Prognostic impact of different definitions of metabolic syndrome in predicting cardiovascular events in a cohort of non-diabetic Tehranian adults

Plasma metabolic fingerprints for large-scale screening and personalized risk stratification of metabolic syndrome

Direct diagnosis and accurate assessment of metabolic syndrome (MetS) allow for prompt clinical interventions. However, traditional diagnostic strategies overlook the complex heterogeneity of MetS. Here, we perform metabolomic analysis in 13,554 participants from the natural cohort and identify 26 hub plasma metabolic fingerprints (PMFs) associated with MetS and its early identification (pre-MetS). By leveraging machine-learning algorithms, we develop robust diagnostic models for pre-MetS and MetS with convincing performance through independent validation. We utilize these PMFs to assess the relative contributions of the four major MetS risk factors in the general population, ranked as follows: hyperglycemia, hypertension, dyslipidemia, and obesity. Furthermore, we devise a personalized three-dimensional plasma metabolic risk (PMR) stratification, revealing three distinct risk patterns. In summary, our study offers effective screening tools for identifying pre-MetS and MetS patients in the general community, while defining the heterogeneous risk stratification of metabolic phenotypes in real-world settings.

Potential of four definitions of metabolic syndrome to discriminate individuals with different 10-year cardiovascular disease risk scores: a cross-sectional analysis of an Iranian cohort

OBJECTIVE

We aimed to reveal the potential of four different metabolic syndrome (Mets) definitions to differentiate subjects according to 10-year risk of cardiovascular disease.

DESIGN

A cross-sectional analysis of a prospective cohort.

SETTING

This study used baseline data from the Shiraz Heart Study, a prospective cohort study in Shiraz, Iran. Participants were screened against Mets definitions including modified WHO, National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), American Heart Association (AHA) and International Diabetes Federation (IDF). Also, Framingham risk score (FRS) and atherosclerotic cardiovascular disease (ASCVD) risk score were determined for each participant.

PARTICIPANTS

A total number of 7225 participants of both genders entered the study. They were selected through defined family physician centres in different geographical areas. Urban residents with no migration plan were included. Those who were far from study centres or with disabilities that made them incapable to cooperate were excluded.

RESULTS

Participants were 47.68% (N=3445) male with the mean age of 52.13±8.00 years. The number of subjects with Mets identified by WHO was the lowest (N=1676), while the percentage of subjects with high risk score was the highest, 17.1% (N=282) in FRS and 9.8% (N=162) in ASCVD risk score. There were statistically significant differences in the mean risk scores between participants with and without Mets according to AHA, WHO and NCEP ATP III definitions (p<0.001). In IDF definition, the risk scores of subjects with Mets were not statistically different compared with peers without Mets, neither based on FRS (p=0.247) nor ASCVD risk score (p=0.193).

CONCLUSIONS

IDF was not the appropriate definition for discrimination of subjects with Mets and/or those at high risk of future cardiovascular events. AHA, WHO and NCEP ATP III definitions were effective to discriminate subjects with Mets from peers without Mets.

Comparison of anthro-metabolic indicators for predicting the risk of metabolic syndrome in the elderly population: Bushehr Elderly Health (BEH) program

BACKGROUND

Metabolic syndrome (MetS) is a cluster metabolic disorder that includes central obesity, insulin resistance, hypertension, and dyslipidemia, and is highly associated with an increased risk of developing non-communicable diseases (NCDs). This study aimed to compare the reliability of anthro-metabolic indices [visceral adiposity index (VAI), body roundness index (BRI), and a body shape index (BSI), body adiposity index (BAI), lipid accumulation product (LAP), waist to hip ratio, and waist to height ratio] in predicting MetS in Iranian older people.

