Abstract
Introduction Metabolic syndrome (MS) is a public health problem without appropriate strategies for prevention, diagnosis and treatment in children. Existing criteria are controversial and not applicable for pediatric population, with variations according to different authors and expert committees, which could have important consequences
in MS diagnosis, treatment and prognosis. Objective: To validate different definitions (NCEP-ATPIII; Cook, Ford and Duncan, et al; Ferranti, et al; Cruz, et al; and IDF1) for metabolic syndrome diagnosis in Mexican children. Methodology: Cross-sectional study of 2599 children aged between 6 and 16 years, residents of Mexico City. MS was defined as the presence of three or more of the five components in the different criteria; and two or more components with the presence of central obesity for IDF. The Gold Standard was considered as the combination of the five diagnostic criteria. To identify the best predictive value, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and likelihood ratio were calculated. Results: A greater proportion of individuals diagnosed with the Ferranti, et al criterion was observed in comparison with the other criteria evaluated. We proposed an ad hoc criteria which showed a high sensitivity (0,89) and specificity (0,90) compared to the Gold Standard applied. Conclusion: Our diagnostic criteria contains a choice of simple and low-cost components that will facilitate its application in health institutions and will unify- diagnostic criteria, treatment, and prognosis, reducing morbidity and mortality rates in Mexican population.
References
2. Robles-Valdés C. Riesgo cardiovascular y síndromemetabólico en niños y adolescentes. Acta Pediatr Mex. 2011; 32: 1-4.
3. Titmuss, AT, Srinivasan S. Metabolic syndrome in children and adolescents: Old concepts in a young population. J Paediatr Child Health. 2016; 52: 928-934.
4. Peña-Espinoza BI, Granados-Silvestre MA, Sánchez-Pozos K, Ortiz-López MG, Menjivar M. Metabolic syndrome in Mexican children: Low effectiveness of diagnostic definitions. Endocrinol, Diabetes Nutr. 2017; 64: 369-376.
5. Rojas-Martínez R, Aguilar-Salinas CA, Jiménez-Corona A, Gómez-Pérez FJ, Barquera S, Lazcano-Ponce E. Prevalence of obesity and metabolic syndrome components in Mexican adults without type 2 diabetes or hypertension. Salud Publica Mex. 2012; 54: 7-12.
6. Parikh RM, Mohan V. Changing definitions of metabolic syndrome. Indian J Endocrinol Metab. 2012; 16: 7-12.
7. Lerman Garber I, Aguilar-Salinas CA, Gómez-Pérez FJ, Reza Albarrán A, Hernández Jiménez S, Vázquez Chávez C, et al. El síndrome metabólico. Posición de la Sociedad Mexicana de Nutrición y Endocrinología, sobre la definición, fisiopatología y diagnóstico. Características del síndrome metabólico en México. Rev Endocrin Nutrición. 2004; 12: 109-122.
8. Macías Tomei C. Síndrome metabólico en niños y adolescentes. Arch Venez Puer Ped. 2009; 72: 30-37.
9. Zimmet P, Alberti G, Kaufman F, Tajima N, Silink M, Arslanian S, et al. The metabolic síndrome in children and adolescents. Lancet. 2007; 369: 2059-2061.
10. Pires Rodríguez MC, Nava Arias AV, Lanzilli P. Síndrome metabólico: prevalencia y factores de riesgo en escolares. Arch Venez Puer Ped. 2009; 72: 47-52.
11. Lee L, Sanders RA. Metabolic Syndrome. Pediatr Rev. 2012; 33: 459-466.
12. Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988-1994. Arch Pediatr Adolesc Med. 2003;157(8): 821-827. doi: 10.1001/archpedi.157.8.821.
13. Duncan GE, Li SM, Zhou XH. Prevalence and trends of a metabolic syndrome phenotype among US adolescents, 1999-2000. Diabetes Care. 2004; 27(10): 2438-2443.
14. De Ferranti SD, Gauvreau K, Ludwig DS, Newfeld EJ, Newburger JW, Rifai N. Prevalence of the metabolic syndrome in american adolescents: findings from the third national health and nutrition examination survey. Circulation. 2004; 110(16): 2494-2497. doi: 10.1161/01.CIR.0000145117.40114.C7.
15. Cruz ML, Weigensberg MJ, Huang TT, Ball G, Shaibi GQ, Goran MI. The metabolic syndrome in overweight Hispanic youth and the role of insulin sensitivity. J Clin Endocrinol Metab. 2004; 89(1): 108-113.
16. Sharma S, Fleming SE. Use of HbA1C testing to diagnose pre-diabetes in high risk African American children: a comparison with fasting glucose and HOMA-IR. Diabetes Metab Syndr. 2012; 6: 157-162.
