Pediatric siMS score: A new, simple and accurate continuous metabolic syndrome score for everyday use in pediatrics

PLOS ONE, Nov 2019

Background 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 for the adult population. Objective 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)—(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.

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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 - 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. (...truncated)


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Rade Vukovic, Tatjana Milenkovic, George Stojan, Ana Vukovic, Katarina Mitrovic, Sladjana Todorovic, Ivan Soldatovic. Pediatric siMS score: A new, simple and accurate continuous metabolic syndrome score for everyday use in pediatrics, PLOS ONE, 2017, Volume 12, Issue 12, DOI: 10.1371/journal.pone.0189232