Pediatric metabolic syndrome predicts adulthood metabolic syndrome, subclinical atherosclerosis, and type 2 diabetes mellitus but is no better than body mass index alone: the Bogalusa Heart Study and the Cardiovascular Risk in Young Finns Study.

BACKGROUND: The clinical utility of identifying pediatric metabolic syndrome (MetS) is controversial. This study sought to determine the status of pediatric MetS as a risk factor for adult subclinical atherosclerosis (carotid intima-media thickness [cIMT]) and type 2 diabetes mellitus (T2DM) and compare and contrast this prediction with its individual components. METHODS AND RESULTS: Using data from the population-based, prospective, observational Bogalusa Heart and Cardiovascular Risk in Young Finns studies, we examined the utility of 4 categorical definitions of youth MetS and their components in predicting adult high cIMT and T2DM among 1781 participants aged 9 to 18 years at baseline (1984 to 1988) who were then examined 14 to 27 years later (2001-2007) when aged 24 to 41 years. Youth with MetS were at 2 to 3 times the risk of having high cIMT and T2DM as adults compared with those free of MetS at youth. Risk estimates with the use of high body mass index were similar to those of MetS phenotypes in predicting adult outcomes. Comparisons of area under the receiver operating characteristic curve and net reclassification index suggested that prediction of adult MetS, high cIMT, and T2DM in adulthood with the use of youth MetS was either equivalent or inferior to classification based on high body mass index or overweight and obesity. CONCLUSIONS: Youth with MetS are at increased risk of meaningful adult outcomes; however, the simplicity of screening for high BMI or overweight and obesity in the pediatric setting offers a simpler, equally accurate alternative to identifying youth at risk of developing adult MetS, high cIMT, or T2DM.

Metabolic syndrome and carotid intima-media thickness in young adults: roles of apolipoprotein B, apolipoprotein A-I, C-reactive protein, and secretory phospholipase A2: the cardiovascular risk in young Finns study.

OBJECTIVE: Aberrations in apolipoprotein (apo) metabolism and increased systemic inflammation associate with the metabolic syndrome (MetS) and may contribute to its atherogenicity. We examined whether the association between carotid atherosclerosis and MetS in a population of young adults is mediated by apoB and apoA-I and/or by inflammatory markers C-reactive protein and type II secretory phospholipase A2. METHODS AND RESULTS: We used cross-sectional and 6-year prospective data from the cardiovascular risk in young Finns study. In young adults (aged 24 to 39 years), apoB, C-reactive protein, and type II secretory phospholipase A2 enzyme activity were significantly higher and apoA-I lower in subjects with MetS (N=325) than in subjects without MetS (N=1858). In prospective analysis (N=1587), both MetS and high apoB predicted (P<0.0001) incident high carotid intima-media thickness, defined as carotid intima-media thickness >90th percentile and/or plaque. The association between MetS and incident high carotid intima-media thickness was attenuated by approximately 40% after adjustment with apoB. Adjustments with apoA-I, C-reactive protein, or type II secretory phospholipase A2 did not diminish the association. CONCLUSIONS: High levels of apoB, C-reactive protein, and type II secretory phospholipase A2 and low levels of apoA-I associate with MetS in young adults. The atherogenicity of MetS in this population assessed by incident high carotid intima-media thickness appears to be substantially mediated by elevated apoB but not inflammatory markers.

Conventional cardiovascular risk factors and metabolic syndrome in predicting carotid intima-media thickness progression in young adults: the cardiovascular risk in young Finns study.

BACKGROUND: Conventional risk factors and metabolic syndrome (MetS) are cross-sectionally associated with subclinical atherosclerosis in young adults. We evaluated the relations of conventional risk factors and MetS to the 6-year progression of carotid intima-media thickness (IMT) in a population of young adults. RESULTS AND METHODS: The study included 1809 subjects (aged 32+/-5 years) who had IMT measured in 2001 and 2007. Risk factor measurements included low-density lipoprotein cholesterol, body mass index, C-reactive protein, smoking, and family history of coronary disease in addition to MetS components. We used European Group for the Study of Insulin Resistance, revised National Cholesterol Education Program, and International Diabetes Federation definitions to diagnose MetS in 2001. Waist circumference (P<0.0001), low-density lipoprotein cholesterol (P=0.01), and insulin (P=0.003) were directly associated with IMT progression in a multivariable model adjusted for age, sex, and baseline IMT (model R(2)=24%). When the MetS/European Group for the Study of Insulin Resistance definition was included in the model, it was directly associated with IMT progression (P=0.03), but its inclusion did not improve the model's predictive value. IMT increased 79+/-7 mum (mean+/-SEM) in subjects with MetS according to the MetS/European Group for the Study of Insulin Resistance definition and 42+/-2 mum in subjects without MetS (P<0.0001). In addition, the number of MetS components was linearly associated with IMT progression (P<0.0001). Similar results were seen with MetS/revised National Cholesterol Education Program and MetS/International Diabetes Federation definitions. CONCLUSIONS: Obesity, high low-density lipoprotein cholesterol, and high insulin level predicted IMT progression in young adults. All MetS definitions identified young adults with accelerated IMT progression, but we found no evidence that MetS would predict IMT progression more than expected from the sum of its risk components.

Depressive symptoms and the metabolic syndrome in childhood and adulthood: a prospective cohort study.

