This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (367)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Metabolic Diseases  • Pediatrics, Other  • Obesity  • Endocrine Diseases  • Diabetes Mellitus  • Alert me on articles by topic

Findings From the Third National Health and Nutrition Examination Survey, 1988-1994

Stephen Cook, MD; Michael Weitzman, MD; Peggy Auinger, MS; Michael Nguyen; William H. Dietz, MD, PhD

Arch Pediatr Adolesc Med. 2003;157:821-827.

Background  In adults the metabolic syndrome imposes a substantial risk for type 2 diabetes mellitus and premature coronary heart disease. Even so, no national estimate is currently available of the prevalence of this syndrome in adolescents.

Objective  To estimate the prevalence and distribution of a metabolic syndrome among adolescents in the United States.

Design and Setting  Analyses of cross-sectional data obtained from the Third National Health and Nutrition Examination Survey (1988-1994), which was administered to a representative sample of the noninstitutionalized civilian population of the United States.

Participants  Male and female respondents aged 12 to 19 years (n = 2430).

Main Outcome Measures  The prevalence and distribution of a metabolic syndrome among US adolescents, using the National Cholesterol Education Program (Adult Treatment Panel III) definition modified for age.

Results  The overall prevalence of the metabolic syndrome among adolescents aged 12 to 19 years was 4.2%; 6.1% of males and 2.1% of females were affected (P= .01). The syndrome was present in 28.7% of overweight adolescents (body mass index [BMI], 95th percentile) compared with 6.8% of at-risk adolescents (BMI, 85th to <95th percentile) and 0.1% of those with a BMI below the 85th percentile (P<.001). Based on population-weighted estimates, approximately 910 000 US adolescents have the metabolic syndrome.

Conclusions  Perhaps 4% of adolescents and nearly 30% of overweight adolescents in the United States meet these criteria for a metabolic syndrome, a constellation of metabolic derangements associated with obesity. These findings may have significant implications for both public health and clinical interventions directed at this high-risk group of mostly overweight young people.

From the Strong Children's Research Center, Department of Pediatrics, University of Rochester School of Medicine and Dentistry (Drs Cook and Weitzman, Ms Auinger, and Mr Nguyen), and the American Academy of Pediatrics Center for Child Health Research (Dr Weitzman, Ms Auinger, and Mr Nguyen), Rochester, NY; and the Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga (Dr Dietz).

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Prevalence and correlates of the metabolic syndrome in a population-based sample of European youth
Ekelund et al.
Am. J. Clin. Nutr. 2009;89:90-96.
ABSTRACT | FULL TEXT  

Determining the Proportion of Children Too Heavy for Age-Appropriate Car Seats in a Practice-Based Research Network
Basco et al.
CLIN PEDIATR 2009;48:37-43.
ABSTRACT  

Reversal of Type 2 Diabetes Mellitus and Improvements in Cardiovascular Risk Factors After Surgical Weight Loss in Adolescents
Inge et al.
Pediatrics 2009;123:214-222.
ABSTRACT | FULL TEXT  

The Metabolic Syndrome
Cornier et al.
Endocr. Rev. 2008;29:777-822.
ABSTRACT | FULL TEXT  

Prevention and Treatment of Pediatric Obesity: An Endocrine Society Clinical Practice Guideline Based on Expert Opinion
August et al.
J. Clin. Endocrinol. Metab. 2008;93:4576-4599.
ABSTRACT | FULL TEXT  

Prevalence of Metabolic Syndrome and Related Characteristics in Obese Adolescents with and without Polycystic Ovary Syndrome
Rossi et al.
J. Clin. Endocrinol. Metab. 2008;93:4780-4786.
ABSTRACT | FULL TEXT  

Glucose Intolerance and Cardiometabolic Risk in Children Exposed to Maternal Gestational Diabetes Mellitus in Utero
Tam et al.
Pediatrics 2008;122:1229-1234.
ABSTRACT | FULL TEXT  

