The online version of this article (doi:10.1186/1475-2840-11-128) contains supplementary material, which is available to authorized users.
The authors have no conflicts of interest to disclose.
MJG helped in the conception and design of the study, acquired the data, analyzed the data and interpreted the results, and wrote the initial draft of the manuscript and contributed in the critical revision process. CLI helped analyzed the data and interpret the results, and critically reviewed and revised the manuscript. SSS helped conceive the study, assisted in the interpretation of the results, and reviewed and revised the manuscript. MDD helped in the conception and design of the study, assisted in the interpretation of the results, and wrote the initial draft of the manuscript and contributed in the critical revision process. All authors read and approved the final manuscript.
The metabolic syndrome (MetS) is a cluster of clinical indices that signals increased risk for cardiovascular disease and Type 2 diabetes. The diagnosis of MetS is typically based on cut-off points for various components, e.g. waist circumference and blood pressure. Because current MetS criteria result in racial/ethnic discrepancies, our goal was to use confirmatory factor analysis to delineate differential contributions to MetS by sub-group.
Using 1999–2010 data from the National Health and Nutrition Examination Survey (NHANES), we performed a confirmatory factor analysis of a single MetS factor that allowed differential loadings across sex and race/ethnicity, resulting in a continuous MetS risk score that is sex and race/ethnicity-specific.
Loadings to the MetS score differed by racial/ethnic and gender subgroup with respect to triglycerides and HDL-cholesterol. ROC-curve analysis revealed high area-under-the-curve concordance with MetS by traditional criteria (0.96), and with elevations in MetS-associated risk markers, including high-sensitivity C-reactive protein (0.71), uric acid (0.75) and fasting insulin (0.82). Using a cut off for this score derived from ROC-curve analysis, the MetS risk score exhibited increased sensitivity for predicting elevations in ≥2 of these risk markers as compared with traditional pediatric MetS criteria.
The equations from this sex- and race/ethnicity-specific analysis provide a clinically-accessible and interpretable continuous measure of MetS that can be used to identify children at higher risk for developing adult diseases related to MetS, who could then be targeted for intervention. These equations also provide a powerful new outcome for use in childhood obesity and MetS research.
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- A confirmatory factor analysis of the metabolic syndrome in adolescents: an examination of sex and racial/ethnic differences
Matthew J Gurka
Christa L Ice
Shumei S Sun
Mark D DeBoer
- BioMed Central
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