The new definition of metabolic syndrome by the international diabetes federation is less likely to identify metabolically abnormal but non-obese individuals than the definition by the revised national cholesterol education program: the Korea NHANES study

Prevalence of metabolic syndrome and its related factors among Vietnamese people: A systematic review and meta-analysis

BACKGROUND AND AIMS

Metabolic risk factors are the leading causes of mortality and morbidity in recent decades, yet the burden of metabolic syndrome (MetS) has not been carefully assessed in Vietnam. This review thus aims to examine the prevalence of MetS and its related factors in Vietnam.

METHODS

A systematic review was conducted using literature retrieved from PubMed/Medline, Web of Science, Embase, Scopus, and Google Scholar up until July 2021. We selected descriptive and analytical studies which reported the prevalence of MetS and related factors among healthy people aged less than 65 years old rather than morbid people in Vietnam. A meta-analysis with a random-effects model was applied to estimate the pooled prevalence from the included studies.

RESULTS

Eighteen studies with 35421 participants were included in the final analysis. The pooled MetS prevalence among the adult population in Vietnam was 16.1% (95% Confidence Interval (CI): 14.1%-18.1%). Higher prevalence was seen among females (17.3%, 95% CI: 13.8%-20.8%). Low level of High Density Lipoprotein-Cholesterol (HDL-C) was the most prevalent component (34.1%), followed by high triglycerides (33.3%). Being female, living in urban areas, having obesity, and having a higher body mass index or body fat percentage were associated with an increased likelihood of having MetS.

CONCLUSIONS

MetS was common in the Vietnamese population. Low HDL-C should be considered as an early detectable indicator for MetS screening programs at the population level. Appropriate interventions should be conducted for high-risk groups such as females, those living in urban areas, and obesity.

Commentary—fat but fit…and cold? Potential evolutionary and environmental drivers of metabolically healthy obesity

As global obesity rates continue to rise, it is important to understand the origin, role and range of human variation of body mass index (BMI) in assessing health and healthcare. A growing body of evidence suggests that BMI is a poor indicator of health across populations, and that there may be a metabolically healthy obese phenotype. Here, we review the reasons why BMI is an inadequate tool for assessing cardiometabolic health. We then suggest that cold climate adaptations may also render BMI an uninformative metric. Underlying evolutionary and environmental drivers may allow for heat conserving larger body sizes without necessarily increasing metabolic health risks. However, there may also be a potential mismatch between modern obesogenic environments and adaptations to cold climates, highlighting the need to further investigate the potential for metabolically healthy obese phenotypes among circumpolar and other populations as well as the broader meaning for metabolic health.

The associations between alcohol intake and cardiometabolic risk in African-origin adults spanning the epidemiologic transition

Background

Cardiometabolic (CM) risk affects approximately 25% of adults globally, and is diagnosed by meeting 3 out of 5 of the following CM risk factors: elevated blood pressure, high triglycerides, elevated blood sugar, low high-density lipoprotein (HDL) level, and abdominal obesity. Adults with CM risk are approximately 22% more likely to have higher mortality rates, and alcohol consumption may be associated with higher CM risk. While previous studies have investigated this potential connection, the majority of them did not include African-origin adults. Therefore, the study aimed to explore the association between alcohol intake and CM risk in 5 African-origin cohorts, spanning the epidemiologic transition in Ghana, South Africa, Jamaica, Seychelles and the United States of America.

Methods

Measurements included clinical measures for CM risk and self-reported alcohol consumption. Each participant was categorized into one of three drinking categories: non-drinker, light drinker (1–3 drinks daily for men and 1–2 drinks daily for women) and heavy drinker (4 or more drinks every day for men and 3 or more drinks per day for women). Using non-drinker status as the reference, the association between alcohol consumption status and prevalence of each of the five CM risk factors and overall elevated CM risk (having 3 out of 5 risk factors) was explored, adjusting for site, age and sex. Associations were explored using logistic regression and significance was determined using odds ratios (OR) and 95% confidence intervals.

Results

Neither light nor heavy drinking was associated with increased odds for having higher CM risk compared to nondrinkers (OR = 1.05, p = 0.792 and OR = 1.11, p = 0.489, respectively). However, light drinking was associated with lower odds for having low high density lipoproteins (HDL) cholesterol (OR = 0.69, p = 0.002) and increased risk for high triglycerides (OR = 1.48, p = 0.030). Heavy drinking was associated with elevated blood pressure (OR = 1.59, p = 0.002), high triglycerides (OR = 1.73, p = 0.006) and decreased risk of low HDL-cholesterol (OR = 0.621, p < 0.0005). Finally, country-specific analyses indicated that the relationship between heavy drinking and elevated CM risk varied widely across sites.

Conclusion

While several CM risk factors were associated with alcohol consumption, the associations were inconsistent and varied widely across five international cohorts of African-origin. Future studies should focus on understanding the individual site-related effects.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12128-2.

Relationship Between Metabolic Syndrome and Bone Fracture Risk in Mid-Aged Korean Women Using FRAX Scoring System

Background: The aim of this study is to investigate the relationship between metabolic syndrome (MetS) and bone fracture risk assessed by the Fracture Risk Algoritham (FRAX) tool in mid-aged Korean women. Methods: Retrospectively, the study reviewed medical records of 1,975 female patients with or without MetS, who underwent routine medical checkups from 2010 to 2016 at Pusan National University Hospital. The MetS group included the patients who met diagnostic criteria for MetS based on the revised National Cholesterol Education Program reported in Adult Treatment Panel III (NCEP-ATPIII), and the control group was composed of those patients without MetS. Each of the patients was assessed through self-report questionnaires and individual interview with a health care provider. The FRAX tool was used for bone fracture risk. Results: Univariate logistic regression analysis of various parameters for MetS showed increase in both FRAX1 and FRAX2 with odds ratio of 1.387 and 1.474 with P < 0.0001 each, respectively. Through Pearson's correlation coefficient study, correlation of patient's high-risk status of bone fracture with age was found. Multivariate analysis of such variables confirmed that only the age of patients was statistically significant in relationship to high-risk of fracture by FRAX tool. Conclusion: MetS was not significantly associated with the patient's high-risk status of bone fracture analyzed by using FRAX; however, the absolute values of FRAX scores were increased in MetS patients (FRAX1 = 4.10 and FRAX2 = 0.40%) compared to their control group (FRAX1 = 3.20% and FRAX2 = 0.20%).

Identification of female-specific genetic variants for metabolic syndrome and its component traits to improve the prediction of metabolic syndrome in females

Background

Metabolic syndrome (MetS), defined as a cluster of metabolic risk factors including dyslipidemia, insulin-resistance, and elevated blood pressure, has been known as partly heritable. MetS effects the lives of many people worldwide, yet females have been reported to be more vulnerable to this cluster of risks.