METHODS

This cross-sectional study was conducted based on the data of 2426 adults aged ≥60 years that participated in the second stage of the Bushehr Elderly Health (BEH) program, a population-based prospective cohort study being conducted in Bushehr, Iran. MetS was defined based on the revised National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. The receiver operating characteristic (ROC) curve analysis was used to assess predictive performance of anthro-metabolic indices and determine optimal cutoff values. Logistic regression analysis was applied to determine the associations between MetS and indices.

RESULTS

2426 subjects (48.1% men) with mean ± SD age of 69.34 ± 6.40 years were included in the study. According to ATP III criteria, 34.8% of men and 65.2% of women had MetS (P < 0.001). Of the seven examined indices, the AUCs of VAI and LAP in both genders were higher than AUCs of other anthro-metabolic indices. Also, in general population, VAI and LAP had the greatest predictive power for MetS with AUC 0.87(0.86-0.89) and 0.87(0.85-0.88), respectively. The lowest AUC in total population belonged to BSI with the area under the curve of 0.60(0.58-0.62). After adjusting for potential confounders (e.g. age, sex, education, physical activity, current smoking) in the logistic regression model, the highest OR in the total population was observed for VAI and LAP, which was 16.63 (13.31-20.79) and 12.56 (10.23-15.43) respectively. The lowest OR for MetS was 1.93(1.61-2.30) for BSI.

CONCLUSION

This study indicated that both VAI and LAP are the most valuable indices among the anthro-metabolic indices to identify MetS among the elderly in both genders. So, they could be used as proper assessment tools for MetS in clinical practice. However, the cost-benefit of these indices compared to the ATP III criteria need further studies.

A nationwide study of metabolic syndrome prevalence in Iran; a comparative analysis of six definitions

Introduction

To integrate and execute a proper preventive plan and reduce the risk of non-communicable diseases (NCDs), policy makers need to have access to both reliable data and a unique definition of metabolic syndrome (MetS). This study was conducted on the data collected by cross-sectional studies of WHO’s STEPwise approach to surveillance of NCD risk factors (STEPs) to estimate the national and sub-national prevalence rates of MetS in Iran in 2016.

Materials and methods

The prevalence of MetS was estimated among 18,414 individuals aged ≥25 years living in urban and rural areas of Iran using various definition criteria; National Cholesterol Education Program Adult Treatment Panel III 2004 (ATP III), International Diabetes Federation (IDF), American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI), Joint Interim Statement (JIS). Regional IDF (RIDF) and JIS (RJIS) were defined using ethnicity-specific values of waist circumference for the country.

Results

National prevalence rate of MetS based on ATP III, IDF, AHA/NHLBI, JIS, RIDF and RJIS criteria were 38.3% (95% CI 37.4–39.1), 43.5% (42.7–44.4), 40.9% (40.1–41.8), 47.6% (46.8–48.5), 32.0% (31.2–32.9), and 40.8% (40.0–41.7), respectively. The prevalence was higher among females, in urban residents, and those aged 65–69 years. MetS was expected to affect about 18.7, 21.3, 20.0, 23.3, 15.7, and 20.0 million Iranians, respectively, based on ATP III, IDF, AHA/NHLBI, JIS, RIDF and RJIS. The two most common components noted in this population were reduced high-density lipoprotein cholesterol (HDL-C) levels and central obesity.

Conclusion

High prevalence rate of MetS among Iranian adults is alarming, especially among females, urban residents, and the elderly. The JIS definition criteria is more appropriate to determine higher number of Iranians at risk of NCDs. Proper management and prevention of MetS is required to adopt multiple national plans including lifestyle modifications, medical interventions, and public education on NCDs risk factors.

