The metabolic syndrome in Chinese, Malays and Asian Indians. Factor analysis of data from the 1998 Singapore National Health Survey

Metabolic Syndrome: Prevalence and Risk Factors among Adolescent Female Intermediate and Secondary Students in Saudi Arabia

Background: Metabolic syndrome (MS) has become one of the major challenges to public health worldwide due to its significant association with increased risk of developing type 2 diabetes and cardiovascular disease (CVD) among children and adolescents. Therefore, this study aims to determine the prevalence and risk factors of MS in Saudi adolescents. Methods: This cross-sectional study was conducted in two female National Guard schools (Um Kalthoom Intermediate School and Zainab Bint Jahsh Secondary School) in Jeddah, Saudi Arabia, between January 2018 and March 2018. Of the 808 female students, 172 (age range of 12–19 years) participated voluntarily, with consent from their guardian(s), fasted for at least 8 h prior to the study, and represent the final study sample. Male students were not included due to cultural constraints in conducting the study. Demographic data, physical measurement (blood pressure, weight, height, body mass index (BMI) and waist circumference (WC)), and biochemical measurement (fasting plasma glucose and triglycerides, high-density lipoprotein (HDL), and low-density lipoprotein) were obtained. The International Diabetes Federation (IDF) criteria was utilized in the diagnosis of MS. Results: Of the 172 female adolescents, 24 (13.75%) are overweight, 20 (11.63%) are obese, and 3 (1.74%) are underweight. High-fasting plasma glucose (n = 85, 49.41%) and high waist circumference (n = 74, 43.02%) were the most common risk factors of MS among female adolescents. The overall prevalence of MS was 7% (n = 12/172). MS is more common among those who are obese or among those with a BMI that falls at the ≥95th percentile (n = 6/20, 30.0%) (p < 0.05) as compared to those who are overweight with a BMI that falls within the 85th to <95th percentiles (n = 2/24, 8.33%). Interestingly, 3.20% of the sample (n = 4/125) with normal BMI were diagnosed with MS. Conclusions: Our study indicates that MS is common among obese and overweight female adolescents but is also present among those who are not obese or with normal BMI. Moreover, the prevalence of overweight, obese, and those with MS in this reference population are lower compared to the cities of Makkah and Riyadh; however, it varies widely around the world due to different criteria and cut-off values in the diagnosis of MS.

Gender-dependent associations between socioeconomic status and metabolic syndrome: a cross-sectional study in the adult Saudi population

Background

To determine the gender-dependent association of socio-economic status variables with the prevalence of metabolic syndrome (MetS) in the adult Saudi population.

Methods

A total of 9164 adult Saudis (aged 18–70 years) were included in this cross-sectional study. Marital status, income, education, and occupation were used as socio-economic indicators while behavioral factor like physical exercise was also taken into account. MetS was defined using the criteria based from the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III).

Results

In males, the odds ratio (OR) of harboring MetS was higher in married [OR1.6 (Confidence Interval (CI) 1.1, 2.4); p < 0.03], and high income class [OR 2.3(CI 1.5, 3.5); p < 0.001] and lowest in retired and unemployed individuals [1.4(1.0, 1.9); p < 0.04, 0.61(0.45, 0.82); p < 0.001] respectively. In females, MetS was inversely related to high income [OR 0.70 (CI 0.46, 1.1); p < 0.09] and education level [OR 0.38 (CI 0.26, 0.56); p < 0.001], and was significantly higher in the unemployed class [OR 1.6 (CI 1.2, 2.2); p < 0.004].

Conclusions

The prevalence of MetS is significantly high among retired, married and high-earning Saudi males while in females, high earners and high education seem to confer a protective effect against MetS.