Methods

To elucidate genetic variants underlying MetS specifically in females, we performed a genome-wide association study (GWAS) for MetS as well as its component traits in a total of 9932 Korean female subjects (including 2276 MetS cases and 1692 controls). To facilitate the prediction of MetS in females, we calculated a genetic risk score (GRS) combining 14 SNPs detected in our GWA analyses specific for MetS.

Results

GWA analyses identified 14 moderate signals (P_meta < 5X10^− 5) specific to females for MetS. In addition, two genome-wide significant female-specific associations (P_meta < 5X10^− 8) were detected for rs455489 in DSCAM for fasting plasma glucose (FPG) and for rs7115583 in SIK3 for high-density lipoprotein cholesterol (HDLC). Logistic regression analyses (adjusted for area and age) between the GRS and MetS in females indicated that the GRS was associated with increased prevalence of MetS in females (P = 5.28 × 10^− 14), but not in males (P = 3.27 × 10^− 1). Furthermore, in the MetS prediction models using GRS, the area under the curve (AUC) of the receiver operating characteristics (ROC) curve was higher in females (AUC = 0.85) than in males (AUC = 0.57).

Conclusion

This study highlights new female-specific genetic variants associated with MetS and its component traits and suggests that the GRS of MetS variants is a likely useful predictor of MetS in females.

Electronic supplementary material

The online version of this article (10.1186/s12881-019-0830-y) contains supplementary material, which is available to authorized users.

Hypertriglyceridemic rats fed high fat diet as a model of metabolic syndrome

People with metabolic syndrome have higher risk of cardiovascular diseases then those without. The aim of the work was to investigate whether high fat diet administered to Prague hereditary hypertriglyceridemic (HTG) rats can induce signs of metabolic syndrome (MetS). Our results showed that HTG rats fed high fat diet (HTGch) had disturbed glucose metabolism and also lipid metabolism - increased serum triacylglycerols (TAG), total cholesterol (Ch), low-density lipoprotein-Ch (LDL-Ch), and decreased high-density lipoprotein-Ch (HDL-Ch). Their livers proved markers of developing steatosis. Moreover, HTGch had increased blood pressure, yet the vascular endothelium was not significantly damaged. All these changes were accompanied with oxidative stress and tissue damage identified as increased liver concentrations of thiobarbituric acid reactive substances (TBARS) and activity of the lysosomal enzyme N-acetyl-D-glucosaminidase (NAGA). We assume that the model used may be suitable for the study of MetS with no evidence of obesity. Prolongation of the high fat diet duration might have a major impact on all parameters tested, especially on vascular endothelial function.

Association Between Drinking and Obesity in Pre- and Postmenopausal Women: Korea National Health and Nutrition Examination Survey 2010-2012

BACKGROUND

Women are more vulnerable to the adverse effects of alcohol than men. The present study aimed to investigate the link between drinking and obesity in pre- and postmenopausal women in Korea.

METHODS

We performed a cross-sectional study of 4374 premenopausal and 2927 postmenopausal women using a multistage probability cluster survey sample to produce nationally representative estimates. We assessed the subjects' alcohol drinking tendencies rates according to their drinking levels as well as Alcohol Use Disorders Identification Test (AUDIT); obesity was identified based on body mass index (BMI) ≥25 kg/m², waist circumference (WC) ≥80 cm, and waist-to-height ratio (WHtR) ≥50%. We performed t-tests and chi-square tests to assess the association between drinking and obesity.

RESULTS

In premenopausal subjects, obesity indices increased significantly as alcohol consumption rose. Significant correlations between drinking level and obesity factors were found in premenopausal women after adjusting for age (odds ratios [ORs] for BMI, WC, and WHtR were 1.58 [1.08-2.31], 1.94 [1.11-3.00], and 1.80 [1.24-2.61], respectively). Furthermore, an AUDIT score of 20 or higher indicated a significantly higher likelihood of obesity (ORs for BMI, WC, and WHtR were 2.02 [1.18-3.46], 2.75 [1.70-4.87], and 2.86 [1.78-4.59], respectively). There was a significant correlation between AUDIT scores and obesity factors after adjusting for age, energy intake, fat intake, exercise, smoking, education, and income in premenopausal women (ORs for BMI and WHtR were 1.71 [0.85-3.47] and 1.73 [0.97-3.06], respectively).

CONCLUSION

Our results suggest that alcohol is associated with a risk factor for obesity in premenopausal women.

The Seoul Metropolitan Lifestyle Intervention Program and Metabolic Syndrome Risk: A Retrospective Database Study

Since 2011, the Seoul Metabolic Syndrome Management (SMESY) program has been employed as a community-wide, lifestyle modification intervention in Seoul, Korea. We aimed to determine if the SMESY intervention would be significantly associated with improvements in metabolic syndrome (MetS) risk factors. This retrospective database study included data from 25,449 participants aged 30–64 years between 1 January 2013 and 30 June 2013. In the SMESY program, 3 risk-stratified groups by the number of MetS factors were followed for 12 months with different intensity and timeframe of intervention. Among the high-(n = 7116) and moderate-risk groups (n = 14,762), all MetS factors (except triglycerides among the moderate-risk group) as well as MetS z-scores significantly improved over 12 months (all p < 0.05). Among the low-risk group (n = 3571), all factors aggravated significantly over 12 months (all p < 0.05). We observed temporal associations between the implementation of the SMESY program and improvements in MetS risk factors. However, such improvements differed by risk-stratified group, being most robust for the high-risk group, modest for the moderate-risk group, and aggravated for the low-risk group. Thus, more intensive interventions targeting different risk-stratified groups are needed, given a better understanding of the increase in risk factors observed in the low-risk group.

Four-Year Changes in Visceral Fat Mass and the Risk of Developing Proteinuria in the General Population

Background

Previous cross-sectional studies demonstrated the close relationship between visceral obesity and the increased prevalence of proteinuria. But, little is known about the role of changes in visceral fat mass (∆VFM) over several years in the development of proteinuria. In this longitudinal cohort study with the general population, the changes in ∆VFM as well as baseline VFM on proteinuria development were evaluated.

Methods

Healthy individuals (n = 2393) who participated in two health screening exams were analyzed. Subjects were divided into three groups based on gender-specific tertiles of baseline VFM and ∆VFM. Each patient was tested for proteinuria using a dipstick, and proteinuria was defined as 1+ or greater.

Results

The mean age was 51.9±7.7 years, and the incidence of proteinuria was 3.9% (n = 93). During the 4 years, 52.5% of the subjects experienced a decline in ∆VFM. However, subjects who developed proteinuria exhibited a significant increase in ∆VFM. Even after adjustment for age, smoking, systolic and diastolic BP, serum creatinine, and hs-CRP levels, the highest tertiles for baseline VFM [men, odds ratio (OR) 3.43, 95% confidence interval (CI) 1.22–9.67; women, OR 2.01, 95% CI 1.05–4.15] and ∆VFM (men, OR 2.92, 95% CI 1.22–6.99; women, OR 3.16, 95% CI 1.56–6.39) were independent predictors of proteinuria development. Following adjustment of both parameters, subjects in the highest baseline VFM and ∆VFM tertiles exhibited the greatest risk of proteinuria development, which suggested the additive harmful effects of the two factors.

