Journal of Obesity & Metabolic Syndrome



June, 2024 | Vol.33 No.2

J Obes Metab Syndr 2023; 32(2): 103-105

Published online June 30, 2023

Copyright © Korean Society for the Study of Obesity.

The Prevalence of Abdominal Obesity and Metabolic Syndrome in Korean Children and Adolescents

Ja Hyang Cho *

Division of Pediatric Endocrinology and Metabolism, Department of Pediatrics, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea

Correspondence to:
Ja Hyang Cho
Department of Pediatrics, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea
Tel: +82-2-440-6092
Fax: +82-2-440-7175

Received: May 18, 2023; Reviewed : May 31, 2023; Accepted: June 5, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Metabolic syndrome (MetS) is an emerging burden associated with significant morbidity and mortality in children and adolescents. In recent decades, the prevalence of obesity has continually increased both worldwide and in Korea.1,2 Trends in mean body mass index (BMI) have recently flattened for both boys and girls in northwestern Europe and Asia-Pacific regions, for boys in southwestern Europe, and for girls in central and Latin America.1 In contrast, the rise in BMI has accelerated for both boys and girls in east and South Asia, and for boys in Southeast Asia.1 Pediatric obesity is often accompanied by MetS. Consequently, accurate evaluation of obesity in children and adolescents is of significant interest because it may result in adulthood obesity and comorbid conditions such as cardiovascular disease, obstructive sleep apnea, insulin resistance, non-alcoholic fatty liver disease, and dyslipidemia.3,4

More than half of all obese children have two or more complications. The definition of MetS by the modified criteria of the National Cholesterol Education Program-Adult Treatment Panel III must include at least three of five criteria: central obesity above the 90th percentile, fasting glucose above 110 mg/dL, hypertriglycerides above 110 mg/dL, low high density lipoprotein cholesterol below 40 mg/dL, and hypertension above the 90th percentile or receiving treatment for hypertension.1 Based on the criteria of the International Diabetes Federation, MetS is a combination of central obesity with the presence of two or more of the other four risk factors.5 According to International Diabetes Federation guidelines, children younger than 6 years are excluded from the definition due to limited data for this age group. MetS cannot be diagnosed at the age of 6 to 10 years. However, additional testing should be performed if there is a family history of MetS, type 2 diabetes mellitus, dyslipidemia, cardiovascular disease, hypertension, or obesity.6

Most studies are based on baseline BMI measurements to evaluate excessive adiposity in humans. BMI is a limited indicator of pediatric metabolic risk due to the paucity of data in this population.7 Waist circumference (WC) and waist-height ratio (WHtR) are helpful measures of central adiposity in both clinical and research settings.8 WC has emerged as an index of pediatric adiposity that predicts fat mass as effectively as or better than BMI.8 Moreover, WC has been shown to be effective in estimating total adiposity, which is strongly linked to intra-abdominal fat.

Several studies have investigated the prevalence of abdominal obesity in children and adolescents and report that it ranges from 9.7% to 11.5% in Korea.9-11 Compared with previous studies,9-11 the prevalence of abdominal obesity increased from 14.71% based on 2022 Korean National Growth Charts (REF2022),12 5.95% higher than that of 8.86% based on 2007 Korean National Growth Charts (REF2007).13 Furthermore, MetS based on REF2022 had a higher prevalence by both the National Cholesterol Education Program definition (3.9%13 by REF2007 and 4.78%12 by REF2022) and the International Diabetes Federation definition (2.29%13 by REF2007 and 3.10%12 by REF2022). A previous study14 found that the prevalence of MetS was underestimated at 2.8% in children (6 to 12 years) and 4.8% in adolescents (13 to 18 years).

This study contributed to our understanding of the prevalence of pediatric abdominal obesity and the development of MetS using Korea National Health and Nutrition Examination Survey data over a follow-up period of approximately 14 years (2007 to 2020).15 The authors compared the prevalence of abdominal obesity and MetS in a database of 21,652 individuals aged 2–18 and 9,592 individuals aged 10–18.15 The results of previous studies of the prevalence of MetS demonstrate underestimates compared to those based on the Lee et al.12

Pediatric abdominal obesity is one of the primary diagnostic criteria for the prevalence of MetS. Therefore, large prospective cohort studies are necessary to understand its prevalence as well as to evaluate and confirm the contribution of MetS. Furthermore, exploration of a potential obesity indicator, the WHtR, should be conducted. The large number of children and adolescents with MetS worldwide demonstrates the urgent necessity for multi-sectoral interventions to minimize the global burden of MetS and factors that contribute to it, such as childhood overweight and obesity.

