Atherosclerosis 213 (2010) 611–615 Contents lists available at ScienceDirect Atherosclerosis journal homepage: www.elsevier.com/locate/atherosclerosis Preclinical manifestations of organ damage associated with the metabolic syndrome and its factors in outpatient children Procolo Di Bonito a,∗ , Nicola Moio b , Carolina Scilla b , Luigi Cavuto b , Girolamo Sibilio b , Claudia Forziato c , Eduardo Sanguigno c , Francesco Saitta c , Maria Rosaria Iardino d , Brunella Capaldo e a Department of Internal Medicine, Pozzuoli Hospital, via Domitiana Loc. La Schiana, 80078 Pozzuoli, Napoli, Italy b Department of Cardiology, “S. Maria delle Grazie”, Pozzuoli Hospital, Italy c Department of Pediatrics, “S. Maria delle Grazie”, Pozzuoli Hospital, Italy d Department of Clinical Pathology, “S. Maria delle Grazie”, Pozzuoli Hospital, Italy e Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy article info Article history: Received 7 July 2010 Received in revised form 1 September 2010 Accepted 16 September 2010 Available online 23 October 2010 Keywords: Pediatric metabolic syndrome Left ventricular mass Alanine aminotransferase Glomerular filtration rate Microalbuminuria Cardiometabolic risk factors abstract Background: To evaluate whether the pediatric metabolic syndrome (MetS) or its factors are useful to detect subclinical abnormalities of cardiac, liver, and glomerular damage in an outpatient population. Methods: The population study included 799 children (age 10 ± 3 years, mean ± SD), 24% of whom were normalweight, 25% overweight, and 51% obese. Alanine-aminotransferase (ALT) levels, estimated glomerular filtration rate (eGFR) and HOMA-IR were analyzed in all children. Microalbuminuria (MA) and left ventricular (LV) geometry and function were evaluated in 501 and 247 children, respectively. MetS was defined using Cook’s criteria. Results: MetS was diagnosed in 131 children (16%). Children with MetS+ and MetS- were similar for age, gender and Tanner stage distribution. Children with MetS+ showed higher ALT levels (31 ± 19 vs 21 ± 11 IU/L, p < 0.0001), LV mass (39 ± 10 vs 34 ± 10 g/h 2.7 , p < 0.001) and relative wall thickness (0.37 ± 0.06 vs 0.35 ± 0.05, p < 0.01) than MetS-. The two groups were similar for MA and eGFR. At multiple logistic regression analysis, children MetS+ showed a higher risk (OR, 95% Cl) adjusted for confounding factors, of high ALT levels (1.71, 1.12–2.59, p = 0.012) and concentric LV hypertrophy (2.17, 1.01–4.66, p = 0.047) than children MetS-. The risk of preclinical liver and cardiac damage associated with the MetS phenotype was not higher than predicted by its single components. Conclusions: Children with MetS show a 2-fold greater risk of having high ALT levels and concentric LV hypertrophy. However, the risk of subclinical manifestations of liver and cardiac damage can be predicted equally well by the single components of the syndrome. © 2010 Elsevier Ireland Ltd. All rights reserved. 1. Introduction The epidemic expansion of childhood obesity is raising great concern in terms of public health and socio-economic impact, since it is a well established risk factor for the development of obesity, diabetes, hypertension and the metabolic syndrome (MetS) in adult life [1]. In addition, obese children often have MetS, although its prevalence is quite variable depending on ethnicity and diagnos- tic criteria adopted. Collectively, clinical and epidemiologic studies report a prevalence of pediatric MetS ranging from 2 to 12% in school-children cohorts, which increases by 2–3 fold in obese chil- dren [2]. Metabolic syndrome in adults is associated with increased risk to develop diabetes [3] and cardiovascular disease as well as ∗ Corresponding author. Tel.: +39 81 8552281. E-mail address: procolodibonito@alice.it (P. Di Bonito). increased mortality from cardiovascular disease and all causes [4]. Furthermore, adults with MetS are more likely to have target organ damage, namely non alcoholic fatty liver disease (NAFLD) [5], microalbuminuria (MA) [6], chronic kidney disease [7], altered left ventricular (LV) geometry and function [8], as well as arte- rial stiffness [9]. In recent years, the concept of pediatric MetS has become a subject of increasing debate [10]. Besides the controver- sies over diagnostic criteria, an important question relates to its clinical and prognostic significance, given the paucity of longitu- dinal data linking children with MetS with adult morbidity and mortality. One clue to address this issue could be to see whether the MetS is associated with preclinical manifestations of organ injury already in children [11], as it is in adults [5–9]. In addition, whether in Caucasian children MetS phenotype is more useful than its single components in identifying subjects with preclinical cardiac, liver and glomerular abnormalities is at present unknown. Against this background, in the present cross-sectional study we investigated whether pediatric MetS or its cardio-metabolic risk factors, defined 0021-9150/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.atherosclerosis.2010.09.017