Conclusions

Baseline VFM and greater increase in ∆VFM were both important risk factors for developing proteinuria in the general population. Appropriate education and interventions to prevent accumulation of VFM should be the major focus of preemptive strategies.

Risk of chronic kidney disease in non-obese individuals with clustering of metabolic factors: a longitudinal study

OBJECTIVE

The impact of the clustering of metabolic factors on chronic kidney disease (CKD) in non-obese individuals remains unclear.

METHODS

We conducted a follow-up study of 23,894 Japanese adults (age, 18-69 years) who continuously received annual health examinations between 2000 and 2011. Obesity, high blood pressure, high triglycerides, low high-density lipoprotein (HDL) cholesterol and high fasting blood sugar were defined as metabolic factors, and CKD was defined as renal dysfunction (estimated glomerular filtration rate: <60 mL/min/1.73 m(2)) or proteinuria (dipstick test: ≥1+). The association between the clustering of metabolic factors and CKD was assessed based on the presence or absence of obesity using a Cox proportional hazard model.

RESULTS

Of 2,867 subjects with ≥3 metabolic factors, 650 (22.7%) were non-obese. These individuals were older and had higher metabolic risks than their obese counterparts at baseline. Among the entire cohort of 23,894 subjects, 1,764 developed renal dysfunction and 904 developed proteinuria during an average follow-up period of 7.8 years. The cumulative incidence of renal dysfunction was higher (22.1% vs. 16.1%), whereas that of proteinuria was lower (10.5% vs. 14.4%), among the non-obese subjects with ≥3 metabolic factors than the obese subjects with ≥3 metabolic factors after 11 years. The adjusted relative risk (RR) (95% confidence interval) of renal dysfunction was 1.54 (1.34-1.77) and 1.67 (1.35-2.07) for the obese and non-obese subjects with ≥3 metabolic factors, respectively.

CONCLUSION

Non-obese subjects with ≥3 metabolic factors, who are missed based on the essential criterion of obesity for metabolic syndrome, may have an equal or slightly higher risk of renal dysfunction than obese subjects with ≥3 metabolic factors.

Ethnic disparities in the prevalence of the metabolic syndrome in American adults: data from the Examination of National Health and Nutrition Examination Survey 1999-2010

Data from the National Health and Nutrition Examination Survey were stratified by weight, gender, and ethnicity for six survey years from 1999 to 2010 for variables that satisfy the criteria for metabolic syndrome (MS). Results showed that 34% of the US adult population had MS. No significant gender disparities in MS prevalence were found. Black men had a significantly lower prevalence of MS than Black women and White men from 1999 to 2008 (P < 0.05). Women had a 60% higher abdominal adiposity than men in the US population (P = 0.00048; pregnant females were excluded). Although there seem to be ethnic differences in the prevalence of MS, the expression of MS is not a sufficient risk to culminate in cardiovascular disease; rather, nutritional, genetic, and environmental factors are necessary to finalize its expression into overt disease.

Relative skeletal muscle mass is associated with development of metabolic syndrome

BACKGROUND

Visceral adiposity is related to insulin resistance. Skeletal muscle plays a central role in insulin-mediated glucose disposal; however, little is known about the association between muscle mass and metabolic syndrome (MS). This study is to clarify the clinical role of skeletal muscle mass in development of MS.

METHODS

A total of 1,042 subjects were enrolled. Subjects with prior MS and chronic diseases were excluded. After 24 months, development of MS was assessed using NCEP-ATP III criteria. Skeletal muscle mass (SMM; kg), body fat mass (BFM; kg), and visceral fat area (VFA; cm(2)) were obtained from bioelectrical analysis. Then, the following values were calculated as follows: percent of SMM (SMM%; %): SMM (kg)/weight (kg), skeletal muscle index (SMI; kg/m(2)): SMM (kg)/height (m(2)), skeletal muscle to body fat ratio (MFR): SMM (kg)/BFM (kg), and skeletal muscle to visceral fat ratio (SVR; kg/cm(2)): SMM (kg)/VFA (cm(2)).

RESULTS

Among 838 subjects, 88 (10.5%) were newly diagnosed with MS. Development of MS increased according to increasing quintiles of BMI, SMM, VFA, and SMI, but was negatively associated with SMM%, MFR, and SVR. VFA was positively associated with high waist circumference (WC), high blood pressure (BP), dysglycemia, and high triglyceride (TG). In contrast, MFR was negatively associated with high WC, high BP, dysglycemia, and high TG. SVR was negatively associated with all components of MS.

CONCLUSION

Relative SMM ratio to body composition, rather than absolute mass, may play a critical role in development of MS and could be used as a strong predictor.

Prevalence of metabolic syndrome in turkmen ethnic groups in gorgan

INTRODUCTION

It has been estimated that the metabolic syndrome may predict cardiovascular disease and the occurrence of sudden death, independent of the presence of other cardiovascular risk factors. The aim of the present study was to assess the metabolic syndrome among Turkmen women in this area.

MATERIAL AND METHODS

The present study consisted of 160 Turkmen women. Baseline data and prevalence of metabolic syndrome and the components of metabolic syndrome in Turkmen women were determined.

OBSERVATIONS AND RESULTS

The prevalence of high levels of fasting glucose, low levels of high density lipoprotein-cholesterol, high triglyceride levels, high waist circumference and high blood pressure were shown to be 29.37%, 70.62%, 35.62%, 75% and 26.25%, respectively. It was shown that high waist circumference (75%) and Low HDL-cholesterol levels (70.62%) were the most frequent characteristics in comparison to other metabolic components. The prevalence of high waist circumference, high triglyceride levels, high levels of fasting glucose, high blood pressure and BMIs which were ≥25 were higher in subjects with metabolic syndrome (92.85%, 73.21%, 73.21%, 57.14% and 83.92%, respectively).

CONCLUSION

Metabolic syndrome is more prevalent among Turkmen women. Our data has shown that the prevalence of abnormal waist circumference in this ethnic group was highest. The waist circumference can be used as a predictor for cardiovascular disease and coronary heart disease.

Design and preliminary results of a metropolitan lifestyle intervention program for people with metabolic syndrome in South Korea

INTRODUCTION

The Seoul Metabolic Syndrome Management (SMESY) project, a metropolitan lifestyle intervention program aimed at decreasing the risk of metabolic syndrome to the residents of the city, has recently been implemented in 2011.

METHODS

Our target population consisted of residents of Seoul who were 30-64 years old. Subjects visiting a Public Health Center were screened for five risk factors for metabolic syndrome and then divided into three groups according to the number of the risk factors: active counseling, for having more than three risk factors; motivational guide, for having one or two; and information support for having none. Members of the active counseling group, the main target of the project, were provided with monthly in-person counseling on health-related lifestyle choices, as well as a follow-up examination every 3 months during the 12-month program.

