Metabolic syndrome in children and adolescents in Crete, Greece, and association with diet quality and physical fitness

Abstract: Aim: To determine the prevalence of metabolic syndrome in children and adolescents in Crete (Greece) and examine associations with diet quality and physical fitness. Subjects and Methods: A representative sample of 1,209 Cretan children and adolescents aged 3–17 1/2 years participated in this cross-sectional survey. The study took place in kindergartens, primary and secondary schools in the cities of Heraklion and Chania and kindergartens and schools in semi-urban and rural regions outside Heraklion. The metabolic syndrome was defined as the presence of ≥3 of: impaired fasting blood glucose, hypertension, abdominal obesity, hypertriglyceridaemia, and low HDL-cholesterol. Diet quality was assessed by the Healthy Eating Index score (USDA) and physical fitness by the 20-m shuttle run test. Results: Approximately 4% of Cretan children and adolescents assessed (4.2% of boys, 3.6% of girls) had three or more metabolic syndrome factors. Over 25% of the subjects had a “poor” diet, defined as Healthy Eating Index <51, and higher diet quality scores correlated with decreased mean body mass index, waist/height ratio, systolic blood pressure, total cholesterol, and number of metabolic syndrome risk factors present. Clustering of metabolic syndrome risk factors was also associated with decreased physical fitness, as well as increased body mass index, waist/height ratio and total cholesterol/HDL-cholesterol ratio. Conclusions: Presence of three or more factors related to the metabolic syndrome was strongly associated with poor diet quality and low physical fitness, as well as overweight, in Cretan children and adolescents. Health promotion strategies in childhood should encourage weight control, the establishment of healthier dietary patterns, and adequate physical activity, as a means of preventing the increase in the prevalence of this public health issue.