Confirmatory-factor-analysis-derived metabolic syndrome risk score: development, validation, and clinical utility in dual adolescent populations.

Abstract

Background: This study developed and validated a continuous metabolic syndrome (MetS) risk score (msRS) for adolescents and evaluated its clinical utility in identifying multiple clinical cardiovascular markers (CCMs) using dual adolescent populations.

Methods: Adolescents aged 12‒18 from two stratified random samples were used: the nationwide Nutrition and Health Survey in Taiwan (NAHSIT, n = 1920) for development and the Adiposity‒Cardiovascular Disease Axis study in Southern Taiwan (adiCards, n = 3295) for validation. Four sex-and-age-specific msRS were developed through confirmatory factor analysis (CFA) utilizing five MetS components-waist circumference, high-density lipoprotein cholesterol, triglycerides, fasting glucose, and mean arterial pressure. Their discriminatory ability for clinical outcomes was validated using the area under receiver operating characteristic (AU-ROC) curve.

Results: The msRS demonstrated exceptional capability in detecting MetS in NAHSIT and adiCards cohorts (AU-ROCs: 0.954‒0.969). Adjusted for covariates, msRS explained higher variability in body-fat percentage, apolipoproteins B/A1, and homeostatic model assessment of insulin resistance (HOMA-IR) than binary MetS and abnormal components count (partial R², 23.7‒26.8% vs 4.1‒20.7%) in the validation dataset. An increase in msRS was associated with a 1.9-, 2.7-, 3.4-, and 14.4-fold risk of elevated low-density lipoprotein cholesterol, hyperuricemia, high HOMA-IR, and ≥3 CCMs.

Conclusion: The CFA-derived sex-and-age-adjusted msRS scheme provides an improving measure to assess and manage adolescent cardiometabolic health.

Impact: Adolescent MetS components share a latent metabolic construct. A scoring system through confirmatory factor analysis captures sex-and-age specific metabolic heterogeneity. Continuous risk score accurately discriminates pediatric MetS. MetS risk score effectively detects pediatric cardiovascular risk. Consideration of population characteristics is essential when developing a continuous MetS score.