RESULTS

In the active counseling group, subjects showed statistically significant improvements in all five risk factors and the average number of retained risk factors decreased from 3.5 to 2.7. However, the percentage of active counseling group members who attended at least 3 out of the 4 sessions provided was only 11.3%. As for the motivational guide group and the information support group, clinically significant improvements were not observed and the percentage of members who attended all sessions were 10.4% and 11.8%, respectively.

CONCLUSIONS

Increased public participation for the ongoing project is expected to lead to great positive changes in the health of people with metabolic syndrome.

Metabolic syndrome, adiponectin, and cardiovascular risk in Spain (the Segovia study): impact of consensus societies criteria

BACKGROUND

We aimed to investigate the prevalence of metabolic syndrome in rural and urban areas in the province of Segovia, Spain, and its relationship to lifestyle habits, cardiovascular risk, and serum adiponectin concentrations.

METHODS

The study had a cross-sectional design and included 888 individual residents in the province of Segovia, Autonomous Community of Castilla-León.

RESULTS

The age/sex standardized prevalence of the metabolic syndrome was by: (1) American Heart Association/National Heart Lung and Blood Institute criteria (AHA/NHLBI), 17%; (2) International Diabetes Federation (IDF), 24.3%; and (3) Consensus Societies/Joint Interim Statement (CS), 27.8%. A high correlation was found between the different criteria. No formal education [odds ratio (OR) 6.9 (2.4-20.2)] and primary education [6.7 (2.8-15.9)] were independently associated with metabolic syndrome. An inverse association with metabolic syndrome was found for subjects doing a high level of exercise during work [0.4 (0.2-0.7)] as well as those who were mild drinkers [alcohol intake of less than 15 grams/daily, 0.4 (0.3-0.8)]. Among subjects with low estimated cardiovascular risk, adiponectin levels are higher in those who do not meet criteria of metabolic syndrome. A total of 29.7% of subjects meeting CS criteria had >20% 10-year predicted risk of cardiovascular disease (CVD) by the Framingham risk score criteria [4.5 (2.4-8.5)].

CONCLUSIONS

Our results show: (1) A higher estimated prevalence of metabolic syndrome according to IDF and CS criteria. (2) Low educational level was independently associated with metabolic syndrome. A high level of physical activity and a daily alcohol intake of less than 15 grams/day were inversely associated with metabolic syndrome. (3) Metabolic syndrome increases the predicted CVD risk. (4) Adiponectin levels are not inversely related to insulin resistance in subjects with high cardiovascular risk and metabolic syndrome.

A Comparison between Revised NCEP ATP III and IDF Definitions in Diagnosing Metabolic Syndrome in an Urban Sri Lankan Population: The Ragama Health Study

Background. The prevalence of metabolic syndrome (MetS) within individual cohorts varies with the definition used. The aim of this study was to compare the prevalence of MetS between IDF and revised NCEP ATP III criteria in an urban Sri Lankan population and to investigate the characteristics of discrepant cases. Methods. 2985 individuals, aged 35-65 years, were recruited to the study. Anthropometric and blood pressure measurements and laboratory investigations were carried out following standard protocols. Results. Age and sex-adjusted prevalences of MetS were 46.1% and 38.9% by revised NCEP and IDF definitions, respectively. IDF criteria failed to identify 21% of men and 7% of women identified by the revised NCEP criteria. The discrepant group had more adverse metabolic profiles despite having a lower waist circumference than those diagnosed by both criteria. Conclusion. MetS is common in this urban Sri Lankan cohort regardless of the definition used. The revised NCEP definition was more appropriate in identifying the metabolically abnormal but nonobese individuals, especially among the males predisposed to type 2 diabetes or cardiovascular disease. Further research is needed to determine the suitability of the currently accepted Asian-specific cut-offs for waist circumference in Sri Lankan adults.

Cardio-metabolic features of type 2 diabetes subjects discordant in the diagnosis of metabolic syndrome

BACKGROUND

The aim of this study is to investigate the cardio-metabolic parameters and surrogate markers of insulin resistance in a discordant group of type 2 diabetes (T2DM) subjects who satisfy the Adults Treatment Panel (ATP) III criteria, but not the International Diabetes Federation (IDF) criteria, for metabolic syndrome (MetS).

METHODS

We assessed the prevalence of MetS in T2DM subjects (n=167) who were selected from subjects registered at the diabetes center of Dong-A University Medical Center. We used the ATP III criteria and the IDF criteria for the diagnosis of MetS and sorted the subjects into 2 MetS groups: one group diagnosed per ATP III criteria (MetSa) and one diagnosed per IDF criteria (MetSi). We then compared the clinical characteristics, metabolic parameters (homeostasis model assessment of insulin resistance, aspartate aminotransferase, alanine aminotransferase, and uric acid values) and co-morbidities (prevalence of microalbuminuria, fatty liver, and cardiovascular disease) between the MetSa, MetSi, and discordant MetS groups.

RESULTS

The prevalence of MetS in the MetSa group (73.6%) was higher than in the MetSi group (62.2%). The MetS prevalence in the discordant group was 11.4%. The discordant group showed no significant differences in clinical characteristics (except waist circumference and body mass index), metabolic parameters, or prevalence of co-morbidities, as compared with subjects with MetS by both criteria.

CONCLUSION

In this study, cardio-metabolic features of the subjects diagnosed with MetS using ATP III criteria, but not IDF criteria, are not significantly different from those of subjects diagnosed with MetS using both criteria.

Sociodemographic disparities in the composition of metabolic syndrome components among adults in South Korea

OBJECTIVE Metabolic syndrome (MetS) is becoming a serious public health concern in many countries, including South Korea, which has faced remarkable changes in lifestyles and disease patterns in recent decades. We examined sex and socioeconomic status (SES) disparities in MetS and its components among South Koreans using recent, nationally representative data. RESEARCH DESIGN AND METHODS Data from the 2007-2008 Korea National Health and Nutrition Examination Surveys for 7,289 adults 19-65 years of age were used to examine the patterns of MetS components (defined using International Diabetes Federation criteria), and regression models were used to study the association of MetS with SES, indicated by education and family income levels. RESULTS MetS prevalence increased with age, from 4.6% at age 19-29 years to 25.0% at age 50-65 years. More men had MetS than women (15.8 vs. 11.6%); men had worse levels of all MetS components. In women, the low-income and low-education group was more likely to have MetS (odds ratio 2.75 [95% CI 1.75-4.31]); the high-income and high-education group was 52% less likely to have MetS (0.48 [0.25-0.89]) compared with the middle-income and middle-education group. The most common combination of MetS components was central obesity + low HDL cholesterol (HDL-C) + hypertriglyceridemia, which occurred in 15.5% of all MetS patients and in 3.4% of all South Korean adults (4.1% in men and 2.9% in women). CONCLUSIONS Those who were older and male as well as low-SES female had higher rates of MetS and its components in South Korea. The SES-MetS association was not found in men. Central obesity + low HDL-C + hypertriglyceridemia was the most common MetS pattern regardless of the SES.

