Background The clinical utility of identifying pediatric metabolic syndrome (MetS) is controversial. This study sought to determine the status of pediatric MetS as a risk factor for adult subclinical atherosclerosis (carotid intima-media thickness, cIMT) and type 2 diabetes mellitus (T2DM), and compare and contrast this prediction with its individual components. Methods and Results Using data from the population-based, prospective, observational Bogalusa Heart and Cardiovascular Risk in Young Finns studies, we examined the utility of four categorical definitions of youth MetS and their components in predicting adult high cIMT, and T2DM among 1781 participants aged 9–18 years at baseline (1984–88) who were then examined 14–27 years later (2001–2007) when aged 24–41 years. Youth with MetS were at 2–3 times the risk of having high cIMT, and T2DM as adults compared with those free of MetS at youth. Risk estimates using high body mass index (BMI) were similar to that of MetS phenotypes in predicting adult outcomes. Comparisons of area under the receiver operating characteristic curve and net reclassification suggested that prediction of adult MetS, high cIMT, and T2DM in adulthood using youth MetS was either equivalent or inferior to classification based on high BMI or overweight and obesity. Conclusions Youth with MetS are at increased risk of meaningful adult outcomes, however, the simplicity of screening for high BMI or overweight and obesity in the pediatric setting offers a simpler, equally accurate alternative to identifying youth at risk of developing adult MetS, high cIMT, or T2DM.

Background-Conventional risk factors and metabolic syndrome (MetS) are cross-sectionally associated with subclinical atherosclerosis in young adults. We evaluated the relations of conventional risk factors and MetS to the 6-year progression of carotid intima-media thickness (IMT) in a population of young adults. Results and Methods-The study included 1809 subjects (aged 32Ϯ5 years) who had IMT measured in 2001 and 2007. Risk factor measurements included low-density lipoprotein cholesterol, body mass index, C-reactive protein, smoking, and family history of coronary disease in addition to MetS components. We used European Group for the Study of Insulin Resistance, revised National Cholesterol Education Program, and International Diabetes Federation definitions to diagnose MetS in 2001. Waist circumference (PϽ0.0001), low-density lipoprotein cholesterol (Pϭ0.01), and insulin (Pϭ0.003) were directly associated with IMT progression in a multivariable model adjusted for age, sex, and baseline IMT (model R 2 ϭ24%). When the MetS/European Group for the Study of Insulin Resistance definition was included in the model, it was directly associated with IMT progression (Pϭ0.03), but its inclusion did not improve the model's predictive value. IMT increased 79Ϯ7 m (meanϮSEM) in subjects with MetS according to the MetS/European Group for the Study of Insulin Resistance definition and 42Ϯ2 m in subjects without MetS (PϽ0.0001). In addition, the number of MetS components was linearly associated with IMT progression (PϽ0.0001). Similar results were seen with MetS/revised National Cholesterol Education Program and MetS/International Diabetes Federation definitions. Conclusions-Obesity, high low-density lipoprotein cholesterol, and high insulin level predicted IMT progression in young adults. All MetS definitions identified young adults with accelerated IMT progression, but we found no evidence that MetS would predict IMT progression more than expected from the sum of its risk components. (Circulation. 2009; 120:229-236.)Key Words: cardiovascular diseases Ⅲ carotid arteries Ⅲ cholesterol Ⅲ insulin Ⅲ obesity A therosclerotic diseases are the leading cause of death in developed countries. Although clinical manifestations of atherosclerosis do not occur until middle age, the development of vascular changes begins early in life. 1 Increased carotid intima-media thickness (IMT), as assessed noninvasively by ultrasound, is a marker of structural atherosclerosis. 2,3 Accelerated progression in IMT is a marker of atherosclerosis development that increases the risk of cardiovascular events. 4 Clinical Perspective on p 236Exposure to atherogenic risk factors in early life may induce changes in arteries that contribute to the development of atherosclerosis. In cross-sectional settings, conventional Received December 16, 2008; accepted May 4, 2009 13,14 Prospective data in this age group are lacking, and it is not known whether MetS predicts the progression of atherosclerosis in young adults. The objective of the present analysis was to e...

