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Background <p>Metabolic syndrome (MS) poses a growing threat to adolescent health, yet its sex-specific patterns remain inadequately characterized. This study aimed to investigate sex differences in MS prevalence, risk factor clustering, and metabolic phenotypes among U.S. adolescents.</p> Methods <p>We analyzed cross-sectional data from 6,989 adolescents aged 12–19 years, representing 30.97&#xa0;million U.S. adolescents, from the National Health and Nutrition Examination Survey (1999–2020). MS was defined based on abdominal obesity, elevated blood pressure, hyperglycemia, and dyslipidemia, using weighted analyses to account for complex survey design.</p> Results <p>The overall MS prevalence was 5.1%, with a significantly higher prevalence in males than in females (6.1% vs. 4.1%, <i>P</i> = 0.017). Critically, no significant temporal trends in MS prevalence were observed over the 20-year period for either sex. Males accumulated more metabolic risk factors than females, showing higher rates of elevated BP (5.9% vs. 0.9%), fasting glucose (22.7% vs. 10.4%), and triglycerides (8.8% vs. 6.4%), whereas, females had higher prevalences of abdominal obesity (25.9% vs. 12.6%) and low HDL-C (22.8% vs. 18.8%). Moreover, metabolically unhealthy obesity was more common in males (13.7% vs. 10.0%). Subgroup analyses showed significant sex disparities persisted among ages 12–15, obese, non-Hispanic White, and high-income subgroups. Sensitivity analyses using alternative definitions, including waist-to-height ratio for abdominal obesity, robustly confirmed the male predominance in MS prevalence.</p> Conclusion <p>Male U.S. adolescents exhibited a higher MS prevalence and a more unfavorable aggregation of metabolic risk factors than females. The stability of MS prevalence over the two-decade period highlighted the need for sex-specific and developmentally targeted interventions, especially within identified high-disparity subgroups.</p>

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Sex differences in metabolic syndrome among U.S. adolescents, NHANES 1999–2020

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月11日

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  • Danwei Zhang,
  • Xiaoyan Huang,
  • Zihan Chen,
  • Yinan Liu

摘要

Background

Metabolic syndrome (MS) poses a growing threat to adolescent health, yet its sex-specific patterns remain inadequately characterized. This study aimed to investigate sex differences in MS prevalence, risk factor clustering, and metabolic phenotypes among U.S. adolescents.

Methods

We analyzed cross-sectional data from 6,989 adolescents aged 12–19 years, representing 30.97 million U.S. adolescents, from the National Health and Nutrition Examination Survey (1999–2020). MS was defined based on abdominal obesity, elevated blood pressure, hyperglycemia, and dyslipidemia, using weighted analyses to account for complex survey design.

Results

The overall MS prevalence was 5.1%, with a significantly higher prevalence in males than in females (6.1% vs. 4.1%, P = 0.017). Critically, no significant temporal trends in MS prevalence were observed over the 20-year period for either sex. Males accumulated more metabolic risk factors than females, showing higher rates of elevated BP (5.9% vs. 0.9%), fasting glucose (22.7% vs. 10.4%), and triglycerides (8.8% vs. 6.4%), whereas, females had higher prevalences of abdominal obesity (25.9% vs. 12.6%) and low HDL-C (22.8% vs. 18.8%). Moreover, metabolically unhealthy obesity was more common in males (13.7% vs. 10.0%). Subgroup analyses showed significant sex disparities persisted among ages 12–15, obese, non-Hispanic White, and high-income subgroups. Sensitivity analyses using alternative definitions, including waist-to-height ratio for abdominal obesity, robustly confirmed the male predominance in MS prevalence.

Conclusion

Male U.S. adolescents exhibited a higher MS prevalence and a more unfavorable aggregation of metabolic risk factors than females. The stability of MS prevalence over the two-decade period highlighted the need for sex-specific and developmentally targeted interventions, especially within identified high-disparity subgroups.