Introduction The metabolic syndrome occurs commonly in both children and adults. However, information is scant on the complex relationships among the metabolic syndrome components in black and white populations during periods of childhood, adolescence, and adulthood.
Methods Path analysis (structural equation modeling) by race was performed on 8,203 healthy subjects (35.7% black and 64.3% white) composed of children (4-11 years), adolescents (12-18 years), and adults (19-44 years) enrolled in the Bogalusa Heart Study. The path diagram was constructed using age and variables of metabolic syndrome (BMI, insulin, glucose, mean arterial pressure, HDL cholesterol, and triglycerides).
Results The comparative fit index ranged from 0.927 to 0.985, indicating a good fit of the six models to the data. The direct effect of BMI on insulin was greatest for each age group in both races. In general, path coefficients were greater in whites than in blacks (except for the age-mean arterial pressure path) and in children and adults than in adolescents. Direct age effect on mean arterial pressure was greater in black versus white adults (p = .010); children and adolescents showed similar but nonsignificant race differences. The direct effect of BMI on mean arterial pressure was greater in whites versus blacks in children (p = .007), adolescents (p = .090), and adults (p = .022). Whites versus blacks showed a greater direct effect of BMI on triglycerides in childhood (p = .003) and insulin on triglycerides in adulthood (p = .0005). Other path parameters, including direct and indirect effects, did not show significant racial differences.
Conclusions Obesity is of critical importance in the relationships among the components of metabolic syndrome beginning in childhood. The black-white differences in the relationships of obesity and insulin resistance measures to other components, especially regarding BMI to mean arterial pressure and insulin/BMI to triglycerides, may account for the lower prevalence of metabolic syndrome in the black population.
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