Prevalence of Obesity and Metabolic Syndrome in Children with Type 1 Diabetes: A Comparative Assessment Based on Criteria Established by the International Diabetes Federation, World Health Organisation and National Cholesterol Education Program

Abstract

To determine the prevalence of obesity and metabolic syndrome (MetS) in children and adolescents with type 1 diabetes (T1D) and to compare the widely accepted and used diagnostic criteria for MetS established by the International Diabetes Federation (IDF), World Health Organisation (WHO) and National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII). Methods: We conducted a descriptive, cross sectional study including T1D patients between 8-18 years of age. The three sets of criteria were used to determine the prevalence of MetS and findings compared. Risk factors related to MetS were extracted from hospital records. Results: The study included 200 patients with T1D (52% boys). Of these, 18% (n=36) were overweight/obese (body mass index percentile ≥85%). MetS prevalence was 10.5%, 8.5% and 13.5% according to IDF, WHO and NCEP criteria, respectively. There were no statistically significant differences in age, gender, family history of T1D and T2D, pubertal stage, duration of diabetes, hemoglobin A1c levels and daily insulin doses between patients with or without MetS. In the overweight or obese T1D patients, the prevalence of MetS was 44.4%, 38.8% and 44.4% according to IDF, WHO and NCEP-ATPIII criteria, respectively. Conclusion: Obesity prevalence in the T1D cohort was similar to that of the healthy population of the same age. Prevalence of MetS was higher in children and adolescents with T1D compared to the obese population in Turkey. The WHO criteria include microvascular complications which are rare in childhood and the NCEP criteria do not include a primary criterion while diagnosing non-obese patients according to waist circumference as MetS because the existence of diabetes is considered as a direct criterion. Our study suggests that IDF criteria which allows the diagnosis of MetS with obesity and have accepted criteria for the childhood are more suitable for the diagnosis of MetS in children and adolescents with T1D.

Global prevalence of metabolic syndrome among patients with type I diabetes mellitus: a systematic review and meta-analysis

“…This high discrepancy may be due to abdominal obesity criteria which is not mandatory in JIS definition. Similar findings in variation of MetS prevalence per diagnostic criteria were also reported in many studies conducted in different corners of the world [ 30 , 33 – 36 , 38 , 46 ]. To solve this problem, an internationally accepted practical and uniform definition of MetS has to be established.…”

Prevalence of Metabolic Syndrome in Children and Adolescents with Type 1 Diabetes Mellitus and Possibilities of Prevention and Treatment: A Systematic Review

“…Nine articles qualified for the quality evaluation. All of them were positively assessed and included in this systematic review [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. The most common reasons for rejection were diabetes mellitus other than type 1, adult population or a mixed population of adults and children without the possibility of isolating data for the pediatric patients, and lack of both percentage and numerical data presenting the incidence of MetS in the cohorts.…”

“…As regards T1DM diagnosis, five articles are consistent with the American Diabetes Association (ADA) criteria [ 1 ] and participants had a marked presence of anti-GAD or anti-insulin antibodies [ 14 , 16 , 17 , 18 , 21 ]. However, in the remaining four research projects, patients also came from hospital clinics [ 15 , 19 , 20 , 22 ]. There was no conflict of interest in any of the studies.…”

“…There was no conflict of interest in any of the studies. Most of them ( n = 7) used the IDF definition [ 14 , 16 , 17 , 19 , 20 , 22 ]; one used criteria consistent with the ATP [ 18 ] and Weiss et al [ 21 ], and another used the IDF, ATP and WHO guidelines [ 15 ]. Six studies were conducted in Europe [ 14 , 15 , 16 , 20 , 21 , 22 ], two in Asia [ 17 , 18 ] and one in Africa [ 19 ].…”

The Problem of Abnormal Body Weight and Dyslipidemia as Risk Factors for Cardiovascular Diseases in Children and Adolescents with Type 1 Diabetes

“…Overweight is more often observed than obesity. The large scale of this problem is indicated by the fact that the abovementioned data is concerned with children with type 1 diabetes from different regions of the world [3][4][5][6][7].…”