[PHNUTR-L] Metabolic syndrome affects nearly 1 in 10 US teens

[Kathrynne Holden]

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Public release date: 25-Jan-2008
http://www.eurekalert.org/pub_releases/2008-01/uorm-msa012508.php

Contact: Heather Hare
heather_hare at urmc.rochester.edu
585-273-2840
University of Rochester Medical Center

Metabolic syndrome affects nearly 1 in 10 US teens

Lack of standard definition of risk factors makes measuring problem 
difficult

About nine percent of teenagers may have metabolic syndrome, a 
clustering of risk factors that put them on the path toward heart 
disease and diabetes in adulthood. This shocking statistic represents 
some of the first concentrated efforts to define and measure metabolic 
syndrome in children and adolescents – a necessary starting point for 
combating the problem, but one that has proven even trickier in youth 
than it has been in adults.

With the number of obese children in the United States rising at an 
alarming rate, pediatricians, family practitioners and researchers are 
concerned about what it means to for children’s future health. The U.S. 
cholesterol guidelines have defined the metabolic syndrome for adults 
who have a cluster of risk factors, including increased waist 
circumference (central adiposity), hypertension (or elevated blood 
pressure), low HDL cholesterol, elevated triglycerides and an elevated 
fasting glucose. Even though these same components can be found in 
children, they have not been developed into a universal definition or 
diagnosis. In fact, they have only recently gained attention with the 
first publication on the syndrome by Stephen Cook, M.D., M.P.H., 
assistant professor of Pediatrics at the University of Rochester Medical 
Center, in 2003, which was based on national data from 1988 to 1994.

In the summer of 2006, a handful of national experts were convened by 
the National Institutes of Health with a task to define the metabolic 
syndrome for children and adolescents. The Pediatric Metabolic Syndrome 
Working Group (PMSWG) chose to tackle this problem affecting overweight 
and obese youth, tapping Cook to participate. The National Institute of 
Child Health and Human Development, National Heart, Lung, and Blood 
Institute, National Institute of Diabetes and Digestive and Kidney 
Diseases and the National Institutes of Health Office of Rare Diseases 
sponsored the conference.

As part of the committee, Cook performed a study, published with a 
collection of reports from the working group in February’s Journal of 
Pediatrics, which analyzes how many teens in the U.S. could be 
considered to have the metabolic syndrome based on four different 
definitions of it.

Based on the most recently available data from the National Health and 
Nutrition Examination Survey from 1999 to 2002, the study shows that the 
definition Cook developed in Rochester (a waist circumference at or 
above the 90th percentile for age and sex; blood pressure at or above 
the 90th percentile; a high triglyceride level at or above 110 mg/dL; a 
low HDL cholesterol level at or below 40 mg/dL; and an impaired glucose 
metabolism at or above 100 mg/dL), reveals that 2.9 million teens – 9.4 
percent of teens overall, and over a third of obese teens – meet the 
definition of the metabolic syndrome.

The original work by Cook and colleagues published in 2003 showed only 4 
percent of teens meet this definition and that the increased prevalence 
is driven by the rise in obesity.

Using two other well-reported definitions with more stringent cut 
points, the study also reports rates as low as 2 percent (or 600,000 
teens); using analyses that apply the U.S. adult definitions, it 
reported rates of 1.8 million teens –5.8 percent of all teens, and 25 
percent of obese teens.

“Even if there is no consensus on a pediatric-specific definition, the 
fact that 1 in 4 obese teens meet the adult definition for this 
clustering of cardiovascular disease risk factors is enough of a 
concern,” said Cook, who is a pediatrician and adult-internist at 
Golisano Children’s Hospital at Strong. “Many longitudinal studies have 
shown that adults with this definition are at increased risk for 
developing type 2 diabetes, heart disease and dying prematurely from 
heart disease.”

While one goal of the committee was to define the metabolic syndrome in 
pediatric populations, the bigger picture was to recognize the 
importance of obesity on cardiovascular risk for pediatric populations.

“We are not saying that adolescents who meet a definition for metabolic 
syndrome are going to develop diabetes or have a heart attack in the 
next few years, but some of the longitudinal studies presented at this 
meeting showed they were at very high risk for developing diabetes or 
heart disease in their 30s,” Cook said. “When you consider all the 
success we’ve had with lowering the death rate from heart disease for 
middle aged and older adults, it’s really disheartening to see actual 
data showing heart disease going up in young adults.”

Cook said there have been advances in technology, pharmaceuticals and 
tremendous public health victories seen with reductions in tobacco use 
and exposure, so the increased rates in cardiovascular risk factors in 
young adults must be considered “the first wave of severe consequences 
of the modern obesity epidemic.”
-- 
Kathrynne Holden, MS, RD < fivestar at nutritionucanlivewith.com >
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