Association with Metabolic Syndrome in Children Diagnosed with Type 1 Diabetes Mellitus: A Cross-Sectional Study

Objective: To evaluate the prevalence of metabolic syndrome (MetS) in children with type 1 diabetes mellitus (T1DM) and to determine the predictive value of simple anthropometric measurements, in particular neck circumference (NC) and waist circumference (WC), for identifying MetS. Methods: Children (aged 6-18 years) and diagnosed with T1DM were included in this cross-sectional study. Anthropometric [NC, WC, hip circumference (HC), body mass index (BMI), tri-ponderal mass index (TMI)] and laboratory parameters, including lipid profile and hemoglobin A1c (HbA1c) were recorded. MetS diagnosis was established using the International Diabetes Federation criteria. Receiver operating characteristic (ROC) curve analysis and Least Absolute Shrinkage and Selection Operator (LASSO) regression were employed to identify key predictors. Results: A total of 168 children with T1DM participated, among whom the prevalence of MetS was 8.9%. Children with MetS had significantly higher BMI, WC, NC, HC, and TMI values compared to non-MetS counterparts. ROC analysis identified WC Z-score having the highest discriminative power [area under the curve (AUC)=0.954], followed by NC Z-score (AUC=0.906). LASSO regression identified NC Z-score and BMI percentile as the most robust predictors. A strong positive correlation was observed between NC and WC (r=0.812, p<0.001), and there was a mild inverse correlation between NC and high-density lipoprotein cholesterol. Conclusion: NC and WC are simple, non-invasive, and reliable tools for early detection of MetS risk in pediatric T1DM patients. Their routine measurement may enhance risk stratification and guide preventive interventions targeting obesity and dyslipidemia. These findings support incorporating NC and WC into standard clinical assessments to improve long-term cardiometabolic outcomes in children with T1DM, with NC z>1.04 or WC z>1.41 as actionable thresholds.