Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지

Prevalence of Metabolic Syndrome in Obese Children

소아 비만증에서 대사 증후군의 유병률

Chang, Jin-Ha;Kim, Duk-Hui;Kim, Ho-Seong;Choe, In-kyoung;Cheong, My-Young;Kim, Dong-Gi
장진하;김덕희;김호성;최인경;정미영;김동기

  • Published : 20040000
⟨ Previous Next ⟩

Abstract

Purpose:Obesity has been known to be a cause of insulin resistance and dyslipidemia, and along with coronary artery disease and diabetes, is associated with metabolic syndrome(MS). This study aimed to ascertain the cause and prevalence of MS in obese children and adolescents. Methods:Two hundred and seventy-seven school children, who showed more than a 95th percentile of body mass index(BMI) for age and sex, underwent oral glucose tolerance tests; fasting plasma lipid profiles, leptin, and CRP were measured; and ultrasonography was done. Results:Out of 277 obese children, the prevalence of MS was 37.5%, with 38.7% occurring in males and 35.2% in females. The prevalence was 20.8% in primary school children and 50.3% in middle school children. MS was present in 25.2% of mildly obese children, 43.9% of moderate and 71.4% of highly obese children, showing increased occurrence among the severer degrees of obese groups. Increased prevalence was observed in males with high blood pressure, and females with high triglyceride levels. The ratio of children satisfying more than one, more than two, more than three, more than four and all of the five criteria for diagnosis of MS were 90.6%, 63.5%, 37.5%, 8.3%, and 0.4%, respectively. Aside from diagnostic criteria for MS, a statistically significant difference was present between obese patients with or without the syndrome in such items as weight, BMI, degree of obesity, visceral fat thickness, ratio of body fat, leptin, and adiponectin, fasting and 2 hour postprandial insulin concentration. Conclusion:The prevalence of MS is currently on the rise among children, due to the rapidly increasing rate of obesity, westernized diet, higher calorie intake and reduced exercise. The prevalence of MS in obese children was 37.5% - higher than US results - after implementation of modified pediatric criteria established by ATP III Asia-Pacific standard in 2003. It would therefore be necessary to establish an acceptable universal standard for the diagnosis of MS, and extend the study to the general pediatric population in order to acquire more accurate data on the prevalence of the disease.

