Examining Metabolic Syndrome Definitions in Overweight Hispanic Youth: A Focus on Insulin Resistance

Objective: To examine the prevalence of the metabolic syndrome in overweight Hispanic youth according to 3 published pediatric definitions. Furthermore, the relationship of each definition to directly measured insulin resistance was examined. Study design: We conducted a secondary data analysis of 218 overweight Hispanic youth with a family history of type 2 diabetes mellitus. The metabolic syndrome was defined as ≥3 of these criteria: elevated triglyceride level, low high-density lipoprotein cholesterol level, elevated blood pressure, abdominal obesity, and hyperglycemia. The cutoff points were derived from updated definitions of Cook et al,¹ Cruz et al,² and Weiss et al.³ Insulin sensitivity was determined with the insulin-modified frequently sampled intravenous glucose tolerance test. Results: Prevalence of the metabolic syndrome ranged from 25.7% to 39%, with moderate to substantial agreement between definitions (kappa = 0.52-0.70). Regardless of definition, an inverse relationship between metabolic risk and insulin sensitivity was noted such that children with the metabolic syndrome had 51% to 60% lower insulin sensitivity compared with children without any risk factors (P ≤.001 for all definitions). Conclusion: The metabolic syndrome is prevalent in overweight Hispanic youth and may provide pediatricians with additional clinical insight for identifying the most metabolically at-risk children. Working toward a uniform and practical definition of the metabolic syndrome may improve its clinical implementation.