Obesity and the Metabolic Syndrome in Children and Adolescents

doi:10.1056/NEJMoa031049

Volume 350:2362-2374		June 3, 2004		Number 23

Obesity and the Metabolic Syndrome in Children and Adolescents

Ram Weiss, M.D., James Dziura, Ph.D., Tania S. Burgert, M.D., William V. Tamborlane, M.D., Sara E. Taksali, M.P.H., Catherine W. Yeckel, Ph.D., Karin Allen, R.N., Melinda Lopes, R.N., Mary Savoye, R.D., John Morrison, M.D., Robert S. Sherwin, M.D., and Sonia Caprio, M.D.

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ABSTRACT

Background The prevalence and magnitude of childhood obesityare increasing dramatically. We examined the effect of varyingdegrees of obesity on the prevalence of the metabolic syndromeand its relation to insulin resistance and to C-reactive proteinand adiponectin levels in a large, multiethnic, multiracialcohort of children and adolescents.

Methods We administered a standard glucose-tolerance test to439 obese, 31 overweight, and 20 nonobese children and adolescents.Baseline measurements included blood pressure and plasma lipid,C-reactive protein, and adiponectin levels. Levels of triglycerides,high-density lipoprotein cholesterol, and blood pressure wereadjusted for age and sex. Because the body-mass index variesaccording to age, we standardized the value for age and sexwith the use of conversion to a z score.

Results The prevalence of the metabolic syndrome increased withthe severity of obesity and reached 50 percent in severely obeseyoungsters. Each half-unit increase in the body-mass index,converted to a z score, was associated with an increase in therisk of the metabolic syndrome among overweight and obese subjects(odds ratio, 1.55; 95 percent confidence interval, 1.16 to 2.08),as was each unit of increase in insulin resistance as assessedwith the homeostatic model (odds ratio, 1.12; 95 percent confidenceinterval, 1.07 to 1.18 for each additional unit of insulin resistance).The prevalence of the metabolic syndrome increased significantlywith increasing insulin resistance (P for trend, <0.001)after adjustment for race or ethnic group and the degree ofobesity. C-reactive protein levels increased and adiponectinlevels decreased with increasing obesity.

Conclusions The prevalence of the metabolic syndrome is highamong obese children and adolescents, and it increases withworsening obesity. Biomarkers of an increased risk of adversecardiovascular outcomes are already present in these youngsters.

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From the Department of Pediatrics (R.W., T.S.B., W.V.T., S.E.T., C.W.Y., S.C.), the Children's General Clinical Research Center (J.D., K.A., M.L., M.S.), and the Department of Internal Medicine (R.S.S.), Yale University School of Medicine, New Haven; and Cincinnati Children's Hospital Medical Center, Cincinnati (J.M.).

Address reprint requests to Dr. Caprio at the Department of Pediatrics, Yale University School of Medicine, P.O. Box 802064, New Haven, CT 06520, or at sonia.caprio{at}yale.edu.

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Obesity and the Metabolic Syndrome in Children and Adolescents
Engelmann G., Lenhartz H., Grulich-Henn J., Davis T. M.E., Ee C. K., Invitti C., Gilardini L., Viberti G., Weiss R., Yeckel C. W., Caprio S.
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N Engl J Med 2004; 351:1146-1148, Sep 9, 2004. Correspondence

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