Insulin resistance and obesity in childhood
Chiarelli and Marcovecchio
Eur J Endocrinol 2008;159:S67-S74.
ABSTRACT | FULL TEXT  

Recognition and Management of Dyslipidemia in Children and Adolescents
Kwiterovich
J. Clin. Endocrinol. Metab. 2008;93:4200-4209.
ABSTRACT | FULL TEXT  

The Impact of Metformin, Oral Contraceptives, and Lifestyle Modification on Polycystic Ovary Syndrome in Obese Adolescent Women in Two Randomized, Placebo-Controlled Clinical Trials
Hoeger et al.
J. Clin. Endocrinol. Metab. 2008;93:4299-4306.
ABSTRACT | FULL TEXT  

Prevalence of metabolic syndrome at age 16 using the International Diabetes Federation paediatric definition
Pirkola et al.
Arch. Dis. Child. 2008;93:945-951.
ABSTRACT | FULL TEXT  

Prevalence of the Metabolic Syndrome Among a Racially/Ethnically Diverse Group of U.S. Eighth-Grade Adolescents and Associations With Fasting Insulin and Homeostasis Model Assessment of Insulin Resistance Levels
Studies to Treat or Prevent Pediatric Type 2 Diabe
Diabetes Care 2008;31:2020-2025.
ABSTRACT | FULL TEXT  

Sleep-Disordered Breathing in Children With Metabolic Syndrome: The Role of Leptin and Sympathetic Nervous System Activity and the Effect of Continuous Positive Airway Pressure
Nakra et al.
Pediatrics 2008;122:e634-e642.
ABSTRACT | FULL TEXT  

Cardiovascular Risk Factors and the Metabolic Syndrome in Pediatric Nonalcoholic Fatty Liver Disease
Schwimmer et al.
Circulation 2008;118:277-283.
ABSTRACT | FULL TEXT  

High-sensitivity C-reactive protein is a good marker of cardiovascular risk in obese children and adolescents.
Soriano-Guillen et al.
Eur J Endocrinol 2008;159:R1-R4.
ABSTRACT | FULL TEXT  

Physical activity, cardiorespiratory fitness, and the metabolic syndrome in youth
Steele et al.
J. Appl. Physiol. 2008;105:342-351.
ABSTRACT | FULL TEXT  

Maternal Waist Circumference and the Prediction of Children's Metabolic Syndrome
Atabek
Arch Pediatr Adolesc Med 2008;162:697-697.
FULL TEXT  

Albumin Excretion Rate in Normal Adolescents: Relation to Insulin Resistance and Cardiovascular Risk Factors and Comparisons to Type 1 Diabetes Mellitus Patients
Rademacher et al.
CJASN 2008;3:998-1005.
ABSTRACT | FULL TEXT  

Lipid Screening and Cardiovascular Health in Childhood
Daniels et al.
Pediatrics 2008;122:198-208.
ABSTRACT | FULL TEXT  

Antipsychotic Use in Children and Adolescents: Minimizing Adverse Effects to Maximize Outcomes
Correll
Focus 2008;6:368-378.
ABSTRACT | FULL TEXT  

Primary Amenorrhea as a Manifestation of Polycystic Ovarian Syndrome in Adolescents: A Unique Subgroup?
Rachmiel et al.
Arch Pediatr Adolesc Med 2008;162:521-525.
ABSTRACT | FULL TEXT  

Body Mass Index, Waist Circumference, and Chronic Disease Risk Factors in Australian Adolescents
Denney-Wilson et al.
Arch Pediatr Adolesc Med 2008;162:566-573.
ABSTRACT | FULL TEXT  

Changes in Insulin Resistance and Cardiovascular Risk During Adolescence: Establishment of Differential Risk in Males and Females
Moran et al.
Circulation 2008;117:2361-2368.
ABSTRACT | FULL TEXT  