Metabolic Syndrome and Cardiovascular Risk Factors in a National Sample of Adolescent Population in the Middle East and North Africa: The CASPIAN III Study

Objective. The present study was designed to investigate the prevalence of different combinations of the metabolic syndrome (MetS) risk factors among a nationally representative sample of adolescents in the Middle East and North Africa (MENA). Methods. The study sample, obtained as part of the third study of the school-based surveillance system entitled CASPIAN III, was representative of the Iranian adolescent population aged from 10 to 18 years. The prevalence of different components of MetS was studied and their discriminative value was assessed by receiver operating characteristic (ROC) curve analysis. Results. The study participants consisted of 5738 students (2875 girls) with mean age of 14.7 ± 2.4 years) living in 23 provinces in Iran; 17.4% of participants were underweight and 17.7% were overweight or obese. Based on the criteria of the International Diabetes Federation for the adolescent age group, 24.2% of participants had one risk factor, 8.0% had two, 2.1% had three, and 0.3% had all the four components of MetS. Low HDL-C was the most common component (43.2% among the overweight/obese versus 34.9% of the normal-weight participants), whereas high blood pressure was the least common component. The prevalence of MetS was 15.4% in the overweight/obese participants, the corresponding figure was 1.8% for the normal-weight students, and 2.5% in the whole population studied. Overweight/obese subjects had a 9.68 increased odds of (95% CI: 6.65-14.09) the MetS compared to their normal-weight counterparts. For all the three risk factors, AUC ranged between 0.84 and 0.88, 0.83 and 0.87, and 0.86 and 0.89 in waist circumference, abdominal obesity, and BMI for boys and between 0.78 and 0.97, 0.67 and 0.93, and 0.82 and 0.96 for girls, respectively. Conclusion. The findings from this study provide alarming evidence-based data on the considerable prevalence of obesity, MetS, and CVD risk factors in the adolescent age group. These results are confirmatory evidence for the necessity of primordial/primary prevention of noncommunicable disease should be considered as a health priority in communities facing a double burden of nutritional disorders.

Metabolic syndrome among obese Qataris attending primary health care centers in Doha, 2010

OBJECTIVES

To determine the prevalence of metabolic syndrome among obese patients using the IDF definition and to identify factors that are associated with it.

MATERIALS AND METHODS

A cross-sectional randomized study was conducted at four primary care centers inside Doha, Qatar. One hundred and thirty-six Adults, ≥ 18 Qatari obese patients, were chosen by systematic random sampling. They were interviewed and screened for the presence of metabolic syndrome, which was diagnosed according to the International Diabetes Federation criteria: An abdominal circumference ≥ 94 cm in males or ≥ 80 cm in females, plus any two of the following: HDL cholesterol < 1.03 mmol / mL (< 40 mg / dL) [males] or < 1.3 mmol / mL (< 50 mg / dL) [females], Triglycerides ≥ 1.7 mmol / mL (≥150 mg / dL), Blood pressure ≥ 130 / 85 mmHg or the patient receiving antihypertensive treatment and baseline glycemia > 5.6 mmol / mL (> 100 mg / dL), or previously-diagnosed type 2 diabetes mellitus.

RESULTS

The overall prevalence of the metabolic syndrome among obese patients was 46.3%. The prevalence was higher in females (50%) than in males (42.4%). It was seen to increase with increasing body mass index class, from class 1 to class 2. The prevalence of metabolic comorbidities of abnormal waist circumference, raised blood pressure, raised fasting blood glucose, high triglycerides, and reduced high density lipoprotein was 88.2, 42.6, 32.4, 31.6, and 27.9%, respectively. Based on the logistic regression multivariable analysis, increasing age and being diabetic were the only significant associated factors that influenced the risk of having the metabolic syndrome.

CONCLUSION

The prevalence of the metabolic syndrome was high, and the highest comorbidities were abnormal waist circumference and high blood pressure. Diabetes and increasing age were the only significant risk factors of having this syndrome.

Risk of metabolic syndrome among children living in metropolitan Kuala Lumpur: a case control study

Background

With the increasing prevalence of childhood obesity, the metabolic syndrome has been studied among children in many countries but not in Malaysia. Hence, this study aimed to compare metabolic risk factors between overweight/obese and normal weight children and to determine the influence of gender and ethnicity on the metabolic syndrome among school children aged 9-12 years in Kuala Lumpur and its metropolitan suburbs.

