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Metabolic syndrome in obese children and adolescents in Serbia: prevalence and risk factors

  • Rade Vukovic EMAIL logo , Dragan Zdravkovic , Katarina Mitrovic , Tatjana Milenkovic , Sladjana Todorovic , Ana Vukovic and Ivan Soldatovic
Published/Copyright: March 4, 2015
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 28 Issue 7-8

Abstract

Objective: To assess the prevalence of metabolic syndrome (MS) in obese children and adolescents in Serbia.

Subjects and methods: The study group consisted of 254 subjects (148 female and 106 male), aged 4.6–18.9 years with diet-induced obesity (body mass index ≥95th percentile). Presence of MS using the International Diabetes Federation definition was assessed in all subjects, as well as oral glucose tolerance test and insulin resistance indices.

Results: Overall prevalence of MS in all subjects aged ≥10 years was 31.2%, namely, 28.7% in children aged 10 to <16 years and 40.5% in adolescents ≥16 years. When adjusted for age, gender and pubertal development, higher degree of obesity was a strong predictor of MS. Multivariate analysis showed that taller subjects and those with higher degree of insulin resistance were at significantly higher risk of MS, independent of the degree of obesity.

Conclusions: High prevalence of MS emphasizes the need for prevention and treatment of childhood obesity.

Keywords: adolescents; insulin resistance; metabolic syndrome X; obesity; pediatric obesity
Corresponding author: Dr. Rade Vukovic, Department of Endocrinology, Mother and Child Health Care Institute of Serbia “Dr Vukan Cupic”, Radoja Dakica 8, 11 070 Belgrade, Serbia, Phone: +381 11 3108193, Fax: +381 11 3108257, E-mail:

Acknowledgments

We gratefully acknowledge the kind assistance of the doctors and nurses at the Mother and Child Health Care Institute of Serbia “Dr Vukan Cupic”. There are no funding sources to disclose. The authors declare no conflict of interest.

References

1. Cali AM, Caprio S. Obesity in children and adolescents. J Clin Endocrinol Metab 2008;93:S31–6.10.1210/jc.2008-1363Search in Google Scholar PubMed PubMed Central

2. Pirkola J, Tammelin T, Bloigu A, Pouta A, Laitinen J, et al. Prevalence of metabolic syndrome at age 16 using the International Diabetes Federation paediatric definition. Arch Dis Child 2008;93:945–51.10.1136/adc.2007.132951Search in Google Scholar PubMed

3. Friend A, Craig L, Turner S. The prevalence of metabolic syndrome in children: a systematic review of the literature. Metab Syndr Relat Disord 2013;11:71–80.10.1089/met.2012.0122Search in Google Scholar PubMed

4. Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, et al. The metabolic syndrome in children and adolescents – an IDF consensus report. Pediatr Diabetes 2007;8:299–306.10.1111/j.1399-5448.2007.00271.xSearch in Google Scholar PubMed

5. Ford ES, Li C, Zhao G, Pearson WS, Mokdad AH. Prevalence of the metabolic syndrome among U.S. adolescents using the definition from the International Diabetes Federation. Diabetes Care 2008;31:587–9.10.2337/dc07-1030Search in Google Scholar PubMed

6. Ekelund U, Anderssen S, Andersen LB, Riddoch CJ, Sardinha LB, et al. Prevalence and correlates of the metabolic syndrome in a population-based sample of European youth. Am J Clin Nutr 2009;89:90–6.10.3945/ajcn.2008.26649Search in Google Scholar PubMed

7. Bokor S, Frelut ML, Vania A, Hadjiathanasiou CG, Anastasakou M, et al. Prevalence of metabolic syndrome in European obese children. Int J Pediatr Obes 2008;3:3–8.10.1080/17477160802404509Search in Google Scholar PubMed

8. Reinehr T, de Sousa G, Toschke AM, Andler W. Comparison of metabolic syndrome prevalence using eight different definitions: a critical approach. Arch Dis Child 2007;92:1067–72.10.1136/adc.2006.104588Search in Google Scholar PubMed PubMed Central