Association of Waist-to-Height Ratio, Metabolic Syndrome, and Carotid Atherosclerosis in Individuals with a High Risk of Stroke: A Cross-Sectional Study of 9605 Study Participants

Background: To determine the association of waist-to-height ratio (WHtR), metabolic syndrome (MetS), and carotid atherosclerosis (CAS) in individuals with a high risk of stroke. Methods: We performed a cross-sectional analysis of 9605 study responders from eight urban area communities in Northern China. Height, weight, waist circumference, blood pressure (BP), and blood lipid were measured. Information of population characteristics, smoking status, alcohol consumption, physical activity, and diet were determined by validated questionnaire. Results: A total of 9605 study responders were included in this study. The average age was 60 ± 9 years with 5911 (61.5%) patients being females. The prevalence of MetS and CAS was 26.2% and 75.1%, respectively. WHtR was significantly associated with CAS using our final adjusted model [odds ratio (OR): 1.233, 95% confidence interval (CI): 1.096-1.378]. The association of CAS with hypertension and hyperglycemia were statistically significant among factors that constitute MetS. Additional risk factors affecting the development of CAS included age, previous stroke, and smoking history (P < 0.05). Conclusion: WHtR was determined to perform better compared with other traditional indicators for correlating CAS. We believe that WHtR is a better indicator for the early identification of CAS in individuals with a high risk of stroke. This will facilitate the early detection and intervention of CAS.

Comparative study on prevalence of metabolic syndrome based on three criteria among adults in Zhejiang province, China: an observational study

OBJECTIVES

In this study, we aimed to estimate the prevalence of metabolic syndrome (MetS) among Chinese adults, describe the disease components and compare utility of the existing international criteria and Chinese diagnostic criteria.

DESIGN, SETTING AND PARTICIPANTS

A retrospective database analysis was conducted for one hospital in Zhejiang province, China. We analysed data (collected in 2017) from a total of 64 902 participants (37 500 males and 27 402 females), aged between 18 and 97 years, and who met the eligibility criteria.

MAIN OUTCOME MEASURES

We employed three criteria for MetS proposed by the International Diabetes Federation (IDF) in 2005, the 2009 Joint Scientific Statement (harmonising criteria) and the China Diabetes Society (CDS) in 2013 to detect prevalence of MetS. Specifically, we analysed waist circumference, blood pressure, fasting plasma glucose, plasma triglycerides and plasma high-density lipoprotein cholesterol.

RESULTS

We found an estimated age-adjusted MetS prevalence of 20.4% using IDF 2005, 30.0% based on harmonising criteria 2009 and 16.3% under the CDS 2013. This prevalence was higher in males, older adults and increased body mass index. Analysis of agreements among the criteria were 87.2% (IDF and CDS), 87.1% (IDF and harmonising criteria) and 81.6% (CDS and harmonising criteria), while their kappa coefficients were 0.641, 0.708 and 0.572 for IDF versus CDS, IDF versus harmonising criteria and CDS versus harmonising criteria, respectively. The most prevalent MetS component was abdominal obesity (50.1%), followed by dyslipidaemia (49.5%) and hypertension (46.8%) using harmonising criteria.

CONCLUSION

These findings revealed moderate agreement among the three criteria with utility in Chinese clinical settings. The harmonising criteria 2009 performed better in early identification of MetS in the Chinese population.

Comparison of coronary heart disease risk assessments among individuals with metabolic syndrome using three diagnostic definitions: a cross-sectional study from China

OBJECTIVE

Metabolic syndrome (MetS) is a notable risk factor of coronary heart disease (CHD). However, there are differences in the methods used to define MetS. The purpose of this study was to determine which MetS definition most fully reflects the 10-year probability of CHD based on the Framingham risk algorithm.

DESIGN

Cross-sectional study.

SETTING

Data were obtained from the China Health and Nutrition Survey and the Influencing Factors of Chronic Diseases Survey conducted among residents of Nanshan District in Shenzhen, China.

PARTICIPANTS

In total, 1721 participants aged 20-80 years were included in this study.

