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Metabolic Syndrome and Its Association with Diet and Physical Activity in US Adolescents

https://doi.org/10.1016/j.jada.2007.10.049Get rights and content

Abstract

Background

Research on the metabolic syndrome and its association with lifestyle behaviors in adolescents is important for identifying subgroups of youth at whom interventions should be targeted.

Objective

To examine the relationship of metabolic syndrome with diet and physical activity in US adolescents.

Design

A sample of 4,450 12- to 19-year-olds was obtained from 4-year combined data of the National Health and Nutrition Examination Survey 1999-2002.

Method

The metabolic syndrome was defined as having three or more of the following conditions: waist circumference ≥90th percentile for age/sex, fasting blood glucose ≥100 mg/dL (5.6 mmol/L), blood triglycerides ≥110 mg/dL (≥1.2 mmol/L), HDL cholesterol ≤35 mg/dL (0.9 mmol/L), and systolic/diastolic blood pressure ≥90th percentile for height or taking antihypertensive drugs. Diet quality was assessed using the Healthy Eating Index and its components, and nutrient intakes. The association between the metabolic syndrome and physical activity was presented as the prevalence of metabolic syndrome by different physical activity levels.

Results

Overall prevalence of metabolic syndrome among US adolescents was 3.5%. More males than females (5.1% vs 1.7%; P<0.0001) had metabolic syndrome. The metabolic syndrome was 16 times higher in overweight adolescents (body mass index ≥95th percentile) compared to those with body mass index <85th percentile (14.5% vs 0.9%; P<0.0001). Prevalence of metabolic syndrome decreased with increments of overall Healthy Eating Index and fruit score quartiles. Higher overall Healthy Eating Index and fruit scores were associated with lower metabolic syndrome (P<0.001). There was a trend toward lower prevalence of metabolic syndrome in adolescents with high physical activity levels (2.6%) compared to those who had low (4.3%) or moderate (3.1%) physical activity levels.

Conclusion

Results support the need to engage adolescents in regular physical activity and healthful dietary practices to prevent excessive weight gain. Weight control should be recommended as the first-line intervention to decrease metabolic syndrome in adolescents.

Section snippets

Methods

The National Health and Nutrition Examination Survey (NHANES) design is a stratified, multistage probability sample of the civilian noninstitutionalized US population. Approximately 9,965 people aged 2 months to 85 years were studied in the NHANES 1999-2000 survey period, and 11,039 in the 2001-2002 survey period. A subsample of more than 3,000 individuals from each survey period was invited to attend a morning examination after fasting overnight. Fully informed consent and child assent were

Results

Demographic characteristics associated with the metabolic syndrome among US adolescents are shown in Table 2. The overall prevalence of metabolic syndrome in adolescents was 3.5% (confidence interval [CI]: 2.4% to 4.5%). Prevalence of metabolic syndrome was considerably higher in male (5.1%) than in female adolescents (1.7%), and was more prevalent in whites (3.8%) than in blacks (2.0%) and Mexican Americans (3.3%). Metabolic syndrome was more prevalent in adolescents aged 15 to 19 years (3.8%)

Discussion

To our knowledge, this is the first study to examine the association between metabolic syndrome and lifestyle behaviors related to diet and physical activity in a nationally representative sample of US adolescents. In this study, approximately 3.5% adolescents overall and 14.5% of overweight adolescents fulfilled our criteria for the metabolic syndrome, suggesting that nearly 1 million adolescents in the United States are currently affected. Within this work, we found that prevalence of

Conclusions

In conclusion, our study suggests that if metabolic syndrome in US youth is to be decreased, lifestyle changes in diet and physical activity should be the first-line intervention to be recommended. Because most adolescents with metabolic syndrome are overweight, interventions should be focused primarily on prevention of excess weight or weight reduction in overweight youth. Adolescents should be encouraged to consume diets high in fruits and vegetables, and to engage in moderate-to-vigorous

Y. Pan is a research assistant, Department of Nutrition and Food Science, University of Maryland, College Park, MD.

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      Pan used NHANES data (1999–2002) to study MetS prevalence in association with diet and PA in adolescents. They found that higher HEI total and fruit scores (and a non-significant trend for greater PA) were associated with lower prevalence of MetS [25]. Likewise, Hooshmand studied a cross-sectional cohort (n = 424) of children and adolescents in Iran and found that those in the highest versus lowest quartiles of a modified HEI score had an adjusted odds ratio of 0.35 for incident MetS [24].

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    Y. Pan is a research assistant, Department of Nutrition and Food Science, University of Maryland, College Park, MD.

    C. A. Pratt is program director, Division of Prevention and Population Science, National Heart, Lung, and Blood Institute, Bethesda, MD.

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