Metabolic Syndrome Factors in Hispanic Adolescents: Association with Atherosclerosis Markers

Susana Mascarell, MD, Nike Mourikes, MD, Meenakshi Pande, MD¹, Carolyn Lopez, MD¹ and Leon Fogelfeld, MD¹

¹John H. Stroger Jr. Hospital of Cook County, Chicago, IL.

Background
The prevalance of metabolic syndrome is highest in adult Hispanics (3%) and is linked to high prevelance of obesity in Hispanics (23%). Its most important health consequence is the risk for cardiovascular disease. The prevalence of overweight (BMI >90% percentile) in Hispanic youth aged 12-19 is high at 23.4%. But little is known of the metabolic syndrome and its determinants in this age group.

Study Question
To understand the early patterns of the development of Metabolic Syndrome (MS) in apparently healthy Hispanic adolescents. We also analyzed the impact of social, cultural, and behavioral factors on Metabolic Syndrome.

Research design and subject selection
We studied 46 healthy adolescents (26 females and 20 males aged 16-19) attending an urban clinic for a routine physical exam. They underwent physical exam and completed validated social and behavioral surveys. Each patient was scored by the number of metabolic syndrome risk factors (MSF).

Methods for data collection and analysis
Physical exam included height, weight, and waist circumference measurements. Laboratory data included 2 hour oral glucose tolerance test (OGTT) with measurement of insulin levels, fasting lipid profile, plasminogen activator inhibitor I (PAI-1), C-reactive protein (CRP) and fibrinogen levels. Complete laboratory results were available in 34 patients. Using modified criteria for metabolic syndrome risk factors (MSRF) the adolescents were classified by scoring the MSRFs (from 0 to 5). Participants also completed validate surveys in English or Spanish on stress, acculturation, physical activities, diet and eating behaviors.

Results
MS (3 MSRFs) was present in 14.7% with majority of the participants (56%) having at least one MSRF and 26.5% had 2 and more MSRFs. MS was present in 21% and 10% of males and females, respectively. The MSRFs score was higher in males (p<0.5) and 75% of males had at least one MSRF vs 25% in females (p<0.05). The males had higher prevalence of the individual MSRFs with elevated blood pressure reaching statistical significance (8/0 males/females, p<0.05). Atherosclerosis markers CRP, PAI-1, and fibrinogen correlated with MSF score (p<0.05).

In bivariate analyses, years in US and higher acculturation, the scores correlated with higher predilection for high fat foods and more frequent visits to fast food restaurants and more sedentary activities (sedentary activities score, sedentary daily/weekly time in hours spent on internet, watching TV, films, reading (p<0.05 ). Healthy eating measures (healthy eating behavior score, preferences for fruits and vegetables and avoidance of fat foods) did not correlate with MS, MSRFs score nor any of the individual MSRFs. However, they correlated with less sedentary activities (p<0.5). Preferences for high calories soft drinks were not related to any of the obesity or MS measures but were inversely related to healthy eating score (p<0.05) and were higher among males (p<0.05). Males had also lower healthy eating scores than females (p<0.05). Parameters of physical activity and sedentary life showed that higher number of sport activities (higher in males), lower sedentary score and daily sedentary time correlated with lower systolic and diastolic blood pressure (p<0.05). Higher sedentary life measures (sedentary life score, sedentary daily/weekly time) correlated with MS, MSRFs score, obesity (BMI) and central obesity measures (waist circumference). Time spent on watching TV correlated with MS, MSRFs score and BMI.

Conclusion
In conclusion, obesity, metabolic syndrome and insulin resistance appear to increase dramatically in young Hispanics and in particular with males. The atherosclerosis markers levels increase as metabolic syndrome factors are accumulating suggesting an early initiation of atherosclerotic changes in adolescents at risk. Sedentary life style, especially TV watching time, appears to be strongly related to development of this syndrome.

These data were presented in 2 abstracts in the 2004 American Diabetes Association meeting in Orlando.

Contact Information
Susana Mascarell, Attending Physician John Stroger, Jr. Hospital of Cook County 1900 W. Polk St. Room 813 Chicago, IL 60612 Tel: 312-864-0501 Susanamascarell@hotmail.com

To understand the early patterns of development of metabolic syndrome (MS) in high risk urban populations, we studied 34 healthy Hispanic adolescents (20 females and 14 males aged 16-19). They had physical exam and laboratory assessment which included oral glucose tolerance test (OGTT) with measurement of insulin levels, fasting lipid profile, plasminogen activator inhibitor 1 (PAI-1), C-reactive protein (CRP) and fibrinogen levels. Using modified criteria for metabolic syndrome factors (MSF) the adolescents were classified by scoring the MSF (from 0 to 5). MS (3 MSF) was present in 14.7% with majority of the participants (56%) having at least one MSF and 26.5% had 2 and more MSFs. The most common MSF was increased triglyceride level (29%) followed by increased waist circumference (24%), low HDL (23.5%) and elevated blood pressure (17.4%). Only 2 participants had impaired glucose levels. MS was present in 21% and 10% of males and females, respectively. The MSF score was higher in males (p<0.05) and 75% of males had at least one MSF vs 25% in females (p<0.05). The males had higher prevalence of the individual MSF with only elevated blood pressure reaching statistical significance (8/0 males/females, p<0.05). The atherosclerosis markers (CRP, PAI-1 and fibrinogen) correlated with the MSF score (p<0.05). They also correlated with measures of body composition (BMI , waist circumference, p<0.05). Triglyceride levels correlated with CRP (p<0.05) and PAI-1 (p=0.07). MSF score, BMI and waist circumference correlated with fasting glucose, insulin levels and insulin resistance (HOMA method). Insulinogenic index (insulin 30 / glucose 30) was not impaired and correlated with CRP. OGTT 120 glucose correlated with MSF score, CRP and fibrinogen (p=0.09, p<0.05, p=0.07, respectively).

In conclusion, the prevalence of metabolic syndrome is very high in young Hispanics especially in males. The atherosclerosis markers levels increase as metabolic syndrome factors are accumulating suggesting an early initiation of atherosclerotic changes in adolescents at risk. Future studies that address prevention and treatment of metabolic syndrome in adolescents are needed.

This study was supported by an unrestricted grant from GlaxoSmithKline.

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