Prevalence of Metabolic Syndrome among Children and Adolescents in High-Income Countries: A Systematic Review and Meta-Analysis of Observational Studies

Abstract

Introduction. Metabolic syndrome (MetS) is an assemblage of interconnected cardiovascular risk factors that are prevalent among children and adolescents in high-income countries (HICs). Despite the presence of several studies on the issue, the study findings are incongruent due to the absence of a gold standard diagnostic method of MetS in children. Thus, the findings of the original studies are inconclusive for policy makers and other stakeholders. This systematic review and meta-analysis is aimed at giving conclusive evidence about MetS among children and adolescents in HICs. Methods. We conducted searches using electronic databases (PubMed, Scopus, Web of Science, CINAHL (EBSCOhost), EMBASE (Elsevier), and Medline (EBSCOhost)) and other sources (Google Scholar and Google) up to September 2020. Observational studies reporting the prevalence of MetS were eligible in this study. The pooled estimates were computed in fixed and random effect models using six diagnostic methods (IDF, ATP III, de Ferranti et al., WHO, Weiss et al., and Cruz and Goran). Publication bias was verified using funnel plots and Egger’s regression tests. Subgroup and sensitivity analysis were performed in case of higher heterogeneities among the included studies. Result. In this study, 77 studies with a total population of 125,445 children and adolescents were used in the final analysis. Metabolic syndrome among the overweight and obese population was computed from 28 studies with the pooled prevalence of 25.25%, 24.47%, 39.41%, 29.52%, and 33.36% in IDF, ATP III, de Ferranti et al., WHO, and Weiss et al. criteria, respectively. Likewise, 49 studies were eligible to compute the pooled prevalence of MetS in the general population of children and adolescents. Hence, MetS was found in 3.70% (IDF), 5.40% (ATP III), 14.78% (de Ferranti et al.), 3.90% (WHO), and, 4.66% (Cruz and Goran) of study participants. Regarding the components of MetS, abdominal obesity in the overweight and obese population, and low HDL-C in the general population were the most common components. Besides, the prevalence of Mets among males was higher than females. Conclusion. This study demonstrates that MetS among children and adolescents is undoubtedly high in HICs. The prevalence of MetS is higher among males than females. Community-based social and behavioral change communications need to be designed to promote healthy eating behaviors and physical activities. Prospective cohort studies could also help to explore all possible risk factors of MetS and to design specific interventions accordingly.

Criteria in the Diagnosis of Metabolic Syndrome in Children: A Scoping Review

“…The greater use of Cook's criteria for the identification of MetS in children observed in this review differs from that carried out by Reisinger et al 43 in which the IDF definition represented 45.28% of the selected studies, followed by Cook et al and de Ferranti et al with 28.30% and 15.09% respectively. Criteria with cut-off points in specific risk parameters for children can improve the accuracy of MetS diagnosis, this has allowed its usefulness in studies of MetS prevalence in children in the last decade, such as Cook et al's criteria, and some that recently appear such as Ahrens et al 40 In this review, new ways of identifying MetS were found, the use of composite and continuous Z scores for MetS is an interesting proposal developed by Shi et al 34 since biochemical parameters can be determined in saliva with values equivalent to those of plasma.…”

Mineral Balance and Metabolic Syndrome in Adolescents: Focus on Calcium and Phosphorus Intake

“…A study analyzing computed tomography (CT) results of 2509 healthy Korean adults found that the risk of coronary calcification increased with serum phosphorus levels [30], a finding that was consistent with the results of this study. Although the present study examined adolescents aged 12-18 years, it is meaningful that similar results were observed between this study and others that examined adults or elderly subjects, since health problems during adolescence such as pediatric obesity have been traditionally considered to be risk factors of metabolic syndrome [3]. This is because these results indicate that similar risk factors are at play between adolescents and adults in cases of metabolic syndrome and that it is closely associated with long-term health problems.…”

“…The incidence of metabolic syndrome among the adolescents included in this study was 5.9% for males and 4.7% for females. This incidence was lower than the prevalence of metabolic syndrome (10.1%) reported for adolescents aged 12-19 years in the 2001-2010 National Health and Nutrition Examination Survey in the United States [25], as well as that (6.3%) reported for Asian countries [3].…”

“…According to the Korea National Health and Nutrition Survey, the prevalence of metabolic syndrome in the last 12 years was 25.5% among those in their 40s, 17.1% among those in their 30s, and 7.1% among those ages 19 to 29, and that prevalence has been increasing overall [2]. Approximately 3.3% of children and adolescents worldwide are estimated to have metabolic syndrome [3], suggesting the need for active prevention and management of metabolic syndrome starting with adolescence.…”

Recent Progress in Metabolic Syndrome Research and Therapeutics

“…Although ascertaining the exact prevalence of MetS remains a challenge, epidemiological studies have suggested that over one billion individuals worldwide suffer from MetS, and the value is in constant escalation, given lifestyle modifications secondary to urbanization in modern society [7]. Children and adolescents in high income regions may be especially prone to MetS [8], marking it a significant clinical, as well as social, issue of concern. Holistic care of MetS patients is essential as these patients are predisposed to a variety of cardiovascular, cerebral, and hepato-renal complications, as well as increased all-cause mortality [9][10][11][12][13][14][15].…”