Abstract
Background: The metabolic syndrome (MS) in pediatrics is controversial. Rather than a dichotomous scale, a continuous metabolic syndrome score (cMets) has been proposed to evaluate MS. The aim of this study was to evaluate the utility of a cMets score among an ethnically diverse cohort of children with acanthosis nigricans (AN).
Methods: A retrospective chart review was used to extract clinical and laboratory information on a cohort of obese children. Criteria for MS components and the cMets score were established using published guidelines. Multiple linear regression evaluated the effect of AN status on MS and cMets. Fisher’s exact test compared the race differential on the presence or absence of MS component disorders.
Results: MS diagnosis was non-significant when considering AN status (p=0.554) and ethnicity (p=0.431). Evaluation of the frequency of component disorders, revealed that Caucasians had significantly higher levels of abnormal triglycerides (TG) (35.1 vs. 10.3%; p<0.001), whereas African Americans had significantly higher homeostatic model assessment of insulin resistance (HOMA-IR) scores (51.3% vs. 22.3%; p<0.001). cMets was sensitive to identifying metabolic risk among Caucasians with AN, only (p=0.029).
Conclusions: This study found differences in health risk among an obese, ethnically diverse sample of children. cMets is a more sensitive marker of metabolic change compared with MS, especially when AN status and race are considered. cMets may pose an opportunity for the clinician to evaluate the interaction of health risks on the health status of obese children.
Acknowledgments
Thank you to Virginia Quick, PhD RD for her contribution in editing the manuscript.
Author contributions: MBH and RDM contributed equally to the study design. MBH designed the study, collected data, assisted with data interpretation, drafted the initial manuscript and approved the final manuscript as submitted. RDM designed the study, participated in data interpretation, reviewed and revised the manuscript and approved the final manuscript as submitted. GY conducted data analysis and generated figures and tables participated in data interpretation, reviewed and revised the manuscript and approved the final manuscript as submitted. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: MBH and GY report have no financial disclosures. RDM is a consultant for Dannon Company, Cargill Company, Abbot Nutrition and The National Dairy Council.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Ford ES, Li C. “Defining the metabolic syndrome in children and adolescents: will the real definition please stand up?” J Pediatr 2008;152:160–4.10.1016/j.jpeds.2007.07.056Search in Google Scholar PubMed
2. Brambilla P, Lissau I, Flodmark CE, Morano LA, Widhalm K, Wabitsch M, et al. Metabolic risk factor clustering estimation in children: to draw a line across pediatric metabolic syndrome. Int J Obes 2007;4:591–600.10.1038/sj.ijo.0803581Search in Google Scholar PubMed
3. Eisenmann JC. On the use of a continuous metabolic syndrome score in pediatric research. Cardiovasc Diabetol 2008;5:7–17.10.1186/1475-2840-7-17Search in Google Scholar PubMed PubMed Central
4. Battista M, Murray RD, Daniels SR. Use of the metabolic syndrome in pediatrics: a blessing and a curse. Semin Pediatr Surg 2009;18:136–43.10.1053/j.sempedsurg.2009.04.003Search in Google Scholar PubMed
5. Eisenmann JC, Laurson KR, DuBose KD, Smith BK, Donnelly JE. Construct validity of a continuous metabolic syndrome score in children. Diabetol Metab Syndr 2010;28:2–8.10.1186/1758-5996-2-8Search in Google Scholar PubMed PubMed Central
6. Okosun IS, Lyn R, Davis-Smith M, Eriksen M, Seale P. Validity of a continuous metabolic risk score as an index for modeling metabolic syndrome in adolescents. Ann Epidemiol 2010;20:843–51.10.1016/j.annepidem.2010.08.001Search in Google Scholar PubMed
7. Center for Disease Control and Prevention. National Center for Health Statistics. n.d. January 2009. <http://www.cdc.gov/growthcharts>.Search in Google Scholar