9. Lafortuna CL, Adorni F, Agosti F, De Col A, Sievert K, et al. Prevalence of the metabolic syndrome among extremely obese adolescents in Italy and Germany. Diabetes Res Clin Pract 2010;88:14–21.10.1016/j.diabres.2010.01.008Search in Google Scholar PubMed

10. van Vliet M, von Rosenstiel IA, Schindhelm RK, Brandjes DP, Beijnen JH, et al. Identifying the metabolic syndrome in obese children and adolescents: do age and definition matter? Curr Clin Pharmacol 2009;4:233–8.10.2174/157488409789375276Search in Google Scholar PubMed

11. Pastucha D, Filipcikova R, Horakova D, Radová L, Marinov Z, et al. The incidence of metabolic syndrome in obese Czech children: the importance of early detection of insulin resistance using homeostatic indexes HOMA-IR and QUICKI. Physiol Res 2013;62:277–83.10.33549/physiolres.932438Search in Google Scholar PubMed

12. Braga-Tavares H, Fonseca H. Prevalence of metabolic syndrome in a Portuguese obese adolescent population according to three different definitions. Eur J Pediatr 2010;169:935–40.10.1007/s00431-010-1143-5Search in Google Scholar PubMed

13. Noto D, Niglio T, Cefalu AB, Martino E, Fayer F, et al. Obesity and the metabolic syndrome in a student cohort from Southern Italy. Nutr Metab Cardiovasc Dis 2009;19:620–5.10.1016/j.numecd.2008.12.003Search in Google Scholar PubMed

14. Caranti DA, Lazzer S, Damaso AR, Agosti F, Zennaro R, et al. Prevalence and risk factors of metabolic syndrome in Brazilian and Italian obese adolescents: a comparison study. Int J Clin Pract 2008;62:1526–32.10.1111/j.1742-1241.2008.01826.xSearch in Google Scholar PubMed

15. Elizondo-Montemayor L, Serrano-Gonzalez M, Ugalde-Casas PA, Cuello-Garcia C, Borbolla-Escoboza JR. Metabolic syndrome risk factors among a sample of overweight and obese Mexican children. J Clin Hypertens (Greenwich) 2010;12:380–7.10.1111/j.1751-7176.2010.00263.xSearch in Google Scholar PubMed PubMed Central

16. Park J, Hilmers DC, Mendoza JA, Stuff JE, Liu Y, et al. 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;25:75–82.10.3346/jkms.2010.25.1.75Search in Google Scholar PubMed PubMed Central

17. Vukovic R, Mitrovic K, Milenkovic T, Todorovic S, Zdravkovic D. Type 2 diabetes mellitus and impaired glucose regulation in overweight and obese children and adolescents living in Serbia. Int J Obes (Lond) 2012;36:1479–81.10.1038/ijo.2011.273Search in Google Scholar PubMed

18. Vukovic R, Mitrovic K, Milenkovic T, Todorovic S, Soldatovic I, et al. Insulin-sensitive obese children display a favorable metabolic profile. Eur J Pediatr 2013;172:201–6.10.1007/s00431-012-1867-5Search in Google Scholar PubMed

19. WHO. WHO AnthroPlus for personal computers: software for assessing growth of the world’s children and adolescents Geneva, Switzerland: World Health Organization, 2009.Search in Google Scholar

20. de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, et al. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007;85:660–7.10.2471/BLT.07.043497Search in Google Scholar PubMed PubMed Central

21. Fernandez JR, Redden DT, Pietrobelli A, Allison DB. Waist circumference percentiles in nationally representative samples of African-American, European-American, and Mexican-American children and adolescents. J Pediatr 2004;145:439–44.10.1016/j.jpeds.2004.06.044Search in Google Scholar PubMed

22. Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child 1969;44:291–303.10.1136/adc.44.235.291Search in Google Scholar

23. Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in boys. Arch Dis Child 1970;45:13–23.10.1136/adc.45.239.13Search in Google Scholar

24. Alberti K. Deffinition, diagnosis and classification of diabetes mellitus and its complications. Report of a WHO consultation. Diabetes Med 1999;15:S39–53.10.1002/(SICI)1096-9136(199807)15:7<539::AID-DIA668>3.0.CO;2-SSearch in Google Scholar

25. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010;33:S62–9.10.2337/dc10-S062Search in Google Scholar

26. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412–9.10.1007/BF00280883Search in Google Scholar

27. Katz A, Nambi SS, Mather K, Baron AD, Follmann DA, et al. Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab 2000;85:2402–10.10.1210/jcem.85.7.6661Search in Google Scholar

28. Matsuda M, DeFronzo RA. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care 1999;22:1462–70.10.2337/diacare.22.9.1462Search in Google Scholar

29. Kelishadi R. Childhood overweight, obesity, and the metabolic syndrome in developing countries. Epidemiol Rev 2007;29: 62–76.10.1093/epirev/mxm003Search in Google Scholar

30. Kisic-Tepavcevic D, Jovanovic N, Kisic V, Nalić D, Repcić M, et al. The prevalence of childhood obesity in a sample of schoolchildren in Belgrade. Srp Arh Celok Lek 2008;136:621–4.10.2298/SARH0812621KSearch in Google Scholar

31. Reinehr T, de Sousa G, Andler W. Longitudinal analyses among overweight, insulin resistance, and cardiovascular risk factors in children. Obes Res 2005;13:1824–33.10.1038/oby.2005.222Search in Google Scholar

32. Moran A, Jacobs DR, Jr., Steinberger J, Cohen P, Hong CP, et al. Association between the insulin resistance of puberty and the insulin-like growth factor-I/growth hormone axis. J Clin Endocrinol Metab 2002;87:4817–20.10.1210/jc.2002-020517Search in Google Scholar PubMed

33. Amiel SA, Caprio S, Sherwin RS, Plewe G, Haymond MW, et al. Insulin resistance of puberty: a defect restricted to peripheral glucose metabolism. J Clin Endocrinol Metab 1991;72:277–82.10.1210/jcem-72-2-277Search in Google Scholar PubMed

34. Iwayama H, Kamijo T, Ueda N. Hyperinsulinemia may promote growth without GH in children after resection of suprasellar brain tumors. Endocrine 2011;40:130–3.10.1007/s12020-011-9493-ySearch in Google Scholar PubMed

35. Wells JC, Cole TJ. Height, adiposity and hormonal cardiovascular risk markers in childhood: how to partition the associations? Int J Obes (Lond) 2014;38:930–5.10.1038/ijo.2014.24Search in Google Scholar PubMed PubMed Central

36. Davey Smith G, Hart C, Upton M, Hole D, Gillis C, et al. Height and risk of death among men and women: aetiological implications of associations with cardiorespiratory disease and cancer mortality. J Epidemiol Community Health 2000;54:97–103.10.1136/jech.54.2.97Search in Google Scholar PubMed PubMed Central

37. Katzmarzyk PT, Barlow S, Bouchard C, Catalano PM, Hsia DS, et al. An evolving scientific basis for the prevention and treatment of pediatric obesity. Int J Obes (Lond) 2014;38:887–905.10.1038/ijo.2014.49Search in Google Scholar PubMed PubMed Central

Received: 2014-12-27
Accepted: 2015-2-4
Published Online: 2015-3-4
Published in Print: 2015-7-1

