The comparison of metabolic syndrome criterias in obese and overweight children and adolescents

Aim: In line with the dramatic rise in childhood obesity and overweight, the prevelance of metabolic syndrome is also increasing. Although the metabolic syndrome is increasing in children and adolescents, no unified criteria have been established. In this study, we compared the frequency of the metabolic syndrome in obese and overweight children and adolescents using the criteria of WHO and NCEP-ATP III criteria which were modified for children and adolescents by Cook et al., de Ferranti et al., Cruz et al. and Ford et al.Material and Methods: Five hundred and eleven obese (295 girls, 216 boys, average age 11,56±3,0, BMI 29,3±4,5 kg/m², BMI SDS 2,61±0,45, average waist circumference 91,4±13,0 cm, average hip circumference 100,3±13,7 cm and average waist/hip ratio 1,0±0,1), 248 overweight (109 girls, 139 boys, average age 11,84±2,3, BMI 25,4±2,2 kg/m², BMI SDS 1,75±0,15, average waist circumference 84,8±9,0 cm, average hip circumference 93,4±9,1 cm and average waist/hip ratio 1,1±0,3), in total 759 children and adolescents were examined. Ages, sexs, heights, weights, waist circumferences, hip circumferences, waist/hip ratios, systolic and diastolic blood pressures of all the cases were noticed. The cases whose BMI SDS ? +2,00 or BMI ? 95p were called obese whereas whose BMI SDS +1,6-+2,00 or BMI 85-95p were called overweight. Baseline blood sample values (blood glucose, insulin, C-peptide, total cholesterol, trigliserite, LDL cholesterol, VLDL cholesterol, HDL cholesterol) which were obtained after 8-12 hours fasting were noted. Oral glucose tolerance test was performed with the administration of 1.75g of glucose per kilogram of body weight. The cases who have impaired fasting glucose, impaired glucose tolerance and diabetes were obtained. The ratios of metabolic syndrome according to WHO [for metabolic syndrome diagnosis at least 2 of the criterias which include hypertension (systolic blood pressure ? 140 mmHg, diastolic blood pressure ? 90 mmHg or using antihypertensive drug), dyslipidemia (TG level ? 150 mg/dl or HDL levels < 35 mg/dl for males, < 39 mg/dl for females), abdominal obesity (BMI > 30 kg/m2 or waist/hip ratio > 0.9 for males, > 0.85 for females), urine albumin excretion ? 20 ?g/sec or ratio of albumin/creatinine ? 30 mg/g) must accompany at least one of the insulin resistance criterias] NCEP-ATP III criteria modified by Cook and et al. [at least 3 of 5 criterias which include impaired fasting glucose ? 110 mg/dl, waist circumference ? 90p (age and sex spesific for Turkish children), blood pressure ? 90p (age, sex and height spesific for Turkish children), TG ? 110 mg/dl, HDL ? 40 mg/dl], NCEP-ATP III criteria modified by de Ferranti and et al. [at least 3 of 5 criterias which include impaired fasting glucose ? 110 mg/dl, waist circumference ? 75p (age and sex spesific for Turkish children), blood pressure ? 90p (age, sex and height spesific for Turkish children), TG ? 100 mg/dl, HDL ? 50 mg/dl], NCEP-ATP III criteria modified by Cruz and et al. [at least 3 of 5 criterias which include impaired glucose tolerance (according to ADA criterion), waist circumference ? 90p (age, sex and race spesific criterias of NHANES III), blood pressure ? 90p (age, sex and height spesific for NHANES III criterias), TG ? 90p (age and sex spesific for NHANES III] and NCEP-ATP III criterias modified by Ford and et al. [three or more of the following: impaired fasting glucose ? 100 mg/dl, waist circumference ? 90p (age and sex spesific for Turkish children), blood pressure ? 90p (age, sex and height spesific for Turkish children), TG ? 110 mg/dl, HDL ? 40 mg/dl] were considered. Tanner stages of all obese and overweight children were determined and the cases who were obtained stage I were called prepubertal whereas the cases who were stage II-V were called pubertal. The metabolic syndrome ratios between prepubertal and pubertal obese and overweight gruops were compaired.Results: The prevelance of metabolic syndrome in obese children and adolescents was %8,6; %43,4; %63,8; %46,4 and %49,1 according to the criteria WHO and modified NCEP-ATP III criteria of Cook et al., de Ferranti et al., Cruz and Ford et al., restpectively. While in overweight children the rate of metabolic syndrome was obtained %7,3 according to WHO; these percentages were %34,3; %60,5; %33,5 and %38,3 according to modified NCEP-ATP III criteria of Cook et al., de Ferranti et al., Cruz and Ford et al., restpectively. According to the WHO criteria, there is no differrance in the percentage of metabolic syndrome betweeen obese and overweight pubertal and prepubertal cases. The metabolic syndrome percentage was higher in obese pubertal cases than obese prepubertal cases when the NCEP-ATP III criteria modified by Cook et al, de Ferranti et al and Ford et al. were taken into acccount. Considering NCEP-ATP III criteria modified by Cruz et al. the persantage of metabolic syndrome in obese pubertal cases were higher than overweight pubertal cases whereas obese prepubertal cases were higher than overweight prepubertal cases. While fasting glucose was the most important criteria for metabolic syndrome diagnosis according to WHO criteria (OR:100,9); waist circumference for Cook et al (OR:22,5), increased TG level for de Ferranti et al (OR:33); decreased HDL cholesterol for both Cruz et al and Ford et al (OR is 14,9; 15,3 respectively) were the most significant parameters in metabolic syndrome diagnosis.Conclusion: Unified criteria for metabolic syndrome is necessary to determine prevelance of metabolic syndrome and also it will be useful for early diagnosis and treatment of metabolic syndrome. While setting these criterias, race and ethnic differances must be considered. According to our study, we believe that the new criterias of metabolic syndrome for Turkish children can be include impaired fasting glucose, waist circumference, TG and HDL cholesterol. We think that using the cut-off criterias that are age and sex spesific for Turkish children for waist circumference and blood pressure will be more helpfull and we also think that it will be benefical to determine and to use cut-off values of TG and HDL cholesterol for Turkish children.Key Words: Metabolic syndrome, prevelance, children and adolescents, WHO, NCEP-ATP III