Lepe Alexander, de Kroon Marlou L A, de Winter Andrea F, Reijneveld Sijmen A
Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Pediatr Res. 2021 Sep;90(3):694-700. doi: 10.1038/s41390-020-01331-3. Epub 2021 Jan 14.
There is no consensus regarding the definition of pediatric metabolic syndrome (MetS). This study assessed the impact of alternative definitions on the prevalence, children identified, and association with socioeconomic status (SES).
Data were from the prospective multigenerational Dutch Lifelines Cohort Study. At baseline, 9754 children participated, and 5085 (52.1%) with average follow-up of 3.0 (SD = 0.75) years were included in the longitudinal analyses; median ages were 12 (IQR = 10-14) and 14 years (IQR = 12-15), respectively. We computed MetS prevalence according to five published definitions and measured the observed proportion of positive agreement. We used logistic regression to assess the SES-MetS association, adjusted for age and sex. Longitudinal models were also adjusted for baseline MetS.
MetS prevalence and positive agreement varied between definitions, from 0.7 to 3.0% and from 0.34 (95% CI: 0.28; 0.41) to 0.66 (95% CI: 0.58; 0.75) at baseline, respectively. We consistently found a socioeconomic gradient; in the longitudinal analyses, each additional year of parental education reduced the odds of having MetS by 8% (95% CI: 1%; 14%) to 19% (95% CI: 7%; 30%).
Alternative MetS definitions had differing prevalence estimates and agreed on 50% of the average number of cases. Additionally, regardless of the definition, low SES was a risk factor for MetS.
Little is known about the impact of using different definitions of pediatric metabolic syndrome on study results. Our study showed that the choice of pediatric metabolic syndrome definition produces very different prevalence estimates. We also showed that the choice of definition influences the socioeconomic gradient. However, low socioeconomic status was consistently a risk factor for having pediatric metabolic syndrome. In conclusion, studies using different definitions of metabolic syndrome could be reasonably compared when investigating the association with socioeconomic status but not always validly when comparing prevalence studies.
关于儿童代谢综合征（MetS）的定义尚无共识。本研究评估了不同定义对患病率、确诊儿童以及与社会经济地位（SES）关联的影响。
数据来自前瞻性多代荷兰生命线队列研究。基线时，9754名儿童参与研究，5085名（52.1%）儿童纳入纵向分析，平均随访3.0年（标准差=0.75）；年龄中位数分别为12岁（四分位间距=10 - 14）和14岁（四分位间距=12 - 15）。我们根据五种已发表的定义计算了MetS患病率，并测量了观察到的阳性一致性比例。我们使用逻辑回归评估SES与MetS的关联，并对年龄和性别进行了调整。纵向模型也对基线时的MetS进行了调整。
不同定义下的MetS患病率和阳性一致性有所不同，基线时分别为0.7%至3.0%和0.34（95%置信区间：0.28；0.41）至0.66（95%置信区间：0.58；0.75）。我们始终发现存在社会经济梯度；在纵向分析中，父母受教育年限每增加一年，患MetS的几率降低8%（95%置信区间：1%；14%）至19%（95%置信区间：7%；30%）。
不同的MetS定义对患病率的估计不同，且在平均病例数的50%上达成一致。此外，无论采用何种定义，低SES都是MetS的一个风险因素。
关于使用不同的儿童代谢综合征定义对研究结果的影响知之甚少。我们的研究表明，儿童代谢综合征定义的选择会产生非常不同的患病率估计。我们还表明，定义的选择会影响社会经济梯度。然而，低社会经济地位始终是患儿童代谢综合征的一个风险因素。总之，在研究与社会经济地位的关联时，使用不同代谢综合征定义的研究可以进行合理比较，但在比较患病率研究时并不总是有效。