©2015 by De Gruyter

Articles in the same Issue

  1. Frontmatter
  2. Highlight: Thyroid
  3. Thyroid disorders revisited
  4. Genetic analysis of the paired box transcription factor (PAX8) gene in a cohort of Polish patients with primary congenital hypothyroidism and dysgenetic thyroid glands
  5. Prognostic factors in pediatric differentiated thyroid cancer patients with pulmonary metastases
  6. Reclassification of cytologically atypical thyroid nodules based on radiologic features in pediatric patients
  7. Evaluation of inflammatory and oxidative biomarkers in children with well-controlled congenital hypothyroidism
  8. Investigation of autoimmune diseases accompanying Hashimoto’s thyroiditis in children and adolescents and evaluation of cardiac signs
  9. Neonatal thyroid storm accompanied with severe anaemia
  10. Functional characterization of the novel sequence variant p.S304R in the hinge region of TSHR in a congenital hypothyroidism patients and analogy with other formerly known mutations of this gene portion
  11. Subclinical hypothyroidism as a rare cofactor in chronic kidney disease (CKD) – related anemia
  12. Cytometric analysis of perforin expression in NK cells, CD8+, and CD4+ lymphocytes in children with autoimmune Hashimoto’s thyroiditis – a preliminary study
  13. Papillary thyroid cancer and autoimmune polyglandular syndrome
  14. Review article
  15. Should radioiodine be the first-line treatment for paediatric Graves’ disease?
  16. Image in pediatric endrocrinology
  17. Diffusion-weighted magnetic resonance imaging in a case of severe classic maple syrup urine disease
  18. Original articles
  19. Novel mutations of DAX1 (NR0B1) in two Chinese families with X-linked adrenal hypoplasia congenita and hypogonadotropic hypogonadism
  20. Rickets and vitamin D deficiency in Alaska native children
  21. Persistent elevation of fibroblast growth factor 23 concentrations in healthy appropriate-for-gestational-age preterm infants
  22. Parents’ experiences of having a baby with ambiguous genitalia
  23. Effect of GnRHa 3.75 mg subcutaneously every 6 weeks on adult height in girls with idiopathic central precocious puberty
  24. Congenital adrenal hyperplasia in children – a survey on the current practice in the UK
  25. Randomized clinical trial evaluating metformin versus oral contraceptive pills in the treatment of adolescents with polycystic ovarian syndrome
  26. Influence of the body weight on the onset and progression of puberty in boys
  27. Therapy monitoring in congenital adrenal hyperplasia by dried blood samples
  28. Hyperinsulinemic hypoglycemia: think of hyperinsulinism/hyperammonemia (HI/HA) syndrome caused by mutations in the GLUD1 gene
  29. Sulfonylurea in the treatment of neonatal diabetes mellitus children with heterogeneous genetic backgrounds
  30. Monitoring gonadotropin-releasing hormone analogue (GnRHa) treatment in girls with central precocious puberty: a comparison of four methods
  31. Dietary intake, body composition, and physical activity among young patients with type 1 diabetes mellitus
  32. Metabolic syndrome in obese children and adolescents in Serbia: prevalence and risk factors
  33. Progressive osseous heteroplasia, as an isolated entity or overlapping with Albright hereditary osteodystrophy
  34. Patient reports
  35. 17α-Hydroylase/17,20-lyase deficiency related to P.Y27*(c.81C>A) mutation in CYP17A1 gene
  36. A patient developing anaphylaxis and sensitivity to two different GnRH analogues and a review of literature
  37. Idiopathic short stature due to novel heterozygous mutation of the aggrecan gene
  38. Triple A syndrome with a novel indel mutation in the AAAS gene and delayed puberty
  39. Case report: long-term follow-up of a 45,X male with SHOX haploinsufficiency
  40. Antenatal Bartter syndrome presenting as hyperparathyroidism with hypercalcemia and hypercalciuria: a case report and review
  41. Successful use of continuous subcutaneous hydrocortisone infusion after bilateral adrenalectomy secondary to bilateral pheochromocytoma
  42. Donohue syndrome: a new case with a new complication
  43. Euprolactinemic galactorrhea secondary to domperidone treatment
  44. 17βHSD-3 enzyme deficiency due to novel mutations in the HSD17B3 gene diagnosed in a neonate
  45. Two different patterns of mini-puberty in two 46,XY newborns with 17β-hydroxysteroid dehydrogenase type 3 deficiency
  46. Short communication
  47. Early onset hearing loss in autosomal recessive hypophosphatemic rickets caused by loss of function mutation in ENPP1
https://doi.org/10.1515/jpem-2014-0533
Keywords for this article
adolescents; insulin resistance; metabolic syndrome X; obesity; pediatric obesity