METHODS

MetS was diagnosed according to the criteria of the National Cholesterol Education Program's Adult Treatment Panel (revised NCEP-ATP III), the International Diabetes Federation (IDF) and the Chinese Diabetes Society (CDS). The NCEP-ATP III algorithm was used to calculate the Framingham risk score, and the Framingham risk score was used to define the probability of developing CHD within 10 years either as low (<6%), moderate (6%-10%), moderately high (10%-20%) or high (>20%). Chi-square tests with or without the Bonferroni correction were used to compare the differences in the distribution of the 10-year estimated risk of developing CHD among the three definitions.

RESULTS

Compared with the other definitions, the revised NCEP-ATP III criteria identified more participants (30.96%, 95% CI 28.8% to 33.2%) as having MetS, while the CDS criteria showed the highest 10-year probability of developing CHD. The 10-year probability of developing CHD in the participants with MetS was significantly higher than that in the participants without MetS (CDS: χ²=157.65, revised ATP III: χ²=45.17, IDF: χ²=306.15, all p<0.001), and all definitions more fully reflect the CHD risk in men than in women (revised NCEP-ATP III: χ²=72.83; IDF: χ²=63.60; CDS: χ²=23.84; all p<0.001).

CONCLUSIONS

This study demonstrates the differences in the prevalence and distribution of the 10-year estimated risk of developing CHD based on the definition of MetS. A significant finding of this study is that the MetS definitions have better performance for men than for women. Further studies in China, especially longitudinal studies, are needed to determine which definition of MetS is best suited for predicting CHD risk.

Metabolic Syndrome: Findings from 20 Years of the Tehran Lipid and Glucose Study

CONTEXT

In recent decades, investigations have been focused on the definition, incidence and predictors of metabolic syndrome (MetS) in Iranians. This study aimed to review systematically investigations on MetS, conducted among the Tehran lipid and glucose study (TLGS) participants.

EVIDENCE ACQUISITION

Literature on MetS documented by TLGS studies published from 2000 to 2017 were searched using Pubmed and Scopus database in English language with a combination of following keywords: Metabolic syndrome, TLGS.

RESULTS

The harmonized definition of MetS was confirmed, based on the estimated cut point of waist circumference (WC) ≥ 95 cm for both genders in Iran. The incidence rate was 550.9/10000 person/years, lower among women (433.5/10000) than men (749.2/10000). The prevalence of abdominal obesity, high triglycerides (TG), low high density lipoprotein cholesterol (HDL-C), high blood pressure (BP), and high fasting blood glucose (FBG) was 30, 46, 69, 34, and 12%, respectively. The prevalence of MetS in adolescents was 10.1% with no significant difference between boys and girls (10.3% in boys and 9.9% in girls). A strong association of WC (OR: 2.32, CI: 2.06 - 2.59) and TGs (OR: 1.95, CI: 1.65 - 2.11) with development of MetS was found. In adolescent boys, WC had the highest OR for MetS risk. WHO-defined MetS was a significant predictor of total and cardiovascular mortality both in men (HR: 1.66, CI: 1.23 - 2.24; HR:1.93, CI: 1.26 - 2.94) and women (HR: 2.01, CI: 1.39 - 2.88; HR:2.71, CI: 1.44 - 5.09).

CONCLUSIONS

Our results indicate high incidence of MetS in Tehranian adults and adolescents; high WC also appears to be a strong predictor of MetS. All definitions of MetS predicted cardiovascular disease.

Comparing associations of different metabolic syndrome definitions with ischemic stroke in Chinese elderly population

OBJECTIVES

Studies have showed the associations between different definitions of metabolic syndrome (MetS) and risk of ischemic stroke were inconsistent. In this study, we compared associations of different MetS definitions with ischemic stroke in Chinese elderly population.

METHODS

A total of 1713 individuals aged 70-84years from Rugao Longevity and Ageing Study were analyzed. The MetS was defined by four different criteria: Chinese Adult Dyslipidemia Prevention Guide, International Diabetes Federation (IDF), Updated ATPIII (Updated ATPIII) by American heart association/American heart, lung and blood institute (AHA/NHLBI), and Joint Interim Statement(JIS) recommended by IDF and the American heart association/American national institutes of health/American heart, lung and blood institute (AHA/NIH/NHLBI).

