Obesity and the metabolic syndrome in children and adolescents.
BACKGROUND
The prevalence and magnitude of childhood obesity are increasing dramatically. We examined the effect of varying degrees of obesity on the prevalence of the metabolic syndrome and its relation to insulin resistance and to C-reactive protein and adiponectin levels in a large, multiethnic, multiracial cohort of children and adolescents.


METHODS
We administered a standard glucose-tolerance test to 439 obese, 31 overweight, and 20 nonobese children and adolescents. Baseline measurements included blood pressure and plasma lipid, C-reactive protein, and adiponectin levels. Levels of triglycerides, high-density lipoprotein cholesterol, and blood pressure were adjusted for age and sex. Because the body-mass index varies according to age, we standardized the value for age and sex with the use of conversion to a z score.


RESULTS
The prevalence of the metabolic syndrome increased with the severity of obesity and reached 50 percent in severely obese youngsters. Each half-unit increase in the body-mass index, converted to a z score, was associated with an increase in the risk of the metabolic syndrome among overweight and obese subjects (odds ratio, 1.55; 95 percent confidence interval, 1.16 to 2.08), as was each unit of increase in insulin resistance as assessed with the homeostatic model (odds ratio, 1.12; 95 percent confidence interval, 1.07 to 1.18 for each additional unit of insulin resistance). The prevalence of the metabolic syndrome increased significantly with increasing insulin resistance (P for trend, <0.001) after adjustment for race or ethnic group and the degree of obesity. C-reactive protein levels increased and adiponectin levels decreased with increasing obesity.


CONCLUSIONS
The prevalence of the metabolic syndrome is high among obese children and adolescents, and it increases with worsening obesity. Biomarkers of an increased risk of adverse cardiovascular outcomes are already present in these youngsters.
Weiss
Ram
R
Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06520, USA.
Dziura
James
J
Burgert
Tania S
TS
Tamborlane
William V
WV
Taksali
Sara E
SE
Yeckel
Catherine W
CW
Allen
Karin
K
Lopes
Melinda
M
Savoye
Mary
M
Morrison
John
J
Sherwin
Robert S
RS
Caprio
Sonia
S
D052242:Adiponectin; D000293:Adolescent; D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D036341:Intercellular Signaling Peptides and Proteins; D015850:Interleukin-6 / Q000097:blood; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000453:epidemiology; D009765:Obesity / Q000097:blood / Q000145:classification / Q000150:complications*; D015995:Prevalence; D011506:Proteins / Q000032:analysis; D012307:Risk Factors; D012720:Severity of Illness Index
D052242:Adiponectin; D036341:Intercellular Signaling Peptides and Proteins; D015850:Interleukin-6; D011506:Proteins; D002097:C-Reactive Protein