Intra-abdominal Adiposity and Individual Components of the Metabolic Syndrome in Adolescence: Sex Differences and Underlying Mechanisms
Syme et al.
Arch Pediatr Adolesc Med 2008;162:453-461.
ABSTRACT | FULL TEXT  

Association between the Metabolic Syndrome and Serum Cortisol in Overweight Latino Youth
Weigensberg et al.
J. Clin. Endocrinol. Metab. 2008;93:1372-1378.
ABSTRACT | FULL TEXT  

Measurement of Insulin Sensitivity in Children: Comparison between the euglycemic-hyperinsulinemic clamp and surrogate measures
Schwartz et al.
Diabetes Care 2008;31:783-788.
ABSTRACT | FULL TEXT  

Prevalence of the Metabolic Syndrome Among U.S. Adolescents Using the Definition From the International Diabetes Federation
Ford et al.
Diabetes Care 2008;31:587-589.
ABSTRACT | FULL TEXT  

Physical Activity: The Epidemic of Obesity and Overweight Among Youth: Trends, Consequences, and Interventions
LaFontaine
AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2008;2:30-36.
ABSTRACT  

Cardiorespiratory Fitness Is Strongly Related to the Metabolic Syndrome in Adolescents: Response to Janssen and Cramp
Shaibi et al.
Diabetes Care 2008;31:e8-e8.
FULL TEXT  

Health Status and Health Care Expenditures in a Nationally Representative Sample: How Do Overweight and Healthy-Weight Children Compare?
Skinner et al.
Pediatrics 2008;121:e269-e277.
ABSTRACT | FULL TEXT  

Being Overweight Modifies the Association Between Cardiovascular Risk Factors and Microalbuminuria in Adolescents
Nguyen et al.
Pediatrics 2008;121:37-45.
ABSTRACT | FULL TEXT  

Childhood Predictors of Young-Onset Type 2 Diabetes
Franks et al.
Diabetes 2007;56:2964-2972.
ABSTRACT | FULL TEXT  

Comparison of metabolic syndrome prevalence using eight different definitions: a critical approach
Reinehr et al.
Arch. Dis. Child. 2007;92:1067-1072.
ABSTRACT | FULL TEXT  

Assessment of Child and Adolescent Overweight and Obesity
Krebs et al.
Pediatrics 2007;120:S193-S228.
ABSTRACT | FULL TEXT  

Aerobic Fitness Attenuates the Metabolic Syndrome Score in Normal-Weight, at-Risk-for-Overweight, and Overweight Children
DuBose et al.
Pediatrics 2007;120:e1262-e1268.
ABSTRACT | FULL TEXT  

Review: Obesity and cardiometabolic syndrome in children
Velasquez-Mieyer et al.
Therapeutic Advances in Cardiovascular Disease 2007;1:61-81.
ABSTRACT  

Insulin Resistance in Hispanic Large-for-Gestational-Age Neonates at Birth
Dyer et al.
J. Clin. Endocrinol. Metab. 2007;92:3836-3843.
ABSTRACT | FULL TEXT  

Clustering of Long-term Trends in Metabolic Syndrome Variables from Childhood to Adulthood in Blacks and Whites: The Bogalusa Heart Study
Chen et al.
Am J Epidemiol 2007;166:527-533.
ABSTRACT | FULL TEXT  

Pharmacotherapeutic Options for Overweight Adolescents
Dunican et al.
The Annals of Pharmacotherapy 2007;41:1445-1455.
ABSTRACT | FULL TEXT  

Association between Metabolic Syndrome and Sleep-disordered Breathing in Adolescents
Redline et al.
Am. J. Respir. Crit. Care Med. 2007;176:401-408.
ABSTRACT | FULL TEXT  

Metabolic Syndrome in Childhood Predicts Adult Cardiovascular Disease 25 Years Later: The Princeton Lipid Research Clinics Follow-up Study
Morrison et al.
Pediatrics 2007;120:340-345.
ABSTRACT | FULL TEXT  

