Prevalence of Metabolic Syndrome and Its Associated Risk Factors Among Schoolchildren Aged 11-13 Years Living in Thiruvananthapuram District, Kerala, India: A Nested Case-Control Study.

Introduction: Metabolic syndrome is a cluster of conditions that includes increased blood pressure, increased blood sugar, excess body fat around the waist, and a rise in triglyceride levels which could increase the risk of developing type 2 diabetes and cardiovascular diseases. While metabolic syndrome is typically associated with adults, concern is growing about its prevalence and implications among children and adolescents. The rapid rise in childhood obesity and physical inactivity has led to an increase in risk factors among young populations, making it a pressing public health issue. This study aims to investigate the risk of metabolic syndrome among children aged 11-13 years, exploring its association with various sociodemographic and clinical factors.

Methods: A nested case-control study was conducted from June 2021 to November 2021 among a cohort of school children aged 11-13 years in Thiruvananthapuram district, Kerala, India. Twenty-two clusters (schools) were identified from the schools in Thiruvananthapuram's educational subdistrict using populations proportionate to size. Data on the sociodemographic characteristics and lifestyle practices of 1,580 schoolchildren and their parents were collected using a questionnaire. Body mass index, waist circumference, and blood pressure were also assessed to screen children for metabolic syndrome. Fasting blood glucose, triglycerides, and high‑density lipoprotein levels were evaluated in 57 cases (children with metabolic syndrome after screening) and 116 controls (children without metabolic syndrome after screening).

Results: The prevalence of pediatric metabolic syndrome as defined by the International Diabetes Federation (IDF) classification in the sample was 3.6% (n=57) (95%CI 1.6-6.6). Modifiable and nonmodifiable risk factors found to be associated with pediatric metabolic syndrome after multivariate analysis were gender, decreased physical activity, especially organized physical activity and moderately vigorous physical activity or play, skipping meals, sleeping for less than eight hours at night, eating with screens on, use of screens for more than two hours daily, and preference for soft drinks or carbonated drinks over water when thirsty. This study also evaluated the predictive power of the associated factors for pediatric metabolic syndrome using receiver operating characteristic (ROC) analysis. The ROC curve showed an area under the curve of 0.926 (95% CI: 0.891-0.961, < 0.001), indicating high predictive power.

Conclusion: The findings of this study brought out evidence of an escalation in the rate of metabolic syndrome among children in their early adolescent stage. This rise is a trend with increasing sedentary time and the overuse of screens by the younger generation in this modern era of gadgets and technologies. Our findings would act as a catalyst in implementing community and school-based activities to improve physical activities and lifestyle modifications among children, thereby reducing the risk of early development of metabolic syndrome.