Prevalence of metabolic syndrome in a cohort of Chinese schoolchildren: comparison of two definitions and assessment of adipokines as components by factor analysis

Qiaoxuan Wang, Jinhua Yin, Lu Xu, Hong Cheng, Xiaoyuan Zhao, Hongding Xiang, Hugh Simon Lam, Jie Mi, Ming Li, Qiaoxuan Wang, Jinhua Yin, Lu Xu, Hong Cheng, Xiaoyuan Zhao, Hongding Xiang, Hugh Simon Lam, Jie Mi, Ming Li

Abstract

Background: Although attention to metabolic syndrome (MetS) in children has increased, there is still no universally accepted definition and its pathogenesis remains unclear. Our aim was to compare the current definitions of childhood MetS in a Chinese cohort and to examine the clustering pattern of MetS risk factors, particularly inclusion of leptin and adiponectin as additional components.

Methods: 3373 schoolchildren aged 6 to 18 years were recruited. Anthropometric and biochemical parameters and adipokines were measured. MetS was identified using both the International Diabetes Federation (IDF) and a modified Adult Treatment Panel III (ATP III) definitions. Exploratory factor analysis was performed to establish grouping of metabolic characteristics.

Results: For children ≥ 10 years, the prevalence of MetS was 14.3% in the obese group and 3.7% in the overweight group according to the new IDF definition, and 32.3% in the obese group and 8.4% in the overweight group according to the modified ATPIII definition. Frequency of hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL-C), impaired fasting glucose, elevated blood pressure, and central obesity according to the new IDF definition was 16.7%, 20.7%, 15.8%, 25.5% and 75.5% in obese boys and 14.7%, 24.0%, 12.0%, 11.0% and 89.0% in obese girls, respectively. Metabolic abnormalities in children under 10 years of age were also noted. Using factor analysis on eight conventional variables led to the extraction of 3 factors. Waist circumference (WC) provided a connection between two factors in boys and all three factors in girls, suggesting its central role in the clustering of metabolic risk factors. Addition of leptin and adiponectin also led to the extraction of 3 factors, with leptin providing a connection between two factors in girls. When using WC, mean arterial pressure, triglyceride/HDL-C ratio, HOMA-IR and leptin/adiponectin ratio as variables, a single-factor model was extracted. WC had the biggest factor loading, followed by leptin/adiponectin ratio.

Conclusions: MetS was highly prevalent amongst obese children and adolescents in this cohort, regardless of the definition used. Central obesity is the key player in the clustering of metabolic risk factors in children, supporting the new IDF definition. Moreover, our findings suggest that a common factor may underlie MetS. Leptin/adiponectin ratio as a possible component of MetS deserves further consideration.

Figures

Figure 1
Figure 1
Component plots with factor diagrams from exploratory factor analysis with varimax rotation. Classic variables, leptin and adiponectin were all included. A, boys (n = 1717). B, girl (n = 1656).