Linkage of epidemiologic evidence with the clinical aspects of metabolic syndrome

Metabolic syndrome (MetS) is characterized by a cluster of cardiovascular risk factors, such as hypertension, glucose intolerance, high triglycerides, and a low high density lipoprotein-cholesterol level. MetS is known to be associated with cardiovascular diseases. In order to diagnose MetS, definitions such as National Cholesterol Education Program Adult Treatment Panel III, American Heart Association/National Heart Lung and Blood Institute, International Diabetes Federation, World Health Organization, European Group for the Study of Insulin Resistance and American College of Endocrinology are widely used. However, using different criteria may lead to confusion regarding the diagnosis and treatment of patients with MetS in the primary care setting. Our objected was to review 3 aspects concerning MetS using the Metabolic Syndrome Research Initiatives study of 123892 healthy Koreans (1994-2001) that had a maximum follow-up of 12 years. The 3 aspects were reviewed by determination of the association of MetS with the development of atherosclerotic cardiovascular disease (ASCVD) and ischemic heart disease (IHD). Based on our findings, each metabolic factor associated with MetS was not weighted equally. The hazard ratio (HR) was higher in individuals with higher glucose compared with the HR in individuals with higher body mass index. Individuals with pre-MetS (having 1 or 2 metabolic factors) had 1.5-2.3 fold higher risk of developing ASCVD and IHD in both genders. In the presence of MetS, both singly and in combination, precede the development of ASCVD and IHD and individuals with pre-MetS must not be ignored as there is no apparent threshold in defining MetS. Furthermore, MetS may complement the Framingham Risk Score and can be used as the first line approach to treat the ASCVD or IHD.

Prevalence and determinants of metabolic syndrome among women in Chinese rural areas

Background and Aims

Metabolic syndrome (MS) is prevalent in recent years but few data is reported in the rural areas in China. The aim of this study was to examine MS prevalence and its risk factors among women in rural China.

Methods and Results

The Nantong Metabolic Syndrome Study (NMSS), a population based cross-sectional study, was conducted during 2007–2008 in Nantong, China. In person interviews, blood glucose and lipid measurements were completed for 13,505 female participants aged 18–74 years. The International Diabetes Federation (IDF), the US Third Report of the National Cholesterol Education Program, the Adult Treatment Panel (ATPIII) and modified ATPIII for Asian population has determined three criteria of MS. These criteria for MS were used and compared in this study. The prevalence of MS was 22.0%, 16.9% and 23.3% according to IDF, ATPIII and ATPIII-modified criteria, respectively. Levels of agreement of these criteria for MS were above 0.75. We found that vigorous-intensity of occupational physical activity was associated with a low prevalence of MS with OR of 0.76 (95% confidence interval (CI): 0.63–0.91). Rice wine drinkers (alcohol >12.8 g/day) had about 34% low risks of developing MS with OR of 0.66 (95% CI: 0.48–0.91), compared with non-drinkers. Odds ratio of MS was 1.81 (95% CI: 1.15–2.84) in women who smoked more than 20 pack-years, compared to non-smokers. Odds ratio of MS was 1.56 (95% CI: 1.25–1.95) in women who had familial history of diseases, including hypertension, diabetes and stroke, compared to women without familial history of those diseases.

Conclusion

MS is highly prevalent among women in rural China. Both physical activity and rice wine consumption play a protective role, while family history and smoking are risk factors in MS development. Educational programs should be established for promoting healthy lifestyles and appropriate interventions in rural China.

Central obesity is important but not essential component of the metabolic syndrome for predicting diabetes mellitus in a hypertensive family-based cohort. Results from the Stanford Asia-pacific program for hypertension and insulin resistance (SAPPHIRe) Taiwan follow-up study

Background

Metabolic abnormalities have a cumulative effect on development of diabetes, but only central obesity has been defined as the essential criterion of metabolic syndrome (MetS) by the International Diabetes Federation. We hypothesized that central obesity contributes to a higher risk of new-onset diabetes than other metabolic abnormalities in the hypertensive families.

Methods

Non-diabetic Chinese were enrolled and MetS components were assessed to establish baseline data in a hypertensive family-based cohort study. Based on medical records and glucose tolerance test (OGTT), the cumulative incidence of diabetes was analyzed in this five-year study by Cox regression models. Contribution of central obesity to development of new-onset diabetes was assessed in subjects with the same number of positive MetS components.

Results

Among the total of 595 subjects who completed the assessment, 125 (21.0%) developed diabetes. Incidence of diabetes increased in direct proportion to the number of positive MetS components (P ≪ 0.001). Although subjects with central obesity had a higher incidence of diabetes than those without (55.7 vs. 30.0 events/1000 person-years, P ≪ 0.001), the difference became non-significant after adjusting of the number of positive MetS components (hazard ratio = 0.72, 95%CI: 0.45-1.13). Furthermore, in all participants with three positive MetS components, there was no difference in the incidence of diabetes between subjects with and without central obesity (hazard ratio = 1.04, 95%CI: 0.50-2.16).

Conclusion

In Chinese hypertensive families, the incidence of diabetes in subjects without central obesity was similar to that in subjects with central obesity when they also had the same number of positive MetS components. We suggest that central obesity is very important, but not the essential component of the metabolic syndrome for predicting of new-onset diabetes. (Trial registration: NCT00260910, ClinicalTrials.gov).

Prevalence of the metabolic syndrome in patients with carotid disease according to NHLBI/AHA and IDF criteria: a cross-sectional study

Background

Metabolic syndrome (MetS) has been related to type 2 diabetes and cardiovascular diseases. Different criteria for diagnosis of MetS have been recommended, but there is no agreement about which criteria are best to use. The aim of the present study was to investigate agreement between the National Heart, Lung, and Blood Institute, American Heart Association (NHLBI/AHA) and the International Diabetes Federation (IDF) definitions of MetS in patients with symptomatic carotid disease and to compare the frequency of cardiovascular risk factor in patients with MetS diagnosed by these two sets of criteria.

Methods

The study was a cross-sectional one involving 644 consecutive patients with verified carotid disease who referred to the Vascular Surgery Clinic Dedinje in Belgrade during the period April 2006 - November 2007. Anthropometric parameters blood pressure, fasting plasma glucose and lipoproteins were measured using standard procedures.

Results

MetS was present in 67.9% of participants, according to IDF criteria, and in 64.9% of participants, according to the NHLBI/AHA criteria. A total of 119 patients were categorized differently by the two definitions. Out of all participants 10.7% had MetS by IDF criteria only and 7.8% of patients had MetS by NHLBI/AHA criteria only. The overall agreement of IDF and NHLBI/AHA criteria was 81.5% (Kappa 0.59, p < 0.001). In comparison with patients who met only IDF criteria, patients who met only NHLBI/AHA criteria had significantly more frequently cardiovascular risk factors with the exception of obesity which was significantly more frequent in patients with MetS diagnosed by IDF criteria.

