Prevalence of the metabolic syndrome in Zhejiang Chinese obese children and adolescents and the effect of metformin combined with lifestyle intervention

Abstract

Objective: We aimed to evaluate the prevalence of metabolic syndrome (MS) in a group of obese children and adolescents in Zhejiang in the south of China, and to compare risk factors such as insulin resistance, adiponectin level and impaired glucose tolerance (IGT) etc with that of simple obese group (SOB) and non-obese healthy group, and also to evaluate the effect of metformin and lifestyle intervention in MS group by up to a 3-month follow-up. Methods: Three hundred and forty eight moderately or severely obese adolescents aged between 7 and 16 years were enrolled. Oral glucose tolerance test (OGTT), biochemical indicators, blood pressure and body mass index (BMI) were assessed in all of them. Three subgroups were selected (MS group, SOB and healthy control). Adiponectin levels, Whole body insulin sensitive index (WBISI), homeostasis model of insulin resistance (HOMA-IR), plasma lipid and blood pressure were compared in these three groups. Thirty out of thirty-six MS subjects with age over 10 years received metformin treatment combined with lifestyle modification. Results: (1) The prevalence of MS was 10.34% among all obese subjects, which increased with the severity of obesity and reached 22.1% in severely obese children and adolescents. The occurrence of more than one complication reached 72.13%. The incidence of type 2 diabetes and IGT were 1.44 and 1.44% respectively. (2) BMI, waist-to-hip ratio (WHR) and HOMA-IR increased stepwise in the control group, SOB and MS group, whereas serum adiponectin and WBISI decreased stepwise (all Po0.01). Systolic pressure, triglyceride, total cholesterol, low-density lipoprotein cholesterol and postprandial 2-h blood glucose in the MS group increased significantly compared to those in control and SOBs (all Po0.01). A correlation analysis showed that serum levels of adiponectin and WBISI were associated with the components of MS (all Po0.05). (3) After metformin and lifestyle intervention, clinical symptoms were ameliorated, serum adiponectin levels were actually increased and HOMA-IR was dropped in 20/30 MS children who had finished a 3-months follow-up (all Po0.01). Conclusion: The prevalence of MS in severely obese children and adolescents in Zhejiang area has reached a high level. Insulin resistance and hypoadiponectinemia were found in these MS children. Metformin combined with lifestyle modification was confirmed to be efficient and safe in treating the obese adolescents with MS.

Inflammatory markers and metabolic syndrome among adolescents

“…31 Obesity, MetS prevalence and associated risk factors in children and adolescents have increased dramatically over decades. [1][2][3]12,[32][33][34] A previous study of our team concluded that half of the Balearic Islands' adolescents had at least one of the MetS components and a significant number of them, especially the obese, had MetS, 31 showing an emerging health problem in this region.…”

“…1,2 This increase is noted even in children. 3 The features of MetS include central obesity, insulin resistance, hyperglycaemia, dyslipidaemia (increased triglyceride and decreased high-density lipoprotein) and hypertension, all risk factors for cardiovascular disease and type 2 diabetes mellitus.…”

Metabolic risk-factor clustering estimation in children: to draw a line across pediatric metabolic syndrome

“…12 Nonetheless, the three proposed definitions have been used in several studies carried out in pediatric populations, which reported high-prevalence of the MS in obese children and adolescents. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] The results of these studies varied according to the selected diagnostic criteria used, as established by a recent comparison study. 34 Moreover, in an evaluation of the different prevalence yields using different definition, Goodman et al 35 found that ATP III definition identified half as many children and adolescents as having MS as did WHO definition in the same population.…”

The Influence of Exercise on Metabolic Syndrome in Youth: A Review

“…For example, a study of Chinese obese youth found that Metformin, in combination with a low-fat diet and 30 min of moderate-intensity aerobics, improved clinical symptoms of MetS. 45 Therefore, the significance of each part of the intervention cannot be determined.Another problem related to the independent effect of training and fitness on MetS is that it may be very difficult to train without changing body composition. Loss of weight can improve the ability to exercise.…”