A proposed simplified definition of metabolic syndrome in children and adolescents: a global perspective

Abstract

Metabolic syndrome (MetS) is becoming prevalent in the pediatric population. The existing pediatric MetS definitions (e.g., the International Diabetes Federation (IDF) definition and the modified National Cholesterol Education Program (NCEP) definition) involve complex cut-offs, precluding fast risk assessment in clinical practice.We proposed a simplified definition for assessing MetS risk in youths aged 6-17 years, and compared its performance with two existing widely used pediatric definitions (the IDF definition, and the NCEP definition) in 10 pediatric populations from 9 countries globally (n = 19,426) using the receiver operating characteristic (ROC) curve analyses. In general, the total MetS prevalence of 6.2 based on the simplified definition was roughly halfway between that of 4.2 and 7.7 estimated from the IDF and NCEP definitions, respectively. The ROC curve analyses showed a good agreement between the simplified definition and two existing definitions: the total area under the curve (95 confidence interval) of the proposed simplified definition for identifying MetS risk achieved 0.91 (0.89-0.92) and 0.79 (0.78-0.81) when using the IDF or NCEP definition as the gold standard, respectively.The proposed simplified definition may be useful for pediatricians to quickly identify MetS risk and cardiometabolic risk factors (CMRFs) clustering in clinical practice, and allow direct comparison of pediatric MetS prevalence across different populations, facilitating consistent pediatric MetS risk monitoring and the development of evidence-based pediatric MetS prevention strategies globally. center dot There is no consensus on definition for assessing pediatric metabolic syndrome (MetS). The existing pediatric MetS also involve age-, sex- or height- specific percentile cut-offs for some components (e.g., central obesity and elevated blood pressure), hindering quick assessment of MetS risk and cardiometabolic risk factors (CMRFs) clustering in clinical practice.center dot The proposed simplified definition of MetS for children and adolescents aged 6-17 years was developed based on two widely used IDF and NCEP definitions with inclusion of simple static cut-offs emerged from the recent literature, and with involvement of two risk assessment levels (monitoring and action levels) to assess severity of MetS risk.center dot The proposed simplified definition showed a good performance in identifying youths with MetS risk when compared with the IDF and NCEP definitions in a diverse sample of 10 pediatric populations globally. Moreover, the simplified definition involves static cut-offs instead of complex cut-offs for each component, supporting quick assessment and easy application in clinical practice.center dot The proposed simplified definition may be useful for pediatricians to quickly identify MetS risk and CMRFs clustering in clinical practice, and allow direct comparison of pediatric MetS prevalence across different populations, facilitating consistent pediatric MetS risk monitoring and the development of evidence-based pediatric MetS prevention strategies globally.