Conclusion

The MetS prevalence in patients with symptomatic carotid disease was high regardless of criteria used for its diagnosis. Since some patients with known cardiovascular risk factors were lost by the use of IDF criteria it seems that NHLBI/AHA definition is more suitable for diagnosis of MetS. Large follow-up studies are needed to test prognostic value of these definitions.

Serum ferritin level is associated with the prevalence of metabolic syndrome in Korean adults: the 2007-2008 Korean National Health and Nutrition Examination Survey

BACKGROUND

Increased ferritin concentrations, which reflect body iron stores, contribute to insulin dysfunction and metabolic syndrome (MetS).

METHODS

This cross-sectional study included 7346 subjects (3229 men and 4117 women) who participated in the 2007-2008 Korean National Health and Nutrition Examination Survey (KNHANES). We adopted the modified Asian criteria for MetS from the American Heart Association/National Heart, Lung, and Blood Institute.

RESULTS

In comparison with participants in the first serum ferritin quartile, the odds ratio (95% confidence interval) for MetS for participants in the fourth serum ferritin quartile was 1.67 (1.24-2.23) in men and 1.41 (1.06-1.88) in women after adjusting for multiple covariates (including menopausal status in women) except insulin resistance. This association was attenuated, however, after additionally adjusting for insulin resistance [1.46 (1.08-1.98) in men and 1.22 (0.91-1.65) in women]. In particular, higher serum ferritin concentrations were associated with increased triglyceride concentrations in men and glucose intolerance in women.

CONCLUSIONS

Increased serum ferritin level was positively associated with the prevalence of MetS and with some diagnostic components of MetS, i.e., we found that increased serum ferritin concentrations were associated with high triglyceride and glucose concentrations in men and women, respectively.

Obesity and metabolic syndrome in Korea

In Korea, a person with a body mass index (BMI) ≥25 kg/m(2) is considered obese, and a person with a BMI ≥30 kg/m(2) is classified as severely obese. Central obesity is defined as a waist circumference ≥90 cm for Korean men and ≥85 cm for Korean women. Recent epidemiologic data show that the prevalence of severe obesity and metabolic syndrome is steadily increasing. These epidemics increased morbidity and mortality of type 2 diabetes, cardiovascular diseases, and obesity-related cancers such as breast, colorectal, and other cancers in Korea. Decreased physical activity, increased fat and alcohol consumption, heavy smoking, and stress/depressed mood are the primary modifiable life-style risk factors for Koreans. Recently, public health interventions to encourage life-style changes have shown promising results in reducing the prevalence of severe obesity and metabolic syndrome.

The metabolic syndrome--from insulin resistance to obesity and diabetes

In today's society with the escalating levels of obesity, diabetes, and cardiovascular disease, the metabolic syndrome is receiving considerable attention and is the subject of much controversy. Greater insight into the mechanism(s) behind the syndrome may improve our understanding of how to prevent and best manage this complex condition.

A Japanese health success story: trends in cardiovascular diseases, their risk factors, and the contribution of public health and personalized approaches

There has been a substantial decline in mortality from stroke and ischemic heart disease (IHD) in Japan between the 1960s and 2000s, which contributed to placing Japanese at the top of world’s life expectancy rankings. That mortality decline was attributable to reductions of blood pressure and smoking, in spite of increases in dyslipidemia and diabetes mellitus. The combination of public health and personalized treatment activities to enhance sodium reduction, balanced diets, smoking prevention/cessation as well as hypertension detection and treatment have contributed to the reduction of cardiovascular diseases, demonstrated by a community-based stroke prevention program. The health success story, however, contains an underlying concern about future health threats, the plateaued IHD mortality decline and increased IHD incidence among urban middle-aged men, probably due to increased dyslipidemia and diabetes. The IHD incidence and mortality trends need to be monitored because of a potential future problem for predictive, preventive and personalized medicine.

Risk stratification based on metabolic syndrome as well as non- metabolic risk factors in the assessment of carotid atherosclerosis

AIM

We aimed to develop a new approach to risk stratification using metabolic syndrome as well as traditional non-metabolic risk factors, and to examine its validity in carotid atherosclerosis.

METHODS

A total of 1,189 men and women aged 21-93 years old were stratified according to the absence or presence of metabolic syndrome defined by Japanese criteria, non-metabolic risk factors, and a past history of coronary heart disease. The risk stratification was as follows: (S-1) persons without a past history, non-metabolic risk factors and metabolic syndrome, (S-2a) those with metabolic syndrome only, (S-2b) those with non-metabolic risk factors only, (S-3) those with non-metabolic risk factors and metabolic syndrome but no past history, and (S-4) those with a past history. Carotid atherosclerosis was defined as maximum intima-media thickness ≥1.1 mm of the far wall of the common carotid artery.

RESULTS

Compared with individuals without these three risk components (S-1), the odds ratio was 7.2 (2.8-18.6) for a past history (S-4), 4.3 (1.7-10.9) for non-metabolic risk factors plus metabolic syndrome but no past history (S-3), 2.6 (1.1-6.4) for non-metabolic risk factors only (S-2b) and 0.5 (0.0-5.7) for metabolic syndrome only (S-2a). Net reclassification improvement from metabolic syndrome only (presence versus absence) to our risk stratification (≥S-3 versus < S-3) was 16.4% (p< 0.0001), suggesting that our risk stratification improved the classification of atherosclerosis in comparison to metabolic syndrome only.

CONCLUSION

Risk stratification based on traditional non-metabolic risk factors plus metabolic syndrome rather than metabolic syndrome only appears to be more useful for the clinical assessment of atherosclerosis, and probably in the prevention and control of atherosclerotic disease.

A revised definition of the metabolic syndrome predicts coronary artery disease and ischemic stroke after adjusting for low density lipoprotein cholesterol in a 13-year cohort study of Japanese: the Suita study

OBJECTIVE

Recently, several major organizations have proposed a unified definition for the metabolic syndrome (MetS), which should be evaluated in multiethnic groups. The effect of Mets on the incidence of cardiovascular disease needs to be assessed after adjusting for serum low density lipoprotein cholesterol (LDLC), a major risk factor for atherosclerotic diseases. This is especially needed to be evaluated in Asian populations with low incidence of coronary artery disease (CAD).

METHODS

We conducted a 13-year prospective study of 4939 Japanese living in an urban area. The MetS was defined using a unified classification that included cut-off points for waist circumference in Asians. The multivariable adjusted hazard ratios (HRs) of MetS for CAD and stroke were calculated using a Cox proportional model adjusted for other potential confounding factors with LDLC.

