Southern California; Gilman Grave, MD, NICHD; Steven Haffner, MD, University of Texas Health Sciences Center San Antonio; Mary Horlick, MD, NIDDK; Terry Huang, PhD, MPH, NICHD; Francine Kaufman, MD, Children’s Hospital of Los Angeles; Rae-Ellen Kavey, MD, NHLBI; SoJung Lee, PhD, Children’s Hospital of Pittsburgh; Ruohong Liang, MD, Wright State University; Barbara Linder, MD, PhD, NIDDK; Kiang Liu, PhD, Northwestern University; Cay Loria, PhD, NHLBI; John Morrison, PhD, Cincinnati Children’s Hospital Medical Center; Tonja Nansel, PhD, NICHD; Eva Obarzanek, PhD, NHLBI; Gabriel Shaibi, PhD, DPT, Arizona State University; Alan Sinaiko, MD, University of Minnesota; Peter Savage, MD, NHLBI; Melinda Sothern, PhD, Louisiana State University Health Sciences Center; Julia Steinberger, MD, University of Minnesota; Shumei Sun, PhD (co-chair), Wright State University; Darrell Wilson, MD, Stanford University; Jack Yanovski, MD, PhD, NICHD.

The PMSWG thanks Ms. Andrea Furia and Ms. Chris Jennings of NICHD for their logistic support of PMSWG activities.

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References 

  1. Grundy SM. Metabolic syndrome scientific statement by the American Heart Association and the National Heart, Lung, and Blood Institute. Arterioscler Thromb Vasc Biol. 2005;25:2243–2244
  2. 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
  3. National Cholesterol Education Program. Executive summary of the third report of the NCEP expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treat Panel III). JAMA. 2002;285:2486–2497
  4. Ford ES, Li C. Defining the metabolic syndrome in children and adolescents: will the real definition please stand up?. J Pediatr. 2008;152:160–164
  5. Cook S, Auinger P, Chaoyang L, Ford E. Metabolic syndrome rates in United States adolescents, from the National Health and Nutrition Examination Survey, 1999-2002. J Pediatr. 2008;152:165–170
  6. Shaibi GQ, Goran MI. Examining metabolic syndrome definitions in overweight hispanic youth: a focus on insulin resistance. J Pediatr. 2008;152:171–176
  7. Lee S, Bacha F, Gungor N, Arslanian S. Comparison of different definitions of pediatric metabolic syndrome: relation to abdominal adiposity, insulin resistance, adiponectin, and inflammatory biomarkers. J Pediatr. 2008;152:177–184
  8. Huang TTK, Nansel TR, Belsheim AR, Morrison JA. Sensitivity, specificity, and predictive values of pediatric metabolic syndrome components in relation to adult metabolic syndrome: the Princeton LRC follow-up study. J Pediatr. 2008;152:185–190
  9. Sun SS, Liang R, Huang TTK, Daniels SR, Arslanian SS, Liu K, et al. Childhood obesity predicts adult metabolic syndrome: the Fels Longitudinal Study. J Pediatr. 2008;152:191–200
  10. Morrison JA, Friedman LA, Wang P, Glueck CJ. Metabolic syndrome in childhood predicts adult metabolic syndrome and type 2 diabetes mellitus 25 to 30 years later. J Pediatr. 2008;152:201–206
  11. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000;320:1240–1243

 Contents of this publication do not necessarily reflect the views and policies of the National Institutes of Health.

PII: S0022-3476(07)00892-X

doi:10.1016/j.jpeds.2007.09.032

Refers to article:

  • Defining the Metabolic Syndrome in Children and Adolescents: Will the Real Definition Please Stand Up? , 01 November 2007

    Earl S. Ford, Chaoyang Li
    The Journal of Pediatrics February 2008 (Vol. 152, Issue 2, Pages 160-164.e13)

  • Metabolic Syndrome Rates in United States Adolescents, from the National Health and Nutrition Examination Survey, 1999–2002 , 18 October 2007

    Stephen Cook, Peggy Auinger, Chaoyang Li, Earl S. Ford
    The Journal of Pediatrics February 2008 (Vol. 152, Issue 2, Pages 165-170.e2)

  • Examining Metabolic Syndrome Definitions in Overweight Hispanic Youth: A Focus on Insulin Resistance , 22 October 2007

    Gabriel Q. Shaibi, Michael I. Goran
    The Journal of Pediatrics February 2008 (Vol. 152, Issue 2, Pages 171-176)

  • Comparison of Different Definitions of Pediatric Metabolic Syndrome: Relation to Abdominal Adiposity, Insulin Resistance, Adiponectin, and Inflammatory Biomarkers , 22 October 2007

    SoJung Lee, Fida Bacha, Neslihan Gungor, Silva Arslanian
    The Journal of Pediatrics February 2008 (Vol. 152, Issue 2, Pages 177-184.e3)

  • Sensitivity, Specificity, and Predictive Values of Pediatric Metabolic Syndrome Components in Relation to Adult Metabolic Syndrome: The Princeton LRC Follow-up Study , 18 October 2007

    Terry T.-K. Huang, Tonja R. Nansel, Allen R. Belsheim, John A. Morrison
    The Journal of Pediatrics February 2008 (Vol. 152, Issue 2, Pages 185-190.e5)

  • Childhood Obesity Predicts Adult Metabolic Syndrome: The Fels Longitudinal Study , 01 November 2007

    Shumei S. Sun, Ruohong Liang, Terry T.-K. Huang, Stephen R. Daniels, Silva Arslanian, Kiang Liu, Gilman D. Grave, Roger M. Siervogel
    The Journal of Pediatrics February 2008 (Vol. 152, Issue 2, Pages 191-200.e1)

  • Metabolic Syndrome in Childhood Predicts Adult Metabolic Syndrome and Type 2 Diabetes Mellitus 25 to 30 Years Later , 05 November 2007

    John A. Morrison, Lisa Aronson Friedman, Ping Wang, Charles J. Glueck
    The Journal of Pediatrics February 2008 (Vol. 152, Issue 2, Pages 201-206)

  • Waist-to-Height Ratio, a Useful Index to Identify High Metabolic Risk in Overweight Children , 19 November 2007

    Claudio Maffeis, Claudia Banzato, Giorgio Talamini, Obesity Study Group of the Italian Society of Pediatric Endocrinology and Diabetology
    The Journal of Pediatrics February 2008 (Vol. 152, Issue 2, Pages 207-213.e2)

The Journal of Pediatrics
Volume 152, Issue 2 , Pages 158-159.e1, February 2008

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