Ability Among Adolescents for the Metabolic Syndrome to Predict Elevations in Factors Associated with Type 2 Diabetes and Cardiovascular Disease: Data from the National Health and Nutrition Examination Survey 1999-2006
Ability Among Adolescents for the Metabolic Syndrome to Predict Elevations in Factors Associated with Type 2 Diabetes and Cardiovascular Disease: Data from the National Health and Nutrition Examination Survey 1999-2006
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DOI：
10.1089/met.2010.0008
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发表时间：
2010-08-01
影响因子：
2.1
通讯作者：
Gurka, Matthew J.
中科院分区：
文献类型：
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作者：
DeBoer, Mark D.;Gurka, Matthew J.
目的：本研究的目的是比较目前提出的儿童代谢综合征标准，以预测与代谢综合征和未来心血管疾病和2型糖尿病相关的“替代”因素升高的能力。这些替代因素包括空腹胰岛素、血红蛋白A1 c（HbA 1c）、高敏C反应蛋白（hsCRP）和尿酸。腰围（WC）、血压、甘油三酯、高密度脂蛋白胆固醇（HDL-C）、空腹血糖、空腹胰岛素、HbA 1c、hsCRP和尿酸测量值来自2，624名青少年（12-18岁）参加了1999-2006年国家健康和营养检查调查。我们根据六套常用的儿科代谢综合征标准确定了患有代谢综合征的儿童。然后，我们定义的替代因素中的海拔高度的值在前5%的队列和计算灵敏度，特异性，阳性预测值（PPV），和阴性预测值（NPV）为每组代谢综合征标准和每个替代factor.Results：目前的儿科代谢综合征标准表现出可变的灵敏度和特异性的替代predictions。代谢综合征标准预测空腹胰岛素的敏感性最高（40-70%），其次是尿酸（31-54%），hsCRP（13-31%）和HbA 1c（7-21%）。de Ferranti的标准（包括WC >75（第）百分位数的儿童，与包括WC >90（第）百分位数的儿童的所有其他集合相比）显示出预测每个替代物的最高灵敏度，与其他标准集相比，特异性仅略有下降。然而，de Ferranti标准也显示出最低的PPV值。相反，儿科国际糖尿病联合会标准表现出最低的灵敏度和最高的specificity.Conclusions：儿科代谢综合征标准表现出中等灵敏度检测升高的替代因素与代谢综合征和未来疾病的风险。纳入WC适度升高的儿童可提高敏感性。
Objective: The aim of this study was to compare currently proposed sets of pediatric metabolic syndrome criteria for the ability to predict elevations in "surrogate" factors that are associated with metabolic syndrome and with future cardiovascular disease and type 2 diabetes mellitus. These surrogate factors were fasting insulin, hemoglobin A1c (HbA1c), high-sensitivity C-reactive protein (hsCRP), and uric acid.Methods: Waist circumference (WC), blood pressure, triglycerides, high-density lipoprotein cholesterol (HDL-C), fasting glucose, fasting insulin, HbA1c, hsCRP, and uric acid measurements were obtained from 2,624 adolescent (12-18 years old) participants of the 1999-2006 National Health and Nutrition Examination Surveys. We identified children with metabolic syndrome as defined by six commonly used sets of pediatric metabolic syndrome criteria. We then defined elevations in the surrogate factors as values in the top 5% for the cohort and calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for each set of metabolic syndrome criteria and for each surrogate factor.Results: Current pediatric metabolic syndrome criteria exhibited variable sensitivity and specificity for surrogate predictions. Metabolic syndrome criteria had the highest sensitivity for predicting fasting insulin (40-70%), followed by uric acid (31-54%), hsCRP (13-31%), and HbA1c (7-21%). The criteria of de Ferranti (which includes children with WC >75(th) percentile, compared to all other sets including children with WC >90(th) percentile) exhibited the highest sensitivity for predicting each of the surrogates, with only modest decrease in specificity compared to the other sets of criteria. However, the de Ferranti criteria also exhibited the lowest PPV values. Conversely, the pediatric International Diabetes Federation criteria exhibited the lowest sensitivity and the highest specificity.Conclusions: Pediatric metabolic syndrome criteria exhibit moderate sensitivity for detecting elevations in surrogate factors associated with metabolic syndrome and with risk for future disease. Inclusion of children with more modestly elevated WC improved sensitivity.