ESPE Abstracts

Aim: Few data are currently available on the reliability of the different anthropometric, instrumental and biochemical indexes in recognizing the presence of the metabolic syndrome (MetS) in severe childhood obesity. The objective of our study was to find out a simple and accurate index to use in deciding whether to initiate a search for MetS in this at-risk population.

Patients and Methods: A retrospective study based on 1065 children and adolescents with severe obesity [563 females, aged 14.6±2.1 (range 10-17) years, and BMI-SDS 3.50±0.36 (range 3.00-5.17)], was performed. For each subject, all the components of MetS, defined according to the IDF criteria, were determined. The following indexes were calculated according to the following formulas: (a). BMI: weight (kg)/height (m2); (b). BMI-SDS: (BMI-mean BMI (for age and sex))/SD; (c) TMI: mass (kg)/height (m3): (d) WtHR: WC (cm)/height (cm); (e) TG/HDL-C ratio: TG (mmol/L)/HDL-C (mmol/L); (f) CMI: WtHR x TG/HDL-C ratio; (g) VAI: males: (WC/39.68+(1.88 x BMI)) x (TG/1.03) x (1.31/HDL): females: (WC/36.58+(1.89 x BMI)) x (TG/0.81) x (1.52/HDL). Median values were tested for statistical significance using 2-tailed Wilcoxon test and nonparametric one-way ANOVA. Spearman correlation coefficients were calculated to assess the relationship between indexes and metabolic characteristics. Adjusted receiver operating characteristic (ROC) analysis using clinical cut points for metabolic risks was performed to determinate the odds ratio of cardiometabolic risk factors across indexes. In addition, positive likelihood ratio (PLR), negative likelihood ratio (NLR), positive predictive value (PPV), and negative predictive value (NPV) were examined.

Results: Overall, the presence of MetS was found in 324 patients (30.4%), 167 males (33.3%) and 157 females (27.9%). We found that three indexes (i.e. VAI, CMI and TG/HDL-C ratio), performed significantly better than the other ones in identifying MetS, with no difference among them. Consequently, we choose the TG/HDL-C ratio as the simplest index. TG/HDL-C ratio showed a strong correlation with the clinical and biochemical parameters of MetS, but not with glucose levels. The odds ratio showed a strong association of TG/HDL-C ratio with the high triglycerides and low HDL-C, but not with glucose serum level, blood pressure and WC.

Conclusion: We have shown that a very simple index, which just need the evaluation of triglycerides and HDL-c serum levels, has the same accuracy of other more sophisticated indexes in recognizing MetS in children and adolescents with severe obesity.