ESPE Abstracts (2016) 86 P-P2-502

Metabolic Syndrome in Prepubertal Obese Children: Inclusion of the Triglyceride/Hdl Ratio as an Alternative Diagnostic Criterion

Carla Boquete, Baran Jesica, Fernanda Alvarez Yuseff, Martha Suarez, Gabriel Fideleff, Miriam Azaretzky, Marcela Aranguren, Mariela Fusero, Gabriela Ruibal, Hugo Fideleff & Hugo Boquete


Endocrinology Unit, Hospital Alvarez, Buenos Aires, Argentina


Background: Although a large number of publications show a high prevalence of Metabolic Syndrome (MS) during childhood, to date, there is no uniform definition for evaluating this condition in children and adolescents. In the pediatric population, there are difficulties for characterizing this condition and the various criteria used might lead to underdiagnosis. In recent years, the triglycerides/HDL (TG/HDL) ratio has been proposed as a new marker.

Objective and hypotheses: To analyse the prevalence of MS using Cook’s diagnostic criteria and to evaluate the inclusion of the TG/HDL ratio as an alternative criterion for MS characterization in obese prepubertal children.

Method: 111 obese prepubertal children (BMI >95th percentile), aged 5–13 years (72 boys; 39 girls) were included. A TG/HDL ≧2 was considered abnormal. Insulin was measured for HOMA-IR calculation.

Results: 16 (22.2%) boys and 16 (41.0%) girls met at least 3/5 Cook’s criteria. The TG/HDL ratio was found to be abnormal in all these subjects. Of the remaining children, 28 boys and 11 girls met 2/5 Cook’s criteria; 78.6% boys and 63.6% girls of these subjects showed elevated TG/HDL ratio, while the HOMA-IR was abnormal in only 46.7% boys and 25% girls of this subgroup. The inclusion of the TG/HDL parameter would increase the prevalence of MS to 52.8% and 59.0% in the obese boys and girls evaluated, respectively.

Conclusion: In this study, using Cook’s criteria, 29% of obese children had a diagnosis of MS; however, 35% (39 out 111) children included had only two components of MS. Based on our findings, we suggest including, as an alternative diagnostic criterion in the latter subgroup, the TG/HDL ratio for reducing underdiagnosis in MS in prepubertal patients of both genders. The lower detection of MS using classical criteria may underestimate cardiometabolic risk in children and delay the strengthening of preventive measures.