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Published on: September 27, 2024
Continuous Metabolic Syndrome Scores for Children Using Salivary Biomarkers
Ping Shi1, J Max Goodson1, Mor-Li Hartman1
1Department of Applied Oral Sciences, the Forsyth Research Institute, Cambridge, Massachusetts, United States of America.
Insights
New continuous metabolic syndrome scores (cmetS) were developed for children using clinical and salivary measures. These scores effectively represent metabolic risk and can be used to study metabolic disease processes.
Area of Science:
- Pediatric Endocrinology
- Metabolic Syndrome Research
- Biomarker Development
Background:
- Traditional binary definitions of metabolic syndrome (MetS) are insufficient for pediatric populations.
- There is a need for comprehensive measures of metabolic risk in children.
Purpose of the Study:
- To develop and evaluate composite and continuous metabolic syndrome scores (cmetS) for metabolically at-risk children.
- To incorporate salivary surrogate variables (glucose, HDLC) alongside standard clinical parameters (WC, SBP).
Main Methods:
- Constructed two cmetS (cmetS-Z and cmetS-PCA) from data of 8,112 Kuwaiti children (aged 10.00 ± 0.67 years).
- cmetS-Z summed standardized residuals; cmetS-PCA used principal component analysis.
- Evaluated scores' predictive ability for severe MetS (≥3 risk factors).
Main Results:
- Both cmetS showed graded relationships with adverse risk factors and high predictive accuracy for severe MetS (AUCs 0.935 for cmetS-Z, 0.912 for cmetS-PCA).
- cmetS-Z associated positively with WC, SBP, glucose, and inversely with HDLC.
- Fitness level inversely associated with cmetS-PCA; WC and SBP were key contributors.
Conclusions:
- Derived continuous summary scores for MetS in children using two novel approaches with salivary surrogates.
- The developed cmetS are viable measures of metabolic risk.
- These scores can facilitate further research into metabolic disease processes.
Background:
Binary definitions of the metabolic syndrome based on the presence of a particular number of individual risk factors are limited, particularly in the pediatric population. To address this limitation, we aimed at constructing composite and continuous metabolic syndrome scores (cmetS) to represent an overall measure of metabolic syndrome (MetS) in a large cohort of metabolically at-risk children, focusing on the use of the usual clinical parameters (waist circumference (WC) and systolic blood pressure (SBP), supplemented with two salivary surrogate variables (glucose and high density lipoprotein cholesterol (HDLC). Two different approaches used to create the scores were evaluated in comparison.
Methods:
Data from 8,112 Kuwaiti children (10.00 ± 0.67 years) were used to construct two cmetS for each subject. The first cmetS (cmetS-Z) was created by summing standardized residuals of each variable regressed on age and gender; and the second cmetS (cmetS-PCA) was defined as the first principal component from gender-specific principal component analysis based on the four variables.
Results:
There was a graded relationship between both scores and the number of adverse risk factors. The areas under the curve using cmetS-Z and cmetS-PCA as predictors for severe metabolic syndrome (defined as the presence of ≥3 metabolic risk factors) were 0.935 and 0.912, respectively. cmetS-Z was positively associated with WC, SBP, and glucose, but inversely associated with HDLC. Except for the lack of association with glucose, cmetS-PCA was similar to cmetS-Z in boys, but had minimum loading on HDLC in girls. Analysis using quantile regression showed an inverse association of fitness level with cmetS-PCA (p = 0.001 for boys; p = 0.002 for girls), and comparison of cmetS-Z and cmetS-PCA suggested that WC and SBP were main contributory components. Significant alterations in the relationship between cmetS and salivary adipocytokines were demonstrated in overweight and obese children as compared to underweight and normal-weight children.
Conclusion:
We have derived continuous summary scores for MetS from a large-scale pediatric study using two different approaches, incorporating salivary measures as surrogate for plasma measures. The derived scores were viable expressions of metabolic risk, and can be utilized to study the relationships of MetS with various aspects of the metabolic disease process.
