Preclinical manifestations of organ damage associated with the metabolic syndrome and its factors in outpatient children.
BACKGROUND
To evaluate whether the pediatric metabolic syndrome (MetS) or its factors are useful to detect subclinical abnormalities of cardiac, liver, and glomerular damage in an outpatient population.


METHODS
The population study included 799 children (age 10 ± 3 years, mean ± SD), 24% of whom were normalweight, 25% overweight, and 51% obese. Alanine-aminotransferase (ALT) levels, estimated glomerular filtration rate (eGFR) and HOMA-IR were analyzed in all children. Microalbuminuria (MA) and left ventricular (LV) geometry and function were evaluated in 501 and 247 children, respectively. MetS was defined using Cook's criteria.


RESULTS
MetS was diagnosed in 131 children (16%). Children with MetS+ and MetS- were similar for age, gender and Tanner stage distribution. Children with MetS+ showed higher ALT levels (31 ± 19 vs 21 ± 11 IU/L, p<0.0001), LV mass (39 ± 10 vs 34 ± 10 g/h(2.7), p<0.001) and relative wall thickness (0.37 ± 0.06 vs 0.35 ± 0.05, p<0.01) than MetS-. The two groups were similar for MA and eGFR. At multiple logistic regression analysis, children MetS+ showed a higher risk (OR, 95% Cl) adjusted for confounding factors, of high ALT levels (1.71, 1.12-2.59, p=0.012) and concentric LV hypertrophy (2.17, 1.01-4.66, p=0.047) than children MetS-. The risk of preclinical liver and cardiac damage associated with the MetS phenotype was not higher than predicted by its single components.


CONCLUSIONS
Children with MetS show a 2-fold greater risk of having high ALT levels and concentric LV hypertrophy. However, the risk of subclinical manifestations of liver and cardiac damage can be predicted equally well by the single components of the syndrome.
Department of Internal Medicine, Pozzuoli Hospital, via Domitiana Loc. La Schiana, 80078 Pozzuoli, Napoli, Italy. procolodibonito@alice.it
Procolo
P
Di Bonito
Nicola
N
Moio
Carolina
C
Scilla
Luigi
L
Cavuto
Girolamo
G
Sibilio
Claudia
C
Forziato
Eduardo
E
Sanguigno
Francesco
F
Saitta
Maria Rosaria
MR
Iardino
Brunella
B
Capaldo
D000293:Adolescent; D000410:Alanine Transaminase / Q000378:metabolism; D000419:Albuminuria / Q000150:complications; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology; D007674:Kidney Diseases / Q000209:etiology; D008107:Liver Diseases / Q000209:etiology; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000503:physiopathology*; D009765:Obesity / Q000150:complications; D050177:Overweight; D012307:Risk Factors
D000410:Alanine Transaminase