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.
    1. 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.
    1. 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.
    1. Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S, Wong G, Bennett P, Shaw J, Caprio S. The metabolic syndrome in children and adolescents - an IDF consensus report. Pediatr Diabetes. 2007;8:299–306.
    1. Simmons RK, Alberti KGMM, Gale EAM. The metabolic syndrome: useful concept or clinical tool? Report of a WHO Expert Consultation. Diabetologia. 2010;53:600–605.
    1. Korner A, Kratzsch J, Gausche R, Schaab M, Erbs S, Kiess W. New predictors of the metabolic syndrome in children—role of adipocytokines. Pediatr Res. 2007;61:640–645.
    1. Gnacińska M, Małgorzewicz S, Stojek M, Łysiak-Szydłowska W, Sworczak K. Role of adipokines in complications related to obesity: a review. Adv Med Sci. 2009;54:150–157.
    1. Agata J, Masuda A, Takada M, Higashiura K, Murakami H, Miyazaki Y, Shimamoto K. High plasma immunoreactive leptin level in essential hypertension. Am J Hypertens. 1997;10:1171–1174.
    1. Leyva F, Godsland IF, Ghatei M, Proudler AJ, Aldis S, Walton C, Bloom S, Stevenson JC. Hyperleptinemia as a component of a metabolic syndrome of cardiovascular risk. Arterioscler Thromb Vasc Biol. 1998;18:928–933.
    1. Wallace AM, McMahon AD, Packard CJ, Kelly A, Shepherd J, Gaw A, Sattar N. Plasma leptin and the risk of cardiovascular disease in the west of Scotland coronary prevention study (WOSCOPS) Circulation. 2001;104:3052–3056.
    1. Hodge AM, Boyko EJ, de Courten M, Zimmet PZ, Chitson P, Tuomilehto J, Alberti KG. Leptin and other components of the metabolic syndrome in Mauritius–a factor analysis. Int J Obes Relat Metab Disord. 2001;25:126–131.
    1. Li S, Shin HJ, Ding EL, van Dam RM. Adiponectin levels and risk of type 2 diabetes: a systematic review and meta-analysis. JAMA. 2009;302:179–188.
    1. Mohan V, Deepa R, Pradeepa R, Vimaleswaran KS, Mohan A, Velmurugan K, Radha V. Association of low adiponectin levels with the metabolic syndrome–the Chennai Urban Rural Epidemiology Study (CURES-4) Metabolism. 2005;54:476–481.
    1. Frystyk J, Berne C, Berglund L, Jensevik K, Flyvbjerg A, Zethelius. Serum adiponectin is a predictor of coronary heart disease: a population-based 10-year follow-up study in elderly men. J Clin Endocrinol Metab. 2007;92:571–576.
    1. Satoh N, Naruse M, Usui T, Tagami T, Suganami T, Yamada K, Kuzuya H, Shimatsu A, Ogawa Y. Leptin-to-adiponectin ratio as a potential atherogenic index in obese type 2 diabetic patients. Diabetes Care. 2004;27:2488–2490.
    1. Yoon JH, Park JK, Oh SS, Lee KH, Kim SK, Cho IJ, Kim JK, Kang HT, Ahn SG, Lee JW, Lee SH, Eom A, Kim JY, Ahn SV, Koh SB. The ratio of serum leptin to adiponectin provides adjunctive information to the risk of metabolic syndrome beyond the homeostasis model assessment insulin resistance: the Korean Genomic Rural Cohort Study. Clin Chim Acta. 2011;412:2199–2205.
    1. Meigs JB. Invited commentary: insulin resistance syndrome? Syndrome X? Multiple metabolic syndrome? A syndrome at all? Factor analysis reveals patterns in the fabric of correlated metabolic risk factors. Am J Epidemiol. 2000;152:908–911.
    1. Wang JJ, Qiao Q, Miettinen ME, Lappalainen J, Hu G, Tuomilehto J. The metabolic syndrome defined by factor analysis and incident type 2 diabetes in a Chinese population with high postprandial glucose. Diabetes Care. 2004;27:2429–2437.
    1. Esteghamati A, Zandieh A, Khalilzadeh O, Morteza A, Meysamie A, Nakhjavani M, Gouya MM. Clustering of leptin and physical activity with components of metabolic syndrome in Iranian population: an exploratory factor analysis. Endocrine. 2010;38:206–213.
    1. Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, Allen K, Lopes M, Savoye M, Morrison J, Sherwin RS, Caprio S. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med. 2004;350:2362–2374.
    1. Lambert M, Paradis G, O’Loughlin J, Delvin EE, Hanley JA, Levy E. Insulin resistance syndrome in a representative sample of children and adolescents from Quebec. Canada. Int J Obes Relat Metab Disord. 2004;28:833–841.
    1. 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.
    1. Pladevall M, Singal B, Williams LK, Brotons C, Guyer H, Sadurni J, Falces C, Serrano-Rios M, Gabriel R, Shaw JE, Zimmet PZ, Haffner S. A single factor underlies the metabolic syndrome: a confirmatory factor analysis. Diabetes Care. 2006;29:113–122.
    1. Li C, Ford ES. Is there a single underlying factor for the metabolic syndrome in adolescents? A confirmatory factor analysis. Diabetes Care. 2007;30:1556–1561.
    1. Martínez-Vizcaíno V, Martínez MS, Aguilar FS, Martínez SS, Gutiérrez RF, López MS, Martínez PM, Rodríguez-Artalejo F. Validity of a single-factor model underlying the metabolic syndrome in children: a confirmatory factor analysis. Diabetes Care. 2010;33:1370–1372.