Insulin Resistance: Link to the components of the metabolic syndrome and biomarkers of endothelial dysfunction in youth
Lee et al.
Diabetes Care 2007;30:2091-2097.
ABSTRACT | FULL TEXT  

Folic Acid Does Not Improve Endothelial Function in Obese Children and Adolescents
Pena et al.
Diabetes Care 2007;30:2122-2127.
ABSTRACT | FULL TEXT  

Primary Prevention of Cardiovascular Disease in Nursing Practice: Focus on Children and Youth: A Scientific Statement From the American Heart Association Committee on Atherosclerosis, Hypertension, and Obesity in Youth of the Council on Cardiovascular Disease in the Young, Council on Cardiovascular Nursing, Council on Epidemiology and Prevention, and Council on Nutrition, Physical Activity, and Metabolism
Hayman et al.
Circulation 2007;116:344-357.
FULL TEXT  

Insulin Resistance and Clustering of Cardiometabolic Risk Factors in Urban Teenagers in Southern India
Ramachandran et al.
Diabetes Care 2007;30:1828-1833.
ABSTRACT | FULL TEXT  

Dietary Patterns and the Metabolic Syndrome in Korean Adolescents: 2001 Korean National Health and Nutrition Survey
Kim et al.
Diabetes Care 2007;30:1904-1905.
FULL TEXT  

Cardiovascular Effects of Sibutramine in the Treatment of Obese Adolescents: Results of a Randomized, Double-Blind, Placebo-Controlled Study
Daniels et al.
Pediatrics 2007;120:e147-e157.
ABSTRACT | FULL TEXT  

Nonalcoholic Fatty Liver Disease and Insulin Resistance in Youth
Bloomgarden
Diabetes Care 2007;30:1663-1669.
ABSTRACT | FULL TEXT  

Is There a Single Underlying Factor for the Metabolic Syndrome in Adolescents?: A confirmatory factor analysis
Li and Ford
Diabetes Care 2007;30:1556-1561.
ABSTRACT | FULL TEXT  

Serum Concentrations of Uric Acid and the Metabolic Syndrome Among US Children and Adolescents
Ford et al.
Circulation 2007;115:2526-2532.
ABSTRACT | FULL TEXT  

Childhood Overweight, Obesity, and the Metabolic Syndrome in Developing Countries
Kelishadi
Epidemiol Rev 2007;0:mxm003v1-26.
ABSTRACT | FULL TEXT  

Adiponectin Independently Predicts Metabolic Syndrome in Overweight Latino Youth
Shaibi et al.
J. Clin. Endocrinol. Metab. 2007;92:1809-1813.
ABSTRACT | FULL TEXT  

Modifying Cardiovascular Risk in Adolescent Obesity
Cook and Gidding
Circulation 2007;115:2251-2253.
FULL TEXT  

Instability in the Diagnosis of Metabolic Syndrome in Adolescents
Goodman et al.
Circulation 2007;115:2316-2322.
ABSTRACT | FULL TEXT  

Overweight, family history of diabetes and attending schools of lower academic grading are independent predictors for metabolic syndrome in Hong Kong Chinese adolescents
Ozaki et al.
Arch. Dis. Child. 2007;92:224-228.
ABSTRACT | FULL TEXT  

Development of Age-Specific Adolescent Metabolic Syndrome Criteria That Are Linked to the Adult Treatment Panel III and International Diabetes Federation Criteria
Jolliffe and Janssen
J Am Coll Cardiol 2007;49:891-898.
ABSTRACT | FULL TEXT  

Risk Profiles for Metabolic Syndrome in a Nonclinical Sample of Adolescent Girls
Ventura et al.
Pediatrics 2006;118:2434-2442.
ABSTRACT | FULL TEXT  

Screening Children to Identify Families at Increased Risk for Cardiovascular Disease
Reis et al.
Pediatrics 2006;118:e1789-e1797.
ABSTRACT | FULL TEXT  