Methods

A case control study was conducted among 402 children, comprising 193 normal-weight and 209 overweight/obese. Weight, height, waist circumference (WC) and body composition were measured, and WHO (2007) growth reference was used to categorise children into the two weight groups. Blood pressure (BP) was taken, and blood was drawn after an overnight fast to determine fasting blood glucose (FBG) and full lipid profile, including triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC). International Diabetes Federation (2007) criteria for children were used to identify metabolic syndrome.

Results

Participants comprised 60.9% (n = 245) Malay, 30.9% (n = 124) Chinese and 8.2% (n = 33) Indian. Overweight/obese children showed significantly poorer biochemical profile, higher body fat percentage and anthropometric characteristics compared to the normal-weight group. Among the metabolic risk factors, WC ≥90^th percentile was found to have the highest odds (OR = 189.0; 95%CI 70.8, 504.8), followed by HDL-C≤1.03 mmol/L (OR = 5.0; 95%CI 2.4, 11.1) and high BP (OR = 4.2; 95%CI 1.3, 18.7). Metabolic syndrome was found in 5.3% of the overweight/obese children but none of the normal-weight children (p < 0.01). Overweight/obese children had higher odds (OR = 16.3; 95%CI 2.2, 461.1) of developing the metabolic syndrome compared to normal-weight children. Binary logistic regression showed no significant association between age, gender and family history of communicable diseases with the metabolic syndrome. However, for ethnicity, Indians were found to have higher odds (OR = 5.5; 95%CI 1.5, 20.5) compared to Malays, with Chinese children (OR = 0.3; 95%CI 0.0, 2.7) having the lowest odds.

Conclusions

We conclude that being overweight or obese poses a greater risk of developing the metabolic syndrome among children. Indian ethnicity is at higher risk compared to their counterparts of the same age. Hence, primary intervention strategies are required to prevent this problem from escalating.

Ethnicity modifies the relationships of insulin resistance, inflammation, and adiponectin with obesity in a multiethnic Asian population

OBJECTIVE

The development of obesity-related metabolic disorders varies with ethnicity. We examined whether ethnicity modifies the relationship between BMI and three metabolic pathways (insulin resistance, inflammation, and adiponectin) that are involved in the pathogenesis of diabetes and cardiovascular disease (CVD).

RESEARCH DESIGN AND METHODS

We analyzed data from 4,804 Chinese, Malay, and Asian-Indian residents of Singapore with complete data on insulin resistance (IR), C-reactive protein (CRP), and total adiponectin levels. Linear regression models with an interaction term ethnicity*BMI were used to evaluate whether ethnicity modifies the association between BMI and IR, CRP, and adiponectin.

RESULTS

In both uni- and multivariate analyses, BMI was directly associated with IR and CRP and inversely with adiponectin across all ethnic groups. When compared with Chinese and Malays, Asian-Indians had higher IR and CRP and lower adiponectin levels. The associations between BMI and its metabolic pathways were significantly stronger in Chinese than in other ethnic groups. The increase in IR and CRP and the decrease in adiponectin for each unit increase in BMI were greater in Chinese than in other ethnic groups. The findings were similar when waist circumference was used in the analyses instead of BMI.

CONCLUSIONS

The impact of BMI on IR, CRP, and adiponectin appears greater in Chinese as compared with other major Asian ethnic groups. This may partly explain the rapid increase in the prevalence of diabetes and CVD in Chinese populations and highlights the importance of weight management in Asian ethnic groups despite the apparently low levels of obesity.

Association between glucokinase regulatory protein (GCKR) and apolipoprotein A5 (APOA5) gene polymorphisms and triacylglycerol concentrations in fasting, postprandial, and fenofibrate-treated states

BACKGROUND

Hypertriglyceridemia is a risk factor for cardiovascular disease. Variation in the apolipoprotein A5 (APOA5) and glucokinase regulatory protein (GCKR) genes has been associated with fasting plasma triacylglycerol.

OBJECTIVE

We investigated the combined effects of the GCKR rs780094C-->T, APOA5 -1131T-->C, and APOA5 56C-->G single nucleotide polymorphisms (SNPs) on fasting triacylglycerol in several independent populations and the response to a high-fat meal and fenofibrate interventions.