The authors declare no conflict of interest.

  1. Nam GE, Kim YH, Han K, Jung JH, Rhee EJ, Lee SS, et al. Obesity fact sheet in Korea, 2019: prevalence of obesity and abdominal obesity from 2009 to 2018 and social factors. J Obes Metab Syndr 2020;29:124-32.
    Pubmed KoreaMed CrossRef
  2. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet 2017;390:2627-42.
  3. Park SI, Suh J, Lee HS, Song K, Choi Y, Oh JS, et al. Ten-year trends of metabolic syndrome prevalence and nutrient intake among Korean children and adolescents: a population-based study. Yonsei Med J 2021;62:344-51.
    Pubmed KoreaMed CrossRef
  4. Seo MY, Kim SH, Park MJ. Changes in anthropometric indices among Korean school students based on the 2010 and 2018 Korea School Health Examination Surveys. Ann Pediatr Endocrinol Metab 2021;26:38-45.
    Pubmed KoreaMed CrossRef
  5. Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S, et al. The metabolic syndrome in children and adolescents: an IDF consensus report. Pediatr Diabetes 2007;8:299-306.
    Pubmed CrossRef
  6. Zimmet P, Alberti G, Kaufman F, Tajima N, Silink M, Arslanian S, et al. The metabolic syndrome in children and adolescents. Lancet 2007;369:2059-61.
    Pubmed CrossRef
  7. Markovic-Jovanovic SR, Stolic RV, Jovanovic AN. The reliability of body mass index in the diagnosis of obesity and metabolic risk in children. J Pediatr Endocrinol Metab 2015;28:515-23.
    Pubmed CrossRef
  8. Brambilla P, Bedogni G, Heo M, Pietrobelli A. Waist circumference-to-height ratio predicts adiposity better than body mass index in children and adolescents. Int J Obes (Lond) 2013;37:943-6.
    Pubmed CrossRef
  9. Kim S and So WY. Prevalence of metabolic syndrome among Korean adolescents according to the national cholesterol education program, adult treatment panel iii and international diabetes federation. Nutrients 2016;8:588.
    Pubmed KoreaMed CrossRef
  10. Lee JH. Prevalence of hyperuricemia and its association with metabolic syndrome and cardiometabolic risk factors in Korean children and adolescents: analysis based on the 2016-2017 Korea National Health and Nutrition Examination Survey. Korean J Pediatr 2019;62:317-23.
    Pubmed KoreaMed CrossRef
  11. Chae J, Seo MY, Kim SH, Park MJ. Trends and risk factors of metabolic syndrome among Korean adolescents, 2007 to 2018. Diabetes Metab J 2021;45:880-9.
    Pubmed KoreaMed CrossRef
  12. Lee J, Kang SC, Kwon O, Hwang SS, Moon JS, Kim J. Reference values for waist circumference and waist-height ratio in Korean children and adolescents. J Obes Metab Syndr 2022;31:263-71.
    Pubmed KoreaMed CrossRef
  13. Moon JS, Lee SY, Nam CM, Choi JM, Choe BK, Seo JW, et al. 2007 Korean National Growth Charts: review of developmental process and an outlook. Korean J Pediatr 2008;51:1-25.
  14. Noubiap JJ, Nansseu JR, Lontchi-Yimagou E, Nkeck JR, Nyaga UF, Ngouo AT, et al. Global, regional, and country estimates of metabolic syndrome burden in children and adolescents in 2020: a systematic review and modelling analysis. Lancet Child Adolesc Health 2022;6:158-70.
    Pubmed CrossRef
  15. Lee J, Kang SC, Kwon O, Hwang SS, Moon JS, Chae HW, et al. Temporal trends of the prevalence of abdominal obesity and metabolic syndrome in Korean children and adolescents between 2007 and 2020. J Obes Metab Syndr 2023;32:170-8.
    Pubmed CrossRef