Keywords

References

  1. Epstein LH, Wing RR, Valoski A. Childhood obesity. Pediatr Clin North Am 1985;32:368-78
  2. Stark O, Atkins E, Wolff OH. Longitudinal study of obesity in the national survey of health and development. Br Med J 1981;283:13-7
  3. Dietz WH. Childhood obesity, susceptibility cause and management. J Pediatr 1983;103:676-85
  4. Grundy SM. Hypertriglyceridemia, insulin resistance, and the metabolic syndrome. Am J Cardiol 1999;83:25F-29F
  5. Grundy SM. Obesity, metabolic syndrome, and cardiovascular disease. J Clin Endocrinol Metab 2004;89:2595-600
  6. Isomma B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001;24: 683-9
  7. National Cholesterol Education Program. Executive summary of the Third Report of the National Cholesterol Eeducation Program(NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults(adult treatment panel III). JAMA 2001;285:2486-97
  8. Reaven GM. Role of insulin resistance in human disease. Diabetes 1988;37:1595-607
  9. Defronzo RA, Ferrannini E. Insulin resistance:a multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care 1991;14:173-94
  10. Park HS, Oh SW, Kang JH, Park YW, Choi JM, Kim YS, et al. Prevalence and associated factors with metabolic syndrome in South Korea:from the Korean national health and nutrition examination survey, 1998. Journal of Korean society for the study of obesity 2003;12:1-13
  11. Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH. Prevalence of a metabolic syndrome phenotype in adolescents:finding from the Third National Health and Nutrition Examination Survey, 1988-1994. Arch Pediatr Adolesc Med 2003;157:821-7
  12. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment:insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412-9
  13. WHO West Pacific Region. The Asia-Pacific perspective:redefining obesity and its treatment. International Obesity Task Force 2000
  14. National Heart, Lung, and Blood Institute, Bethesda, MD:Report of the Second Task Force on Blood Pressure Control in Children-1987. Pediatrics 1987;79:1-25
  15. Lee JB, Lee JO, Kim SW, Kang JH, Yang YJ. The prevalence and risk factors of childhood obesity in elementary students in Seoul. J Korean Acad Fam Med 2000;21:866-75
  16. Moon HN, Hong SJ, Suh SJ. The prevalence of obesity in children and adolescents. Korean J Nutr 1992;25:413-8
  17. Bray GA. Medical consequences of obesity. J Clin Endocrinol Metab 2004;89:2583-9
  18. World Health Organizaion. Obesity:preventing and managing the global epidemic. Report on a WHO consultation on obesity 1997
  19. Dietz WH, Bellizzi MC. Introduction; the use of body mass index to assess obesity in children. Am J Clin Nutr 1999; 70:1235-55
  20. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide:international survey. BMJ 2000;320:1240-3
  21. Haffner SM, Valdez RA, Hazuda HP, Mitchell BD, Morales PA, Stern MP. Prospective analysis of the insulin resistance syndrome(Syndrome X). Diabetes 1992;41:715-22
  22. Ten S, Maclaren N. Insulin resistance syndrome in children. J Clin Endocrinol Metab 2004;89:2526-39
  23. Falkner B, Hassink S, Ross J, Gidding S. Dysmetabolic syndrome:multiple risk factors for premature adult disease in an adolescent girl. Pediatrics 2002;110:e14
  24. Arberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1:diagnosis and classification of diabetes mellitus-provisional report of a WHO consultation. Diabet Med 1998;15:539-53
  25. Park YW. Evaluation of abdominal obesity. Journal of Korean society for the study of obesity 2001;10:297-305
  26. Kim SK, Kim HJ, Hur KY, Choi SH, Ahn CW, Lim SK, et al. Visceral fat thickness measured by ultrasonography can estimate not only visceral obesity but also risks of cardiovascular and metabolic diseases. Am J Clin Nutr 2004;79: 593-9
  27. Cruz ML, Weingenberg 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 2003;89:108-13
  28. Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 2004;350:2362- 74
  29. Barker DJ. In utero programming of cardiovascular disease. Theriogenology 2000;53:555-74
  30. Wilkin TJ, Metcalf BS, Murphy MJ, Kirkby J, Jeffery AN, Voss LD. The relative contribution of birth weight, weight change, and current weight to insulin resistance in contemporary 5-year-olds:the Early Bird study. Diabetes 2002;51: 3468-72
  31. Murtaugh MA, Jacobs DR, Moran A, Steinberger J, Sinaiko AR. Relation of birth weight to fasting insulin, insulin resistance, and body size in adolescence. Diabetes Care 2003;26:187-92
  32. Triot NA, Mantzoros CS. Leptin:its role in obesity and beyond. Diabetologia 1997;40:1371-9
  33. Ouchi N, Kihara S, Funahashi T, Matsuzawa Y, Walsh K. Obesity, adiponectin and vascular inflammatory disease. Curr Opin Lipidol 2003;14:561-6
  34. Visser M, Bouter LM, MacQuillan GM, Wener MH, Harris TB. Elevated C-reactive protein levels in overweight and obese adults. JAMA 1999;282:2131-5
  35. Goran MI, Hunter G, Nagy TR, Johnson R. Physical activity related energy expenditure and fat mass in young children. Int J Obes Relat Metab Disord 1997;21:171-8
  36. Durant RH, Baranowski T, Johnson M, Thompson WO. The relationship among television watching, physical activity, and body composition of young children. Pediatrics 1994;94:449-55
  37. Alessi MC, Peiretti F, Morange P, Henry M, Nalbone G, Juhan-Vague I. Production of plasminogen activator inhibitor 1 by human adipose tissue:possible link between visceral fat accumulation and vascular disease. Diabetes 1997; 46:860-7
  38. De Pergola G, Pannacciulli N. Coargulation and fibrinolysis abnormalities in obesity. J Endocrinol Invest 2002;25:899- 904