8. Tanner JM, Whitehouse RH, Takaishi M. Standards from birth to maturity for height, weight, height velocity and weight velocity: British children. Arch Dis Child 1966;46:613–35.10.1136/adc.41.220.613Search in Google Scholar PubMed PubMed Central
9. Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. J Pediatr 2007;150:12–17.10.1016/j.jpeds.2006.08.042Search in Google Scholar PubMed
10. Adolescents., National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and “The fourth report on the diagnosis, evaluation and treatment of high blood pressure in children and adolescents.” Pediatrics 2004;114:555–76.10.1542/peds.114.S2.555Search in Google Scholar
11. Conwell LS, Trost SG, Brown WJ, Batch JA. Indexes of insulin resistance and secretion in obese children and adolescents: a validation study. Diabetes Care 2004;27:314–9.10.2337/diacare.27.2.314Search in Google Scholar PubMed
12. Keskin M, Kurtoglu S, Kendirici M, Atabek ME, Yazici Z. Homeostasis model assessment is more reliable than fasting glucose/insulin ration and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents. Pediatrics 2005;115:e500–3.10.1542/peds.2004-1921Search in Google Scholar
13. Daniels SR, Greer FR. and the Committee on Nutrition. Lipid screening and cardiovascular health in childhood. Pediatrics 2008;122:198–208.10.1542/peds.2008-1349Search in Google Scholar
14. Mukhtar Q, Cleverley G, Voorhees RE, McGrath JW. Prevelence of acanthosis nigricans and its association with hyperinsulinemia in New Mexico adolescents. J Adol Health 2001:28:372–6.10.1016/S1054-139X(00)00217-2Search in Google Scholar
15. Brickman WJ, Huang J, Silverman BL, Metzger BE. Acanthosis nigricans identifies youth at high risk for metabolic abnormalities. J Pediatr 2010:156:87–92.10.1016/j.jpeds.2009.07.011Search in Google Scholar
16. Kong AS, Vanderbloemen L, Skipper B, Leggott J, Sebesta E, Glew R, et al. Acanthosis nigricans predicts the clustering of metabolic syndrome components in Hispanic elementary aged children. J Pediatr Endcrinol Metab 2012;25:1095–102.10.1515/jpem-2012-0117Search in Google Scholar
17. Santoro N, Amato A, Grandone A, Brienza C, Savarese P, Tartaglione N, et al. Predicting metabolic syndrome in obese children and adolescents: look, measure and ask. Obesity Facts 2013;1:48–56.10.1159/000348625Search in Google Scholar
18. Guran T, Turan S, Akcay T, Bereket A. Significance of acanthosis nigricans in childhood obesity. Paediatr and Child Health 2008;44:338–41.10.1111/j.1440-1754.2007.01272.xSearch in Google Scholar
19. Steward CA, Pate CJ, Peters EJ. Prevelence of acanthosis nigricans in an unselected population. Am J Med 1989;87:269–72.10.1016/S0002-9343(89)80149-4Search in Google Scholar
20. Bell RA, Mayer-Davis EJ, Beyer JW, D’Augostino R Jr, Imperatore G, Lawrence JM, et al. Diabetes in non-Hispanic white youth: prevalence, incidence and clinical characteristics: the SEARCH for diabetes in youth study. Diabetes Care 2009;32:S102–11.10.2337/dc09-S202Search in Google Scholar PubMed PubMed Central
21. Mayer Davis EJ, Beyer J, Bell RA, Dabelea D, D’Augustino R Jr, Imperatore G, et al. Diabetes in African American youth: prevalence, incidence and clinical characteristics: the SEARCH for diabetes in youth study. Diabetes Care 2009;32:112–22.10.2337/dc09-S203Search in Google Scholar PubMed PubMed Central
22. Weiss R, Dziura JD, Burgert TS, Taksali SE, Tamborlane WV, Caprio S. Racial differences in beta cell adaptation to insulin resistance in obese children and adolescents. Diabetologia 2006;49:571–9.10.1007/s00125-005-0109-zSearch in Google Scholar PubMed
23. Arslanian SA, Saad R, Lewy V, Danadian K, Janosky J. Hyperinsulinemia in African American children: decreased insulin clearance and increased insulin secretion and its relationship to insulin sensitivity. Diabetes 2002;51:3014–9.10.2337/diabetes.51.10.3014Search in Google Scholar PubMed