RESULTS

Prevalence of MetS in the whole population was 24.0% (Chinese guide), 32.5% (IDF), 38.8% (Updated ATPIII) and 24.0% (JIS) and in stroke population was 27.1% (Chinese guide), 41.1% (IDF), 48.8% (Updated ATPIII) and 27.1% (JIS), respectively. The agreement between definitions was highest in Updated ATPIII vs. IDF (kappa=0.863). It showed that only definitions of IDF (OR 1.55, 95%CI 1.04-2.31, p=0.031) and Updated ATPIII (OR 1.64, 95%CI 1.11-2.42, p=0.013) were independently associated with risk of ischemic stroke in multivariable logistic regression analysis. The risk of ischemic stroke increased with the increasing of numbers of Mets components in Updated ATPIII (p<0.05).

CONCLUSION

In this population, Updated ATPIII criteria was a more suitable definition of Mets than definitions of Chinese guide, IDF and JIS for screening high-risk individuals of ischemic stroke, and the additive effects of Mets components might play a greater role than its composition alone in ischemic stroke.

Which insulin resistance-based definition of metabolic syndrome has superior diagnostic value in detection of poor health-related quality of life? Cross-sectional findings from Tehran Lipid and Glucose Study

Background

The superiority of the diagnostic power of different definitions of metabolic syndrome (MetS) in detecting objective and subjective cardiovascular outcomes is under debate. We sought to compare diagnostic values of different insulin resistance (IR)-based definitions of MetS in detecting poor health-related quality of life (HRQoL) in a large sample of Tehranian adults.

Methods

This cross-sectional study conducted within the framework of the Tehran Lipid and Glucose Study on a total sample of 742 individuals, aged ≥ 20 years. Metabolic syndrome was defined according to the World Health Organization (WHO), the European Group for the study of Insulin Resistance (EGIR), and the American Association of Clinical Endocrinology (AACE). Health-related quality of life was assessed using the Short Form Health Survey (SF-36). Logistic regression analysis and Receiver Operating Characteristic (ROC) curve were used to investigate the impact of the three IR-based definitions of MetS on HRQoL and compare their discriminative powers in predicting poor HRQoL.

Results

Compared with other definitions, the WHO definition identified more participants with MetS (41.8 %). Although the AACE definition had higher adjusted odds ratios for reporting poor physical HRQoL (OR: 1.95; CI: 0.84–4.53 and OR: 1.01; CI: 0.55–1.85 in men and women respectively) and mental HRQoL (OR: 0.97; CI: 0.41–2.28 and OR: 1.00; CI: 0.56–1.79 in men and women respectively), none of the three studied definitions were significantly associated with poor physical or mental HRQoL in either gender; nor did ROC curves show any significant difference in the discriminative powers of IR-based definitions in detecting poor HRQoL in either gender.

Conclusions

None of the three studied IR-based definitions of MetS could significantly detect poor HRQoL in the physical or mental domains, indicating no significant superior diagnostic value for any of these definitions.

Fast Food Intake Increases the Incidence of Metabolic Syndrome in Children and Adolescents: Tehran Lipid and Glucose Study