Insulin Gene Variable Number of Tandem Repeats (INS VNTR) Genotype and Metabolic Syndrome in Childhood Obesity
Santoro et al.
J. Clin. Endocrinol. Metab. 2006;91:4641-4644.
ABSTRACT | FULL TEXT  

Recent Trends in Waist Circumference and Waist-Height Ratio Among US Children and Adolescents
Li et al.
Pediatrics 2006;118:e1390-e1398.
ABSTRACT | FULL TEXT  

The Association of Child and Household Food Insecurity With Childhood Overweight Status
Casey et al.
Pediatrics 2006;118:e1406-e1413.
ABSTRACT | FULL TEXT  

Case 31-2006 -- A 15-Year-Old Girl with Severe Obesity.
Hoppin et al.
NEJM 2006;355:1593-1602.
FULL TEXT  

Prevalence of Fatty Liver in Children and Adolescents
Schwimmer et al.
Pediatrics 2006;118:1388-1393.
ABSTRACT | FULL TEXT  

Influence of Insulin Resistance and Body Mass Index at Age 13 on Systolic Blood Pressure, Triglycerides, and High-Density Lipoprotein Cholesterol at Age 19
Sinaiko et al.
Hypertension 2006;48:730-736.
ABSTRACT | FULL TEXT  

Prevalence and Treatment of Metabolic Syndrome in Adolescents with Type 2 Diabetes
Sanders et al.
The Annals of Pharmacotherapy 2006;40:1517-1521.
ABSTRACT | FULL TEXT  

Frequency of the metabolic syndrome in obese Spanish pediatric population.
Lopez-Capape et al.
Eur J Endocrinol 2006;155:313-319.
ABSTRACT | FULL TEXT  

Prevalence of Cardiovascular Disease Risk Factors in U.S. Children and Adolescents With Diabetes: The SEARCH for Diabetes in Youth Study
Rodriguez et al.
Diabetes Care 2006;29:1891-1896.
ABSTRACT | FULL TEXT  

Physical Activity, Cardiovascular Fitness, and Insulin Sensitivity Among U.S. Adolescents: The National Health and Nutrition Examination Survey, 1999-2002
Imperatore et al.
Diabetes Care 2006;29:1567-1572.
ABSTRACT | FULL TEXT  

Urinary C-Peptide Excretion in Free-Living Healthy Children Is Related to Dietary Carbohydrate Intake but Not to the Dietary Glycemic Index
Buyken et al.
J. Nutr. 2006;136:1828-1833.
ABSTRACT | FULL TEXT  

Inflammation and Changes in Metabolic Syndrome Abnormalities in US Adolescents: Findings from the 1988-1994 and 1999-2000 National Health and Nutrition Examination Surveys
de Ferranti et al.
Clin. Chem. 2006;52:1325-1330.
ABSTRACT | FULL TEXT  

Prevalence of abnormal lipid and blood pressure values among an ethnically diverse population of eighth-grade adolescents and screening implications.
Jago et al.
Pediatrics 2006;117:2065-2073.
ABSTRACT | FULL TEXT  

Improvement in Risk Factors for Metabolic Syndrome and Insulin Resistance in Overweight Youth Who Are Treated With Lifestyle Intervention
Monzavi et al.
Pediatrics 2006;117:e1111-e1118.
ABSTRACT | FULL TEXT  

Prevalence of Diabetes and Impaired Fasting Glucose Levels Among US Adolescents: National Health and Nutrition Examination Survey, 1999-2002
Duncan
Arch Pediatr Adolesc Med 2006;160:523-528.
ABSTRACT | FULL TEXT  

Management of Dyslipidemia in Special Populations
Tovar and Schering
Journal of Pharmacy Practice 2006;19:63-78.
ABSTRACT  