OBJECTIVE: To examine the reciprocal associations between depressive symptoms and clinical definitions of the metabolic syndrome in childhood and adulthood. DESIGN: Population-based prospective cohort study of 921 participants (538 women and 383 men) in Finland. The components of the metabolic syndrome were measured in childhood (mean age 12 years) and again in adulthood (mean age 33 years). A revised version of the Beck Depression Inventory was used to assess depressive symptoms at the mean ages of 24 and 33. MAIN OUTCOME MEASURES: Metabolic syndrome defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP), the European Group for the Study of Insulin Resistance, and the International Diabetes Federation criteria. RESULTS: In women, depressive symptoms were associated with increased risk of the metabolic syndrome in adulthood (odds ratio for NCEP metabolic syndrome per 1 SD increase in depressive symptoms 1.40, 95% confidence interval 1.05-1.85). The metabolic syndrome in childhood, in turn, predicted higher levels of depressive symptoms in adulthood (p = .03). In men, no associations were found between depressive symptoms and the clinical definitions of the metabolic syndrome. CONCLUSION: The process linking depressive symptoms with the metabolic syndrome may go into both directions and may begin early in life.

Childhood predictors of the metabolic syndrome in adulthood. The Cardiovascular Risk in Young Finns Study.

BACKGROUND: Obese youths may be susceptible to develop the metabolic syndrome (MS) later in life. AIM: To study childhood predictors of MS in adulthood. METHOD: Prospective cohort study including 2,195 subjects, aged 3-18 years at base-line in 1980, who were re-examined in 1983, 1986, and 2001. RESULTS: In adults (aged 24-39 years) in 2001, the prevalence of MS (using the International Diabetes Federation criteria) was 19% in men and 12% in women. Multivariable logistic regression model selected obesity, male sex, high triglycerides, high insulin, high C-reactive protein (CRP), and family history of hypertension and type 2 diabetes, as independent predictors of adult MS. Youth obesity (body mass index (BMI)>80th age- and sex-specific percentile) was the strongest risk factor for MS. During the 21-year follow-up, there was an increasing trend in BMI, insulin, systolic blood pressure, and triglycerides, and a decreasing trend in high-density lipoprotein cholesterol in obese subjects who developed MS in adulthood compared to those obese subjects who did not develop MS. CONCLUSIONS: Youth determinants of adult MS included obesity, high triglycerides, high insulin, high CRP, and family history of hypertension and type 2 diabetes. Identifying these risk factors at an early stage could help identifying children and adolescence at greater risk of developing MS later in life.

The longitudinal effects of physical activity history on metabolic syndrome.

PURPOSE: To examine the relationship of physical activity and its changes over a 9-yr follow-up to the prevalence of metabolic syndrome (MetS) in 2060 young adults (24-39 yr) enrolled in the Cardiovascular Risk in Young Finns Study. METHODS: Leisure-time physical activity (LTPA) was assessed using a self-report questionnaire completed in connection with a medical examination at two consecutive measurements in 1992 and 2001. By summing the LTPA items, a physical activity index (PAI) was formed for both measurement points according to which the participants were divided into tracking groups: persistently active, increasingly active, decreasingly active, and persistently inactive. MetS in 2001 was defined by the guidelines of the European Group for the Study of Insulin Resistance (EGIR), the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), and the International Diabetes Federation (IDF). A continuous metabolic risk score was also calculated by summing the z-scores for the metabolic risk factors. RESULTS: There was a significant linear relationship between MetS and LTPA at baseline in men and at follow-up in both sexes according to all three definitions. Persistent physical activity during 9 yr was associated with a lower prevalence of MetS than persistent physical inactivity on all definitions (all P < 0.05). Similar results were found for increasingly active women (all P < 0.05). All of these associations remained significant after adjustment for potential confounders. In both men and women, the 9-yr change in LTPA was related to the metabolic risk score after adjustments for baseline LTPA, age, smoking, and education. CONCLUSIONS: A physically active lifestyle across the lifespan may prevent or delay the onset of metabolic syndrome in young male and female adults.

Arterial structure and function in young adults with the metabolic syndrome: the Cardiovascular Risk in Young Finns Study.

AIMS: To study the relations between the metabolic syndrome (MS) and subclinical atherosclerosis in young adults. METHODS AND RESULTS: International Diabetes Federation (msIDF), National Institute of Health Adult Treatment Panel III (msNCEP), and European Group for the Study of Insulin Resistance (msEGIR) definitions of MS were related to carotid artery intima-media thickness (cIMT), brachial flow-mediated dilatation (FMD), and carotid artery compliance (CAC) in 2163 Finnish adults (aged 32 +/- 5years). All definitions associated with increased cIMT and decreased CAC in both sexes. The cIMT values (mean+/-SD) were 0.576 +/- 0.088 mm in subjects without the syndrome, 0.615 +/- 0.102 mm in msIDF, 0.617 +/- 0.104 mm in msNCEP, and 0.607 +/- 0.097 mm in msEGIR (P < 0.0001). Corresponding CAC values were 2.26 +/- 0.72, 1.76 +/- 0.66, 1.73 +/- 0.66, 1.72 +/- 0.66%/10 mmHg (P < 0.001). Impaired brachial FMD was not related to MS but it modified the relations between MS and cIMT: MS correlated with increased cIMT in subjects with an impaired FMD response (P = 0.003) but not in subjects with an enhanced FMD response (P = 0.75). CONCLUSION: All current definitions of MS identify a population of young adults with evidence of increased subclinical atherosclerosis. Impaired brachial endothelial response is not a hallmark of MS in young adults, but the status of endothelial function modifies the association between metabolic risk factors and atherosclerosis.