    1. Li M, Fisette A, Zhao XY, Deng JY, Mi J, Cianflone K. Serum resistin correlates with central obesity but weakly with insulin resistance in Chinese children and adolescents. Int J Obes. 2009;33:424–439.
    1. Wan NJ, Mi J, Wang TY, Duan JL, Li M, Gong CX, Du JB, Zhao XY, Cheng H, Hou DQ, Wang L. Metabolic syndrome in oberweight and obese schoolchildren in Beijing. Zhonghua Er Ke Za Zhi. 2007;6:417–421.
    1. Group of China Obesity Task Force. Body mass index reference norm for screening overweight and obesity in Chinese children and adolescents. Zhonghua Liu Xing Bing Xue Za Zhi. 2004;25:97–102.
    1. Marshall WA, Tanner JM. In: Human growth. Volume 2. Falkner F, Tanner JM, editor. New York: Plenum Press; 1986. Puberty; pp. 171–210.
    1. Li M, Wu C, Song A, Zhang K. Development and preliminary application of enzyme-linked immunosorbent assay for human net insulin in serum. Chin J Endocrinol Metab. 1997;13:214–217.
    1. Li M, Yin JH, Zhang K, Wu CY. A highly sensitive enzyme-linked immunosorbent assay for measurement of leptin secretion in human adipocytes. Zhonghua Yi Xue Za Zhi. 2008;46:3293–3297.
    1. Xu H, Li Y, Liu A, Zhang Q, Hu X, Fang H, Li T, Guo H, Li Y, Xu G, Ma J, Du L, Ma G. Prevalence of the metabolic syndrome among children from six cities of China. BMC Publ Health. 2012;12:13.
    1. Lawlor DA, Ebrahim S, May M, Davey Smith G. (Mis) use of factor analysis in the study of insulin resistance syndrome. Am J Epidemiol. 2004;159:1013–1018.
    1. Hanley AJ, Meigs JB, Williams K, Haffner SM, D’Agostino RB Sr. Re: “(Mis)use of factor analysis in the study of insulin resistance syndrome”. Am J Epidemiol. 2005;161:1182–1184.
    1. Park J, Hilmers DC, Mendoza JA, Stuff JE, Liu Y, Nicklas TA. Prevalence of metabolic syndrome and obesity in adolescents aged 12 to 19 years: comparison between the United States and Korea. J Korean Med Sci. 2010;25:75–82.
    1. Sangun Ö, Dündar B, Köşker M, Pirgon Ö, Dündar N. Prevalence of metabolic syndrome in obese children and adolescents using three different criteria and evaluation of risk factors. J Clin Res Pediatr Endocrinol. 2011;3:70–76.
    1. Papoutsakis C, Yannakoulia M, Ntalla I, Dedoussis GV. Metabolic syndrome in a Mediterranean pediatric cohort: prevalence using International Diabetes Federation- derived criteria and associations with adiponectin and leptin. Metabolism. 2012;61:140–145.
    1. Goodman E, Daniels SR, Meigs JB, Dolan LM. Instability in the diagnosis of metabolic syndrome in adolescents. Circulation. 2007;115:2316–2322.
    1. Gustafson JK, Yanoff LB, Easter BD, Brady SM, Keil MF, Roberts MD, Sebring NG, Han JC, Yanovski SZ, Hubbard VS, Yanovski JA. The stability of metabolic syndrome in children and adolescents. J Clin Endocrinol Metab. 2009;94:4828–4834.
    1. Daniels SR. Cardiovascular disease risk factors and atherosclerosis in children and adolescents. Curr Atheroscler Rep. 2001;3:479–485.
    1. Retnakaran R, Zinman B, Connelly PW, Harris SB, Hanley AJ. Nontraditional cardiovascular risk factors in pediatric metabolic syndrome. J Pediatr. 2006;148:176–182.
    1. Lago F, Gómez R, Gómez-Reino JJ, Dieguez C, Gualillo O. Adipokines as novel modulators of lipid metabolism. Trends Biochem Sci. 2009;34:500–510.
    1. Wabitsch M, Blum WF, Muche R, Braun M, Hube F, Rascher W, Heinze E, Teller W, Hauner H. Contribution of androgens to the gender difference in leptin production in obese children and adolescents. J Clin Invest. 1997;100:808–813.
    1. Rathmann W, Haastert B, Herder C, Hauner H, Koenig W, Meisinger C, Holle R, Giani G. Differential association of adiponectin with cardiovascular risk markers in men and women? The KORA survey 2000. Int J Obes. 2007;31:770–776.
    1. Martínez-Vizcaino V, Ortega FB, Solera-Martínez M, Ruiz JR, Labayen I, Eensoo D, Harro J, Loit HM, Veidebaum T, Sjöström M. Stability of the factorial structure of metabolic syndrome from childhood to adolescence: a 6-year follow-up study. Cardiovasc Diabetol. 2011;10:81.
    1. Xu L, Li M, Yin J, Cheng H, Yu M, Zhao X, Xiao X, Mi J. Change of body composition and adipokines and their relationship with insulin resistance across pubertal development in obese and Nonobese Chinese children: the BCAMS study. Int J Endocrinol. 2012;2012:389108.
    1. Després JP, Lemieux I, Bergeron J, Pibarot P, Mathieu P, Larose E, Rodés-Cabau J, Bertrand OF, Poirier P. Abdominal obesity and the metabolic syndrome: contribution to global cardiometabolic risk. Arterioscler Thromb Vasc Biol. 2008;28:1039–1049.
    1. Labruna G, Pasanisi F, Nardelli C, Caso R, Vitale DF, Contaldo F, Sacchetti L. High leptin/adiponectin ratio and serum triglycerides are associated with an “at-risk” phenotype in young severely obese patients. Obesity (Silver Spring) 2011;19:1492–1496.

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