24. Lee S, Gungor N, Bacha F, Arslanian S. Insulin resistance: link to the components of the metabolic syndrome and biomarkers of endothelial dysfunction in youth. Diabetes Care 2007;30:2091–7.10.2337/dc07-0203Search in Google Scholar PubMed
25. Lteif AA, Han K, Mather KJ. Obesity, insulin resistance, and the metabolic syndrome: determinants of endothelial dysfunction in white and blacks. Circulation 2005;112:32–8.10.1161/CIRCULATIONAHA.104.520130Search in Google Scholar PubMed
26. Giannini C, Santoro N, Caprio S, Kim G, Lartaud D, Shaw M, et al. Association with insulin resistance in obese youths of different ethnic backgrounds. Diabetes Care 2011;34:1869–74.10.2337/dc10-2234Search in Google Scholar PubMed PubMed Central
27. Hannon TS, Gupta S, Li Z, Eckert G, Carroll AE, Pratt JH, et al. The effect of body mass index on blood pressure varies by race among obese children. J Pediatr Endocrinol Metab 2015;28:533–8.10.1515/jpem-2014-0225Search in Google Scholar PubMed
28. Freedman DS, Wnag J, Thornton JC, Mei Z, Pierson RN, Dietz WH, et al. Racial differences in body fatness among children and adolescents. Obesity 2008;16:1105–11.10.1038/oby.2008.30Search in Google Scholar PubMed
29. Goran MI, Bergman RN, Gower BA. Influence of total vs. viceral fat on insulin action and secretion in African American and white children. Obes Res 2001;9:423–31.10.1038/oby.2001.56Search in Google Scholar PubMed
30. Liska D, Dufour S, Zern TL, Cali AM, Cziura J, Shulman GI, et al. Interethnic differences in muscle, liver and abdominal fat partitioning in obese adolescents. PLoS ONE 2007;2:e569.10.1371/journal.pone.0000569Search in Google Scholar PubMed PubMed Central
31. Gruson E, Montaye M, Kee F, Wagner A, Bingham A, Ruidavets JB, et al. Anthropometric assessment of abdominal obesity and coronary heart disease risk in men: the PRIME study. Heart 2010;96:136–40.10.1136/hrt.2009.171447Search in Google Scholar PubMed
32. Despres JP. Body fat distribution and risk of cardiovascular disease: an update. Circulation 2012;126:1301–13.10.1161/CIRCULATIONAHA.111.067264Search in Google Scholar PubMed
33. Alvey NJ, Pedley A, Rosenquist KJ, Massaro JM, O’Donnell CJ, Hoffmann U, et al. Association of fat density with subclinical atherosclerosis. J Am Heart Assoc 2014;3:1–8.10.1161/JAHA.114.000788Search in Google Scholar PubMed PubMed Central
34. Fox CS, Massaro JM, Hoffmann U, Pou KM, Maurovich-Horvat P, Liu CY, et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation 2007;116:39–48.10.1161/CIRCULATIONAHA.106.675355Search in Google Scholar PubMed
35. Bacha F, Saad R, Gungor N, Janosky J, Arslanian SA. Obesity, regional fat distribution, and syndrome X in obese black versus white adolescents:race differential in diabetogenic and atherogenic risk factors. J Clin Endocrinol Metab 2003;88:2534–40.10.1210/jc.2002-021267Search in Google Scholar PubMed
36. Osei K. Metabolic syndrome in blacks: are the criteria right? Curr Diab Rep 2010;10:199–208.10.1007/s11892-010-0116-4Search in Google Scholar PubMed
37. Ten S, Bhangoo A, Ramchandani N, Mueller C, Vogiatzi M, New M, et al. Characterization of insulin resistance syndrome in children and young adults. When to screen for prediabetes? J Pediatr Endcrinol Metab 2007;20:989–1000.10.1515/JPEM.2007.20.9.989Search in Google Scholar PubMed
38. Executive summary: Standards of medical care in diabetes-2014. Diabetes Care 2014;37:S14–S80.10.2337/dc14-S014Search in Google Scholar PubMed
39. Ice CL, Murphy E, Minor VE, Neal WA. Metabolic syndrome in fifth grade children with acanthosis nigricans: results from the CARDIAC project. World J Pediatr 2009;5:23–30.10.1007/s12519-009-0004-7Search in Google Scholar PubMed
40. Steinberger J, Daniels SR, Eckel RH, Hayman L, Lustig RH, McCrindle B, et al. Progress and challenges in metabolic syndrome in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular Nursing; and Council on Nutrition, Physical Activity, and Metabolism. Circulation 2009;119:628–47.10.1161/CIRCULATIONAHA.108.191394Search in Google Scholar PubMed
©2016 by De Gruyter