RESULTS AND CONCLUSION

During the follow-up period, there were 155 cases of CAD and 204 of stroke including 118 cerebral infarctions. In participants under 65 years old, the multivariable HRs of MetS for CAD were 1.21 (95% C.I., 0.64-2.28) in men and 4.44 (95% C.I., 1.73-11.4) in women; the HRs for ischemic stroke were 3.24 (95% C.I., 1.55-6.77) in men and 3.99 (95% C.I., 1.34-11.8) in women. In participants aged 65 years old and over, MetS only showed a significant association with CAD in men (HR 1.89, 95% C.I., 1.11-3.21). Serum LDLC was associated with increased risk of CAD in men irrespective of age group; however, it was not associated with CAD in women. There was no association between serum LDLC and ischemic stroke in any group stratified by sex and the age of 65. These results indicate that the new uniform MetS definition is useful for detecting high risk individuals, especially for middle-aged population. However, continuous screening for hypercholesterolemia is necessary to prevent CAD, especially in men, even in Asian countries such as Japan.

Gender and age-related differences in patients with the metabolic syndrome in a highly endogamous population

The objective of the study was to examine the differences in gender and age prevalences of metabolic syndrome (MetS) among adult Qatari population according to the revised criteria of NCEP ATP III and IDF, assess which component contributed to the higher prevalence of the MetS and identify the characteristics of the subjects with MetS. The study was designed as a cross-sectional study. The survey was carried out in urban and semi-urban primary health care centers. The survey was conducted in the period from January 2007 to July 2008 among Qatari nationals above 20 years of age. Of the 1536 subjects who were approached to participate in the study, 1222 (79.6%) gave their consent. Face to face interviews were conducted using a structured questionnaire followed by laboratory tests. MetS was defined using the National Cholesterol Education Program - Third Adult Treatment Panel (ATP III) as well as the International Diabetes Federation (IDF). The overall prevalence of MetS in studied subjects was 26.7% and 33.9% according to ATPIII and IDF (p<0.001) criteria respectively. The prevalence of MetS by both definitions peaked in the 30-39 years age group among males, and the 40-49 years age group among females. The greatest number of males with MetS were university educated; while the greatest number of females with MetS were either illiterate or had a primary school education. The prevalence of MetS was higher among females. Among the components of MetS, the prevalence of central obesity was significantly higher in studied subjects. The overall prevalence of MetS and its components according to IDF criteria was higher in studied subjects than the estimates given by the ATPIII criteria. Overall, the prevalence of the metabolic syndrome in the State of Qatar is about 10-15% higher than in most developed countries, with generally higher prevalence rates for women. Preventive strategies will require identifying socio-demographic factors and addressing modifiable risk behaviours, including lack of physical activity, and dietary intake.

Ionizing radiation-induced diseases in Korea

Radiation risk has become well known through epidemiological studies of clinically or occupationally exposed populations, animal experiments, and in vitro studies; however, the study of radiation related or induced disease has been limited in Korea. This study is to find the level of occupational radiation exposure for various kinds of accidents, compensated occupational diseases, related studies, and estimations on future occupational disease risks. Research data of related institutions were additionally investigated. About 67% of 62,553 radiation workers had no exposure or less than 1.2 mSv per year. The 5 reported cases on radiation accident patients in Korea occurred during nondestructive testing. According to the recent rapid increase in the number of workers exposed to radiation, a higher social recognition of cancer, and an increasing cancer mortality rate, it is expected that occupational disease compensation will rapidly increase as well. Therefore, it is important to develop scientific and objective decision methods, such as probability of causation and screening dose in the establishment of an exposure and health surveillance system.

The modified NCEP ATP III criteria maybe better than the IDF criteria in diagnosing Metabolic Syndrome among Malays in Kuala Lumpur

BACKGROUND

Metabolic Syndrome is associated with increased risk for type 2 diabetes and cardiovascular diseases. However, different diagnostic criteria have been recommended by different expert groups. In Malaysia, there is a lack of research comparing these different diagnostic criteria. Therefore, it is our aim to study the concordance between the IDF and the modified NCEP ATP III definitions of Metabolic Syndrome among a Malay cohort in Kuala Lumpur; and to demonstrate if all participants have the same cardiometabolic risks.

METHODS

This was an analytical cross sectional study. Ethics approval was obtained and informed consent was given by all participants. Anthropometric measurements, blood pressure, fasting blood glucose and lipid profile were taken following standard protocols.

RESULTS

Metabolic Syndrome was diagnosed in 41.4% and 38.2% participants using the modified NCEP and IDF criteria respectively. Among those diagnosed with Metabolic Syndrome by modified NCEP, 7.6% were missed by the IDF criteria. Participants diagnosed by the modified NCEP criteria had lower BMI and waist circumference but had higher cardiometabolic risks than those diagnosed with both criteria. Their blood pressure, glucose, total cholesterol and triglyceride were more adverse than the IDF group. This demonstrated that central obesity may not be a prerequisite for the development of increased cardiometabolic risks within this Malay cohort.

CONCLUSION

Metabolic syndrome is common in this Malay cohort regardless of the criterion used. The modified NCEP ATP III criteria may be more suitable in diagnosis of metabolic syndrome for this Malay cohort.

Prevalence and clinical characteristics of metabolic syndrome for at-risk people in a rural community

BACKGROUND

Substantial socioeconomic and demographic changes have resulted in an increase in the incidence of metabolic syndrome in Korea, especially in aged, postmenopausal women and in rural populations. As rural populations age, metabolic syndrome is expected to be a significant health problem. The purpose of this study was to determine the prevalence and clinical characteristics of metabolic syndrome for an at-risk population in a rural community health-care center.

METHODS

Data were collected from 136 people who were defined as being at risk for metabolic syndrome by being over 40 years of age and being treated for hypertension, diabetes mellitus, dyslipidemia, or central obesity at a rural community health-care center in Korea. Prevalence and clinical characteristics were evaluated by the diagnostic guidelines of National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) and World Health Organization Asia-Pacific (WHO-AP).

RESULTS

The prevalence of metabolic syndrome among this group was 64.7% and 74.3% according to the NCEP-ATP III and WHO-AP criteria, respectively. The prevalence of metabolic syndrome increased with age and was higher in women. Of the five risk factors, fasting blood sugar and central obesity in women were the most prevalent (81.6%), followed by systolic hypertension (80.1%).

CONCLUSION

The prevalence of metabolic syndrome for at-risk people was high in the rural Korean health-care center used in this study. Population-wide management strategies are apparently needed.

Prevalence and determinants of metabolic syndrome according to three definitions in middle-aged Chinese men

BACKGROUND

The prevalence of metabolic syndrome has varied markedly between different studies because of the lack of internationally agreed-upon criteria to define the condition. We estimated the prevalence and lifestyle risk factors of metabolic syndrome according to three definitions of metabolic syndrome in urban Chinese men participating in the Shanghai Men's Health Study (SMHS).

METHODS

In this cross-sectional study, 3988 middle-aged, urban Chinese men 40-74 years of age who were free of type 2 diabetes at baseline provided fasting blood samples, anthropometric measurements, and information on lifestyle factors and disease history.