The aim of the study was to evaluate the association between fast food consumption and incidence of metabolic syndrome (MetS) and its components among children and adolescents over a 3.6 year follow-up. Dietary data of 424 healthy subjects, aged 6–18 years, was collected using a valid and reliable food frequency questionnaire. Metabolic syndrome was defined according to the Cook et al criteria. Consumption of fast foods including hamburgers, sausages, bologna (beef), and fried potatoes was calculated and further categorized to quartiles. Multiple logistic regression models were used to estimate the incidence of MetS and its components in each quartile of fast food intake. The incidence of MetS was 11.3% after a 3.6 year follow up. In the fully adjusted model, compared to the lowest quartile of fast food intake, individuals in the highest had odds ratios of 2.96 (95% CI: 1.02–8.63; P for trend<0.001), 2.82 (95% CI: 1.01–7.87; P for trend = 0.037), and 2.58 (95% CI: 1.01–6.61; P for trend = 0.009) for incidence of MetS, hypertriglyceridemia, and abdominal obesity, respectively. No significant association was found between fast food intakes and other components of MetS. Fast food consumption is associated with the incidence of MetS, abdominal obesity, and hypertriglyceridemia in Tehranian children and adolescents.

"Adolescent metabolic phenotypes and early adult metabolic syndrome: Tehran lipid and glucose study"

OBJECTIVE

To investigate the predictive role of adolescent metabolic phenotypes in development of early adult metabolic syndrome (MetS).

STUDY DESIGN

A group of 1446 adolescents (44.8% boys), participants of the Tehran Lipid and Glucose Study, with a mean (SD) of age 14.6 (2.2) years, followed for 10.4 years. Logistic regression models were developed to evaluate the predictive power of different metabolic phenotypes for adult MetS. Moreover, areas under the receiver operating characteristic (ROC) curve were estimated to compare the prediction power of metabolic phenotypes for adult MetS.

RESULTS

The prevalence of MetS was 14.6% (29.7% and 2.4% for adult males and females, respectively) at the end of follow up. The most frequent metabolic phenotype in adolescent was high TGs/low HDL-C (23.7%), while the prevalence of high TGs/high WC was 10.4% and the other phenotypes were less than 10%. After adjustment for baseline BMI Z-Score and BMI change, high TGs/low HDL-C (OR: 1.70, 95%CI: 1.23-2.37), high WC/high BP (OR: 1.75., 95%CI: 1.08-2.84), high BP/low HDL-C (OR:1.68, 95%CI: 1.05-2.60) and high WC/low HDL-C (OR: 2.41, 95% CI: 1.37-4.23) phenotypes were associated with adult MetS. However, their AUCs were significantly lower than overweight or obesity.

CONCLUSION

Some combinations of metabolic abnormalities in adolescence predict early adult MetS, independent of baseline BMI Z-Score and BMI change. However, the discriminative power of these phenotypes was weak, in comparison to adolescent overweight or obesity.

Diagnostic values of different definitions of metabolic syndrome to detect poor health status in Iranian adults without diabetes

AIMS

This study aimed to compare the diagnostic impact of four definitions of the metabolic syndrome for detection of poor health status in adults without diabetes living in Tehran.

METHODS

A representative sample of 950 individuals (64% women), aged ≥ 20 years, participants of the Tehran Lipid and Glucose Study in 2005-2007, were recruited for the study. Health status was assessed using the Iranian version of the 36-item Short Form Health Survey. We assessed the detectability of poor health status by definitions of the National Cholesterol Education Program Adult Treatment Panel III, the International Diabetes Federation, the American Heart Association/National Heart, Lung, and the Blood Institute and the Joint Interim Statement.

RESULTS

Compared with other definitions, the Joint Interim Statement identified more participants (46.9%) having the metabolic syndrome. Using the National Cholesterol Education Program Adult Treatment Panel III, the International Diabetes Federation and the Joint Interim Statement, the metabolic syndrome was significantly related to poor physical health status, even after adjustment for confounding variables, in women, but not in men. None of the four definitions of the metabolic syndrome was related to the mental health status in either gender. The receiver operating characteristic curves showed no significant difference in the discriminative power of the metabolic syndrome definitions in detecting poor health status in either gender. However, women showed a higher area under the curve for all definitions, in comparison with men.

CONCLUSION

There was no difference in the four different definitions of the metabolic syndrome in detecting poor health status among Iranian adults.