Comparison of Four Definitions for the Diagnosis of Metabolic Syndrome and its Relationship with the HOMA-IR and TG/HDL-cholesterol Ratio in Obese Children between 10 to 14 Years Old

Trabajo Ganador del Segundo Lugar en el XXVIII Congreso Peruano de Pediatría. Ica, Perú

Abstract

Introduction: Childhood obesity is a growing problem in silent increase, with strong association with MS, which predicts the risk of DM2 by index of insulin resistance (HOMA-IR) and CVR with TG / HDL-C ratio. There is no consensus for diagnosing MS in children and adolescents.

Objectives: To compare the criteria of Cook, Cruz, IDF and AAP to diagnose MS and prediction of IR and CVR.

Materials and methods: We included 98 obese patients (10-14 years, 57M/41F). Anthropometry, blood pressure, glucose, insulin, triglycerides, HDL-cholesterol, HOMA-IR and TG/HDL-C was assessed. The prevalence of MS was compared according to the above criteria. Sensitivity and specificity considering TG/HDL-C≥2.32 and HOMA- IR> 3.1 was determined. Bivariate and inferential statistics and tests of concordance were employed.

Results: The prevalence of MS was 51% (95% CI: 40.7-61.3) as Cook and APP, 48% (95% CI 37.8- 58.3) according to Cruz, with a significant difference (p<0.002) with IDF, 34.7% (95 %: 40.7-61.3). The agreement between the criteria TG/HDL-C was 55.5% and 41.5% HOMA-IR. AAP criteria as PPV was higher compared to the other criteria (92%) for predicting insulin resistance. The Cook and AAP criteria showed higher sensitivity and specificity for predicting the CVR. Concordance between Cook and AAP criteria was 79.6%.

Conclusions: Cook and AAP criteria identified higher prevalence of MS and agreement with TG/HDL-C. The AAP showed a PPV high risk for predicting insulin resistance. The AAP and Cook showed higher sensitivity and specificity for diagnosing MS and higher PPV for predicting cardiovascular risk.