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Diagnostic Criteria for Metabolic Syndrome Are Not Reliable in Children

Posted: Sunday, January 17, 2010

Traditional diagnostic criteria for metabolic syndrome are not reliable in children, researchers from the National Institutes of Health report.

Senior author Dr. Jack A. Yanovski from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, stated that, "Children's lab results appear to be more likely to change from day to day than those of adults, so diagnoses based on reaching particular cut points are unstable both in the short-term and the long-term."

Dr. Yanovski and colleagues based their conclusions on findings in two cohorts. First, in 220 obese children ages 7 to 18, they assessed what they called "short-term metabolic syndrome stability" -- that is, diagnostic criteria confirmed at two clinic visits within 60 days of each other.

In this group, during a mean follow-up interval of 19.8 days, the prevalence of metabolic syndrome ranged from 17.3% at baseline to 31.8% at follow-up, the authors report.

Almost a third of the youngsters with metabolic syndrome at baseline did not have it at the second visit, whereas 24% of those without metabolic syndrome at baseline met the diagnostic criteria only days to weeks later.

The researchers also assessed the long-term stability of a pediatric diagnosis of metabolic syndrome, this time in 146 obese and nonobese children ages 6 to 13 at baseline. In this group, the authors compared test results from two visits at least 18 months apart.

At baseline, 7.5% in this group met the diagnostic criteria for metabolic syndrome. At an average of 5.6 years later, 8.9% had metabolic syndrome. About one third of cases were unstable, and each individual component of metabolic syndrome was unstable in at least 15% of the cases, according to the article.

"These data support the view that the diagnosis of metabolic syndrome in youth, established using dichotomous cutoff points from measurements obtained at a single point in time, may have limited clinical utility," the investigators conclude.

"It is still a bit unclear if it is of real use to make this diagnosis among children," Dr. Yanovski said. But clearly, he continued, the "diagnostic criteria for metabolic syndrome will have to be different for children, because as children grow they change not just in size, but also in what constitutes the normal range for many lab values -- including the laboratory measures ... that make up the metabolic syndrome."

"Just because it may be difficult to make a diagnosis of metabolic syndrome in childhood doesn't mean the concept isn't useful," Dr. Yanovski added. "Children whose values are above or even close to the criteria for pediatric metabolic syndrome are likely to be at high risk for metabolic complications later on in life -- and should be counseled accordingly."

Source: Diabetes In Control: J Clin Endocrinol Metab, December 2009;94:4828-4834.

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