ISSN 1662-4009 (Online)

ESPE Yearbook of Paediatric Endocrinology (2019) 16 12.7 | DOI: 10.1530/ey.16.12.7

Prospective associations between socioeconomically disadvantaged groups and metabolic syndrome risk in European children. Results from the IDEFICS study

Iguacel I, Michels N, Ahrens W, Bammann K, Eiben G, Fernandez-Alvira JM, Marild S, Molnar D, Reisch L, Russo P, Tornaritis M, Veidebaum T, Wolters M, Moreno LA, Bornhorst C & Bornhorst IDEFICS consortium

To read the full abstract: Int J Cardiol 2018;272:333–340.

Summary: In a multi-center prospective cohort study of 2401 European children, early life exposure to socioeconomic disadvantages, particularly living in low-educated families, having a non-traditional family structure, parental unemployment and the accumulation of >3 disadvantages were associated with higher risk for the metabolic syndrome (MetS), already during childhood.

Comment: Socioeconomic status (SES) is an important predictor of health and a major determinant for inequalities in health care. Among adults in developed countries, lower SES has been found to be associated with a higher risk of cardiovascular disease. Furthermore, lower SES in childhood showed a residual effect 31 years later, and was associated with clinically significant increased risks for MetS, IFG and T2DM in adulthood.1 In the current study, the impact of low SES on MetS components was demonstrated already in early childhood.

SES variables including: social network, family structure, parental income, education, employment status and origin, as well as psychosocial factors and lifestyle were assessed in 2401 European children aged 2.0–9.9 from eight European countries (Belgium, Cyprus, Estonia, Germany, Hungary, Italy, Spain and Sweden) at baseline and two years later at ages 4.0–11.9.

Education and income were found to act as ‘causes-of-causes’, and unemployment and non-traditional family structure were associated with a higher metabolic risk in children. Suggested possible mechanisms for the impacts of SES on MetS include living in more deprived neighborhoods with lower availability of fresh products, more fast-food outlets, a greater consumption of cheaper but calorie-dense foods, physical inactivity due to few recreational opportunities, limited knowledge regarding healthy lifestyle, and limited accessibility to health services. Another possible underlying mechanism is the stress-mediated pathway. Lower SES has been shown to be associated with greater stress hormone levels, catecholamines and cortisol.

Poverty and poor health worldwide are inextricably linked. It is crucial to tackle the root causes of poor health and address the factors that sustain the cycle of poor health, such as lack of education and poor nutrition.

Reference: 1. Puolakka E, Pahkala K, Laitinen TT, Magnussen CG, Hutri-Kähönen N, Tossavainen P, et al. Childhood Socioeconomic Status in Predicting Metabolic Syndrome and Glucose Abnormalities in Adulthood: The Cardiovascular Risk in Young Finns Study. Diabetes care. 2016; 39(12): 2311–7.