Articles in the same Issue

  1. Frontmatter
  2. Highlight: Thyroid
  3. Thyroid disorders revisited
  4. Genetic analysis of the paired box transcription factor (PAX8) gene in a cohort of Polish patients with primary congenital hypothyroidism and dysgenetic thyroid glands
  5. Prognostic factors in pediatric differentiated thyroid cancer patients with pulmonary metastases
  6. Reclassification of cytologically atypical thyroid nodules based on radiologic features in pediatric patients
  7. Evaluation of inflammatory and oxidative biomarkers in children with well-controlled congenital hypothyroidism
  8. Investigation of autoimmune diseases accompanying Hashimoto’s thyroiditis in children and adolescents and evaluation of cardiac signs
  9. Neonatal thyroid storm accompanied with severe anaemia
  10. Functional characterization of the novel sequence variant p.S304R in the hinge region of TSHR in a congenital hypothyroidism patients and analogy with other formerly known mutations of this gene portion
  11. Subclinical hypothyroidism as a rare cofactor in chronic kidney disease (CKD) – related anemia
  12. Cytometric analysis of perforin expression in NK cells, CD8+, and CD4+ lymphocytes in children with autoimmune Hashimoto’s thyroiditis – a preliminary study
  13. Papillary thyroid cancer and autoimmune polyglandular syndrome
  14. Review article
  15. Should radioiodine be the first-line treatment for paediatric Graves’ disease?
  16. Image in pediatric endrocrinology
  17. Diffusion-weighted magnetic resonance imaging in a case of severe classic maple syrup urine disease
  18. Original articles
  19. Novel mutations of DAX1 (NR0B1) in two Chinese families with X-linked adrenal hypoplasia congenita and hypogonadotropic hypogonadism
  20. Rickets and vitamin D deficiency in Alaska native children
  21. Persistent elevation of fibroblast growth factor 23 concentrations in healthy appropriate-for-gestational-age preterm infants
  22. Parents’ experiences of having a baby with ambiguous genitalia
  23. Effect of GnRHa 3.75 mg subcutaneously every 6 weeks on adult height in girls with idiopathic central precocious puberty
  24. Congenital adrenal hyperplasia in children – a survey on the current practice in the UK
  25. Randomized clinical trial evaluating metformin versus oral contraceptive pills in the treatment of adolescents with polycystic ovarian syndrome
  26. Influence of the body weight on the onset and progression of puberty in boys
  27. Therapy monitoring in congenital adrenal hyperplasia by dried blood samples
  28. Hyperinsulinemic hypoglycemia: think of hyperinsulinism/hyperammonemia (HI/HA) syndrome caused by mutations in the GLUD1 gene
  29. Sulfonylurea in the treatment of neonatal diabetes mellitus children with heterogeneous genetic backgrounds
  30. Monitoring gonadotropin-releasing hormone analogue (GnRHa) treatment in girls with central precocious puberty: a comparison of four methods
  31. Dietary intake, body composition, and physical activity among young patients with type 1 diabetes mellitus
  32. Metabolic syndrome in obese children and adolescents in Serbia: prevalence and risk factors
  33. Progressive osseous heteroplasia, as an isolated entity or overlapping with Albright hereditary osteodystrophy
  34. Patient reports
  35. 17α-Hydroylase/17,20-lyase deficiency related to P.Y27*(c.81C>A) mutation in CYP17A1 gene
  36. A patient developing anaphylaxis and sensitivity to two different GnRH analogues and a review of literature
  37. Idiopathic short stature due to novel heterozygous mutation of the aggrecan gene
  38. Triple A syndrome with a novel indel mutation in the AAAS gene and delayed puberty
  39. Case report: long-term follow-up of a 45,X male with SHOX haploinsufficiency
  40. Antenatal Bartter syndrome presenting as hyperparathyroidism with hypercalcemia and hypercalciuria: a case report and review
  41. Successful use of continuous subcutaneous hydrocortisone infusion after bilateral adrenalectomy secondary to bilateral pheochromocytoma
  42. Donohue syndrome: a new case with a new complication
  43. Euprolactinemic galactorrhea secondary to domperidone treatment
  44. 17βHSD-3 enzyme deficiency due to novel mutations in the HSD17B3 gene diagnosed in a neonate
  45. Two different patterns of mini-puberty in two 46,XY newborns with 17β-hydroxysteroid dehydrogenase type 3 deficiency
  46. Short communication
  47. Early onset hearing loss in autosomal recessive hypophosphatemic rickets caused by loss of function mutation in ENPP1
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