DESIGN

We used a cross-sectional design to investigate the association with fasting triacylglycerol in 8 populations from America, Asia, and Europe (n = 7,730 men and women) and 2 intervention studies in US whites (n = 1,061) to examine postprandial triacylglycerol after a high-fat meal and the response to fenofibrate. We defined 3 combined genotype groups: 1) protective (homozygous for the wild-type allele for all 3 SNPs); 2) intermediate (any mixed genotype not included in groups 1 and 3); and 3) risk (carriers of the variant alleles at both genes).

RESULTS

Subjects within the risk group had significantly higher fasting triacylglycerol and a higher prevalence of hypertriglyceridemia than did subjects in the protective group across all populations. Moreover, subjects in the risk group had a greater postprandial triacylglycerol response to a high-fat meal and greater fenofibrate-induced reduction of fasting triacylglycerol than did the other groups, especially among persons with hypertriglyceridemia. Subjects with the intermediate genotype had intermediate values (P for trend <0.001).

CONCLUSIONS

SNPs in GCKR and APOA5 have an additive effect on both fasting and postprandial triacylglycerol and contribute to the interindividual variability in response to fenofibrate treatment.

Prevalence and component analysis of metabolic syndrome: an Indian atherosclerosis research study perspective

Asian Indians have a high predisposition to metabolic syndrome (MS) and coronary artery disease (CAD). The present study aimed to estimate MS prevalence in 531 Asian Indian families comprising of 2318 individuals. Anthropometrics and lipid profile were assessed. MS prevalence was estimated using standard Adult Treatment Panel III (ATP-III) and World Health Organisation (WHO) criteria and modified definitions which included lowered cut-offs for waist circumference (WC) (≥90 cm for men and ≥80 cm for women], body mass index (BMI) (≥23 kg/m²) and impaired fasting glucose (IFG) levels. ATP-III criteria identified a significantly higher proportion of people with MS (N = 933; 40.3%) compared with WHO (N = 708; 30.6%; p < 0.0001) while modified ATP-III showed maximum gain in percent prevalence among the revised criteria (17.3%; p = 0.0056). The IDF criteria identified similar proportion of subjects with MS (N = 809; 34.9%) as the revised WHO criteria (N = 792; 34.2%). The number of MS subjects was highest in the 50–59 years age group. MS was diagnosed a decade earlier in unaffected subjects compared with those with CAD/diabetes using the modified MS criteria. WC correlated significantly with BMI and waist–hip ratio (WHR) (p = 0.000). Among MS components, high density lipoprotein cholesterol and BMI contributed significantly in males (71.4% and 85.9%) and females (86.8% and 88.8%), respectively. The higher percentage contribution of WC among males and WHR among females indicates the influence of gynecoid/android pelvis on WHR measures. In conclusion, the revision of definition criteria for MS with lowered cut-offs for WC and BMI is critical for the accurate assessment of MS among Asian Indians.

Gender difference on the development of metabolic syndrome: a population-based study in Taiwan

Little is known regarding the development of metabolic syndrome. This study examining gender difference in the characteristics of metabolic components aimed to estimate the development of metabolic syndrome in both genders. This nation-wide, population-based survey included 5,880 men and women aged 20-79 years in Taiwan. Metabolic syndrome was defined by the revised National Cholesterol Education Program Adult Treatment Panel III, with adoption of the Asian criteria for abdominal obesity. The results indicate that metabolic syndrome was prevalent in 20.4% of the men and 15.3% of the women. Lipid components occurred the earliest in both genders. The appearance of the first isolated component was earlier in women than in men (mean age 43.4 vs. 45.6 years, P < 0.05). In contrast, the mean prevalent age of metabolic syndrome appeared earlier in men than in women by 4.9 years (mean age 51.3 vs. 56.2 years, P < 0.05). The differences in prevalent age from the appearance of any isolated component to metabolic syndrome were 12.8 years in women and 5.7 years in men, respectively. If men had a body mass index less than 23 kg/m(2) and exercise habits, the difference in the prevalent age from the isolated component to metabolic syndrome was 15.4 years, longer than for all women subjects. We conclude lipid components appeared the earliest. Women had the first isolated component earlier, presenting as metabolic syndrome later than men. The development of metabolic syndrome was slower in subjects without overweight characteristics and with exercise habits.