17. Kuri Morales P, Lara Esqueda A, Raquel Ortiz Solís GR, De la Cabada Tamez E, Castro Alba PJ, Vital Calvo O, García Torres H. Manual de calibración y mantenimiento de esfigmomanómetros. Subsecretaría de Prevención y Promoción de la Salud Centro Nacional de Vigilancia Epidemiológica y Control de Enfermedades. México Distrito Federal.
2007. p. 1-40.
18. Hernández B, Gortmaker SL, Laird NM, Colditz GA, Parra-Cabrera S, Peterson KE. Validez y reproducibilidad de un cuestionario de actividad e inactividad física para escolares de la Ciudad de México. Salud Publica Mex 2000; 42: 315-323.
19. Gidding SS, Dennison BA, Birch LL, Daniels SR, Gillman MW, Lichtenstein AH, et al. Dietary recommendations for children and adolescents: a guide for practitioners. Pediatrics. 2006; 117: 544-559.
20. Wacher-Rodarte N. Epidemiología del síndrome metabólico. Gac Med Méx. 2009; 145: 384-391.
21. American Diabetes Association. Standards of Medical Care in Diabetes 2013. Diabetes Care.2013; 36: S11-S66.
22. Burrows R. Prevención del sobrepeso en la niñez: la mejor estrategia para la prevención de las Enfermedades Crónicas no Transmisibles (ECNT) del adulto. Revista Hospital Clínico Universidad de Chile. 2005; 16: 341-350.
23. Durán P, Piazza N, Agnestein C, Bay L, Cotti A, Trifone L, et al. Consenso sobre factores de riesgo de enfermedad cardiovascular en pediatría. Obesidad. Arch Argent Pediatr. 2005; 103: 262-281.
24. Cabrera-Rode E, Bioti Torres Y, Marichal Madrazo S, Parlá Sardiñas J, Arranz Calzado C, Olano Justiniani R, et al. Índice cintura-cadera contra perímetro cintura para el diagnóstico del síndrome metabólico en niños y adolescentes con familiares de primer grado diabéticos tipo 1. Rev Cubana Endocrinol. 2011; 22: 182-195.
25. Magalhäes EI, Sant’Ana LF, Priore SE, Franceschini Sdo C. Waist circumference, waist/height ratio, and neck circumference as parameters of central obesity assessment in children. Rev Paul Pediatr. 2014; 32: 273-281.
26. González Garrido JA, Ceballos Reyes GM, Méndez Bolaina DE. Obesidad: más que un problema de peso. Rev Divulg Cient Tec Univ Veracruzana. La Ciencia y el Hombre. 2010; 23(2).
27. Silveira LS, Buonani C, Monteiro PA, Mello Antunes BM, Freitas Júnior IF. Metabolic syndrome: criteria for diagnosing in children and adolescents. Endocrinol Metab Synd. 2013; 2: 1-6.
28. Halpern A, Mancini MC, C Magalhaes ME, Fisberg M, Radominski R, Bertolami MC, et al. Metabolic syndrome, dyslipidemia, hypertension and type 2 diabetes in youth: from diagnosis to treatment. Diabetol Metab Syndr. 2010; 2: 55.
29. Costa RF, Santos NS, Goldraich NP, Barski TF, de Andrade KS, Kruels LFM. Metabolic syindrome in obese adolescents: a comparison of three different diagnostic criteria. J Pediatr (Rio J). 2012; 88: 303-309.
30. Reinehr T, de Sousa G, Toschke AM, Andler W. Comparison of metabolic syndrome prevalence using eight different definitions: a critical approach. Arch Dis Child. 2007; 92: 1067-1072.
31. Camarillo-Romero E, Domínguez García MV, Amaya-Chávez A, Huitrón-Bravo G, Majluf-Cruz A. Dificultades en la clasificación del síndrome metabólico. El ejemplo de los adolescentes en México. Salud Publica Mex. 2010; 52: 524-527.
32. Ramírez-Vélez R, Anzola A, Martínez-Torres J, Vivas A, Tordecilla-Sanders A, Prieto-Benavides D, et al. Metabolic syndrome and associated factors in a population-based Sample of Schoolchildren in Colombia: The FUPRECOL Study. Metab Syndr Relat Disord. 2016; 14(9): 455-462. doi: 10.1089/met.2016.0058.
Se autoriza la reproducción total o parcial de la obra para fines educativos, siempre y cuando se cite la fuente.
Esta obra está bajo una Licencia Creative Commons Atribución 4.0 Pública Internacional.