Relationship of Adolescent Polycystic Ovary Syndrome to Parental Metabolic Syndrome
Leibel et al.
J. Clin. Endocrinol. Metab. 2006;91:1275-1283.
ABSTRACT | FULL TEXT  

Heart Disease and Stroke Statistics--2006 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Thom et al.
Circulation 2006;113:e85-e151.
FULL TEXT  

Adolescent Girls with Polycystic Ovary Syndrome Have an Increased Risk of the Metabolic Syndrome Associated with Increasing Androgen Levels Independent of Obesity and Insulin Resistance
Coviello et al.
J. Clin. Endocrinol. Metab. 2006;91:492-497.
ABSTRACT | FULL TEXT  

Dietary Recommendations for Children and Adolescents: A Guide for Practitioners
American Heart Association et al.
Pediatrics 2006;117:544-559.
ABSTRACT | FULL TEXT  

The regulation of appetite
Druce and Bloom
Arch. Dis. Child. 2006;91:183-187.
ABSTRACT | FULL TEXT  

Clustering of metabolic abnormalities in adolescents with the hypertriglyceridemic waist phenotype
Esmaillzadeh et al.
Am. J. Clin. Nutr. 2006;83:36-46.
ABSTRACT | FULL TEXT  

Prevalence and Cardiovascular Disease Correlates of Low Cardiorespiratory Fitness in Adolescents and Adults
Carnethon et al.
JAMA 2005;294:2981-2988.
ABSTRACT | FULL TEXT  

Relation between elevated serum alanine aminotransferase and metabolic syndrome in Korean adolescents
Park et al.
Am. J. Clin. Nutr. 2005;82:1046-1051.
ABSTRACT | FULL TEXT  

Development of the Metabolic Syndrome in Black and White Adolescent Girls: A Longitudinal Assessment
Morrison et al.
Pediatrics 2005;116:1178-1182.
ABSTRACT | FULL TEXT  

Treating Overweight Children and Adolescents in the Clinic
Young
CLIN PEDIATR 2005;44:647-653.
ABSTRACT  

Type 2 Diabetes in Children and Adolescents: Risk Factors, Diagnosis, and Treatment
Copeland et al.
Clin. Diabetes 2005;23:181-185.
ABSTRACT | FULL TEXT  

Current and Future Treatment of Metabolic Syndrome and Type 2 Diabetes in Children and Adolescents
Mallare et al.
Diabetes Spectr. 2005;18:220-228.
ABSTRACT | FULL TEXT  

Dietary Recommendations for Children and Adolescents: A Guide for Practitioners: Consensus Statement From the American Heart Association
Endorsed by the American Academy of Pediatrics et al.
Circulation 2005;112:2061-2075.
ABSTRACT | FULL TEXT  

Tobacco Smoke Exposure Is Associated With the Metabolic Syndrome in Adolescents
Weitzman et al.
Circulation 2005;112:862-869.
ABSTRACT | FULL TEXT  

Metabolic Syndrome Growing Problem in Children and Adolescents
Goldfarb
DOC News 2005;2:10-10.
FULL TEXT  

Effects of Dietary Macronutrient Intake on Insulin Sensitivity and Secretion and Glucose and Lipid Metabolism in Healthy, Obese Adolescents
Sunehag et al.
J. Clin. Endocrinol. Metab. 2005;90:4496-4502.
ABSTRACT | FULL TEXT  

Effect of Obesity and High Blood Pressure on Plasma Lipid Levels in Children and Adolescents
Boyd et al.
Pediatrics 2005;116:442-446.
ABSTRACT | FULL TEXT  

Screening and Counseling Associated With Obesity Diagnosis in a National Survey of Ambulatory Pediatric Visits
Cook et al.
Pediatrics 2005;116:112-116.
ABSTRACT | FULL TEXT  

Screening and Interventions for Overweight in Children and Adolescents: Recommendation Statement
US Preventive Services Task Force
Pediatrics 2005;116:205-209.
ABSTRACT | FULL TEXT