Pediatric siMS score: A new, simple and accurate continuous metabolic syndrome score for everyday use in pediatrics
December
Pediatric siMS score: A new, simple and accurate continuous metabolic syndrome score for everyday use in pediatrics
Rade Vukovic 1 2
Tatjana Milenkovic 2
George Stojan 0 2
Ana Vukovic 2
Katarina Mitrovic 1 2
Sladjana Todorovic 1 2
Ivan Soldatovic 2 3
0 BIDMC ± Harvard Medical School , Boston , Massachusetts, United States of America, 4 Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Belgrade , Belgrade , Serbia
1 Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic" , Belgrade , Serbia , 2 Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic" , Belgrade , Serbia
2 Editor: Zhong-Cheng Luo, Mount Sinai Health System, University of Toronto , CANADA
3 Institute for Medical Statistics and Informatics, School of Medicine, University of Belgrade , Belgrade , Serbia
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Data Availability Statement: All relevant data are
within the paper and its Supporting Information
files.
Funding: The authors received no specific funding
for this work.
Competing interests: The authors have declared
that no competing interests exist.
Background
for the adult population.
Objective
The dichotomous nature of the current definition of metabolic syndrome (MS) in youth
results in loss of information. On the other hand, the calculation of continuous MS scores
using standardized residuals in linear regression (Z scores) or factor scores of principal
component analysis (PCA) is highly impractical for clinical use. Recently, a novel, easily
calculated continuous MS score called siMS score was developed based on the IDF MS criteria
To develop a Pediatric siMS score (PsiMS), a modified continuous MS score for use in the obese youth, based on the original siMS score, while keeping the score as simple as possible and retaining high correlation with more complex scores.
Subjects and methods
The database consisted of clinical data on 153 obese (BMI
95th percentile) children and
adolescents. Continuous MS scores were calculated using Z scores and PCA, as well as
the original siMS score. Four variants of PsiMS score were developed in accordance with
IDF criteria for MS in youth and correlation of these scores with PCA and Z score derived
MS continuous scores was assessed.
Results
PsiMS score calculated using formula: (2xWaist/Height) + (Glucose(mmol/l)/5.6) + (triglycerides(mmol/l)/1.7) + (Systolic BP/130)Ð(HDL(mmol/l)/1.02) showed the highest
correlation with most of the complex continuous scores (0.792±0.901). The original siMS
score also showed high correlation with continuous MS scores.
Conclusion
PsiMS score represents a practical and accurate score for the evaluation of MS in the obese youth. The original siMS score should be used when evaluating large cohorts consisting of both adults and children.
Introduction
The pandemic of childhood obesity has resulted in significant concerns regarding associated
comorbidities in the pediatric population, with metabolic syndrome (MS) in youth gaining a
lot of attention during recent years [1±3]. In 2007, the International Diabetes Federation (IDF)
has published the first international definition of MS in children and adolescents [
2
]. This was
an important step which overcame the use of multiple definitions of childhood MS with widely
varying criteria [
3, 4
]. However, some important issues in the evaluation of MS still remain.
First, and most importantly, the dichotomous (present/absent) nature of the current MS
definition results in loss of information [
5
]. Namely, minimal changes of MS parameters in
one subject, or clinically negligible differences between two subjects could result in classifying
patients as having MS or not. Secondly, the dichotomous nature of MS definition is very
limited in quantifying the effects of MS treatment over time [
5
]. For example, the treatment effect
can be quantified only by determining if the patient has or does not have MS after treatment.
On the other hand, significant improvements of cardiometabolic risk parameters in a patient
which still has MS are undetected by the dichotomous definition.
In order to overcome these limitations of the dichotomous MS definition, an alternative
approach to the assessment of MS was developed during the last decade. Several continuous
MS scores were developed for both adult and pediatric populations, using standardized resid
uals in linear regression (Z scores) or factor scores of principal component analysis [6±20].
Although these scoring methods overcame limitations of the dichotomous MS definition, cal
culation of scores requires the use of sophisticated statistical software and the scores are
sample specific [
5
]. In practical terms, changes in the continuous MS score of a single patient
over time could not be evaluated, and neither could differences between patients from
different populations (samples). Most importantly, these scores are highly impractical for clinical
use.
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