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

Pediatric Research (2025)Cite this article

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.

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Fig. 1: Schematic diagram for data analysis in developing and validating adolescent metabolic syndrome risk score.

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Data availability

The findings of this study are based on data analyzed under institutional confidentiality agreements and are not available for public access. All data are anonymized to ensure participant privacy. For specific data inquiries, please contact the corresponding author, Chien-Hung Lee.

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Acknowledgements

The adolescent NAHSIT survey data were obtained from the Nutrition and Health Survey in Taiwan (NAHSIT) on Junior and Senior High School Students, 2010–2011. This NAHSIT project was sponsored by the Food and Drug Administration, Department of Health, Executive Yuan (99TFDA-FS-408 and 100TFDA-FS-406). This nationwide survey was conducted by the Division of Preventive Medicine and Health Services Research, the Institute of Population Health Sciences of the National Health Research Institutes (NHRI). We thank the director Wen-Harn Pan and all members of the office of Nutrition Survey, the Division of Preventive Medicine and Health Services Research, the Institute of Population Health Sciences of NHRI for providing the dataset. The views expressed here are solely those of the authors. This research work was supported by the Taiwan Ministry of Science and Technology [MOST 103-2314-B-037-019-MY3, MOST 106-2314-B-037-021-MY3, and MOST 109-2314-B-037-070-MY3], the Taiwan National Science and Technology Council [NSTC-112-2314-B-037-083-MY3], and the Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan from The Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan and by Kaohsiung Medical University Research Center Grant [KMU-TC113A01], and College Featured Research Projects (KMU-TB114007).

Author information

Authors and Affiliations

  1. Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan

    Yu-Ting Chin, Pei-Wen Wu, Pin-Rui Huang & Chien-Hung Lee

  2. Department of Laboratory Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan

    Sharon Tsai

  3. Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA

    Wei-Ting Lin

  4. Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Chun-Ying Lee

  5. Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Wei-Chung Tsai

  6. Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Wei-Chung Tsai

  7. Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Chien-Hung Lee

  8. Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Chien-Hung Lee

  9. College of Professional Studies, National Pingtung University of Science and Technology, Pingtung, Taiwan

    Chien-Hung Lee

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  1. Yu-Ting Chin
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Contributions

C.H.L. and Y.T.C. conceived and designed the study. Y.T.C. and P.W.W. led the Project administration. Data curation and investigation were conducted by all authors (Y.T.C., P.W.W., P.R.H., S.T., W.T.L., C.Y.L., and W.C.T.). Y.T.C. and C.H.L. performed the formal analysis. The first draft of the manuscript was written by Y.T.C. and C.H.L., with all authors contributing to review and editing. C.H.L. supervised the study and obtained funding. All authors discussed the results and approved the final manuscript.

Corresponding author

Correspondence to Chien-Hung Lee.

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The authors declare no competing interests.

Consent Statement

Informed assent and consent were collected from all student participants and their guardians to ensure voluntary participation and compliance with ethical standards in both studies. The Institutional Review Board of Kaohsiung Medical University Hospital approved the study protocol (approval no. KMUHIRB-20120103).

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Chin, YT., Wu, PW., Huang, PR. et al. Confirmatory-factor-analysis-derived metabolic syndrome risk score: development, validation, and clinical utility in dual adolescent populations. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04419-w

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  • DOI: https://doi.org/10.1038/s41390-025-04419-w

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