During a 20-month period we studied 175 pregnant women at high risk for hypertensive disorders of pregnancy or intrauterine growth retardation, and 172 patients at low risk, in a prospectively designed cross-sectional trial. Using duplex pulsed wave Doppler ultrasound, we recorded blood velocity waveforms from both main uterine arteries, the uteroplacental arteries in the region of placental implantation and the umbilical artery at 21-24 weeks of gestation. Persistent notches in the main stem uterine arteries and elevated resistance indices of > 0.68 in the uterine arteries and > 0.38 in the uteroplacental arteries were defined as abnormal waveforms. The incidence of proteinuric pregnancy-induced hypertension (PPIH) and intrauterine growth retardation (IUGR) were recorded as main outcome measures. Doppler proved to be more efficient at predicting a complicated pregnancy in those patients who were at high risk: a positive medical history alone was associated with a three-fold greater risk of developing PPIH and/or IUGR. In the high-risk group a single pathological Doppler sign accounted for an additional three- to four-fold increased risk, and the combination of all three pathological signs, a seven-fold additional risk for later disease. In this group PPIH and/or IUGR was found in 58.3%, compared to 8.3% if Doppler results were normal. The criterion for the definition of pathological Doppler results, whether persistent notching, the resistance index (RI) of the main stem uterine artery, or the RI in the arteries of the uteroplacental bed, was of minor importance, as all Doppler parameters were strongly correlated. However, the combination of all parameters was superior to a single parameter, and a bilateral notch was superior to a unilateral notch in terms of minimizing false-positive results. However, Doppler was less powerful in the population at low risk. Here PPIH and/or IUGR was seen in 6.1-6.4% in the group with abnormal Doppler findings compared to 5.2% in pregnancies with normal findings. None of the patients showed bilateral notching. In conclusion, pathological Doppler velocimetry of the uterine and uteroplacental circulation was a powerful predictor of PPIH and/or IUGR in high-risk pregnancies, identifying a group in which 58.3% would suffer from disease later in pregnancy. A combination of several Doppler parameters was superior to a single parameter, although the parameters were strongly correlated with each other.

BackgroundThere is paucity of knowledge concerning the specific age in youth when the associations of metabolic syndrome (MetS) begin to be operative. Thus, we investigated the relation of age to the associations of childhood MetS with adult MetS, type 2 diabetes mellitus and high carotid intima‐media thickness.Methods and ResultsFive thousand eight‐hundred three participants were analyzed in 4 cohort studies (Cardiovascular Risk in Young Finns, Bogalusa Heart Study, Princeton Lipid Research Study, Insulin Study). International cutoffs and previously used 75th percentile cutoffs were used for children to define MetS and its components. Mean follow‐up period was 22.3 years. Logistic regression was used to calculate risk ratios and 95% confidence intervals. Childhood MetS and overweight were associated with over 2.4‐fold risk for adult MetS from the age of 5 years onward. Risk for type 2 diabetes mellitus was increased from the age of 8 (risk ratio, 2.6–4.1; 95% confidence interval, 1.35–6.76 and 1.12–7.24, respectively) onward for the 2 childhood MetS criteria based on international cut‐off values and for childhood overweight. Risk for high carotid intima‐media thickness was significant at ages 11 to 18 years in relation to childhood MetS or overweight (risk ratio, 2.44–4.22; 95% confidence interval, 1.55–3.55 and 2.55–5.66, respectively). Continuous childhood MetS score was associated with adult MetS from the age of 5, with type 2 diabetes mellitus from the age of 14 and with high carotid intima‐media thickness from the age of 11 years onward.ConclusionsAdult MetS was predicted by MetS in childhood beginning at age 5. However, adult type 2 diabetes mellitus and subclinical atherosclerosis were not predicted by childhood data until after age 8. Body mass index measurement alone at the same age points provided similar findings.