RESULTS

The three definitions of metabolic syndrome used in this report are from the International Diabetes Federation (IDF), the U.S. Third Report of the National Cholesterol Education Program, Adult Treatment Panel (ATP III), and a modified version of the ATP III criteria for Asian populations (ATP III-modified criteria). The prevalence of metabolic syndrome was 18.63%, 18.36%, and 29.34% according to IDF, ATP III, and ATP III-modified criteria, respectively. Agreement between the IDF and ATP III criteria was moderate (kappa = 0.43), whereas agreement between ATP III-modified and the IDF and ATP III criteria was good (kappa = 0.71 and 0.70, respectively). Physical activity was associated with a lower prevalence of metabolic syndrome, whereas drinking more than three drinks per day was associated with a higher risk of metabolic syndrome, regardless of the criteria employed. The association between smoking and the prevalence of metabolic syndrome in this population failed to reach significance.

CONCLUSIONS

Results from this representative sample of middle-aged, urban Chinese men show that metabolic syndrome is highly prevalent in this population. Our data support the hypothesis that physical activity decreases the risk of developing metabolic syndrome and that high alcohol consumption increases risk.

The effects of hormone therapy on metabolic risk factors in postmenopausal Korean women

OBJECTIVE

We sought to assess the prevalence of metabolic syndrome (MetS) among Korean postmenopausal women and to investigate the effect of hormone therapy status and reproductive characteristics on body composition and MetS risk factors.

STUDY DESIGN

We performed a cross-sectional study involving a cohort of 2005 postmenopausal Korean women. We defined MetS using the modified National Cholesterol Education Program (NCEP) criteria proposed by the American Heart Association/National Heart, Lung, and Blood Institute guidelines. The criteria for abdominal obesity were adopted from the cut-offs suggested by the Korean Society for the Study of Obesity. Participants with three or more of the following conditions were classified as having MetS: waist circumference ≥ 85 cm; blood pressure ≥ 130/85 mmHg; fasting plasma triglycerides ≥ 150 mg/dl; high density lipoprotein cholesterol < 50 mg/dl; glucose ≥ 100 mg/dl and/or receiving treatment for their condition.

RESULTS

The prevalence of MetS was 22.1% in the study population and increased with age. After adjusting for age and related reproductive characteristics, it was found that ever-use of hormone therapy (prior or current) was associated with decreased risk of postmenopausal MetS. Among individual risk factors for MetS, current hormone therapy seemed to be associated with decreased prevalence of abdominal obesity and better glucose metabolism and prior use of hormone therapy were associated with lower risk of abdominal obesity and high blood pressure.

CONCLUSION

Postmenopausal hormone therapy is associated with decreased risk of MetS in postmenopausal Korean women.

Effects of a 6-month lifestyle modification intervention on the cardiometabolic risk factors and health-related qualities of life in women with metabolic syndrome

Although therapeutic lifestyle modification (TLM) has been recommended as a cornerstone treatment of metabolic syndrome (MetS), little is known about the biobehavioral effects of a TLM program for patients in a community. The purpose of this study was to examine the effects of a 6-month TLM program on MetS risk factors and health-related qualities of life (HRQOL) among middle-aged and older women in a community in Korea. Fifty-two women (mean age, 62.7 +/- 9.0 years) with MetS were recruited from 3 community health centers and were randomly assigned to the intervention (n = 31) or control (n = 21) groups. The patients in the intervention group participated in supervised TLM sessions for 6 months. The TLM program included health monitoring, counseling, health education, exercise, and dieting. Metabolic risk factors and HRQOL were measured at baseline, during the study (month 3), at completion (month 6), and post completion (month 12) of the TLM program. Compared with the control group, the TLM group showed significantly greater reductions in body weight (P < .001) and waist circumference (P < .001); these effects were sustained for 6 months after intervention. With regard to HRQOL, the TLM group showed greater improvements in physical function (P = .017), general health (P < .001), vitality (P = .008), and mental health (P = .027). These improvements, however, were not sustained after the intervention. The results indicate that a nurse-led systematic TLM program may be an effective strategy for managing middle-aged and older women with MetS at a community level.

Metabolic risk profiles and associated risk factors among Vietnamese adults in Ho Chi Minh City

BACKGROUND

A clustering of metabolic risk factors increases the likelihood of cardiovascular diseases. This study reports the metabolic risk profiles and the prevalence of metabolic risk factors and associated factors among Vietnamese adults in Ho Chi Minh City.

METHODS

A cross-sectional study was carried out in a representative sample of adults aged 25-64 years in Ho Chi Minh City in 2005. Metabolic risk factors, including central obesity, elevated fasting glucose, elevated total cholesterol, and raised blood pressure, were collected to estimate their prevalence and association with socioeconomic and health-related behavioral risk factors. Multivariate logistic models were performed to examine the associations between socioeconomic and behavioral risk factors and the odds of having metabolic risk factors.

RESULTS

The prevalence of individual risk components was: 28.9% high blood pressure, 18.3% central obesity, 16.8% high total cholesterol, and 6.4% high fasting glucose. There were significant gender differences in central obesity and high blood pressure. The prevalence of metabolic risk cluster (two or more risk factors) was 17.0% in men and 17.6% in women. The metabolic risk cluster appeared earlier in men, but women showed higher rates at older ages. Increasing age and household wealth were associated with the metabolic risk cluster across both genders, but additional risk factors in men were smoking in the past and in women education level and sitting and reclining time.

CONCLUSIONS

Strategies to prevent metabolic risk factors through the prevention of abdominal obesity must be established for young adults and should include promoting physical activity, healthy eating, and preventing alcohol abuse and tobacco use.

Prevalence and trends of metabolic syndrome among Korean adolescents: from the Korean NHANES survey, 1998-2005

OBJECTIVES

To evaluate the prevalence and trend of metabolic syndrome (MetS) among Korean adolescents.

STUDY DESIGN

Data from 1998, 2001, and 2005 Korean National Health and Nutrition Examination Surveys were analyzed (N = 4164; age, 10 to 19 years) for MetS prevalence using the modified International Diabetes Federation criteria.

RESULTS

The combined prevalence of MetS in Korean adolescents was 2.2% in 1998, 3.6% in 2001, and 1.8% in 2005. MetS in Korean boys increased from 1.4% in 1998 to 5.3% in 2001 but decreased to 2.0% in 2005. The prevalence of MetS in girls decreased over the study periods (3.0% in 1998, 1.9% in 2001, and 1.6% in 2005). MetS prevalence declined from 1998 to 2005 despite an increase in overweight or obese individuals among both sexes (1998: boys, 15.1%; girls, 17.8%; 2005: boys, 26.8%; girls, 21.7%). Among individual MetS components, hyperglycemia decreased dramatically in 2005 in both sexes and accounted for the majority of the decline in the prevalence of the MetS in Korean adolescents.

CONCLUSIONS

The prevalence of MetS has declined despite an increase in obesity in Korean youth. Recent changes in physical activity in addition to national health care initiatives in Korea may have had a positive impact on the prevalence of MetS.

Optimal cutoff points of waist circumference for the criteria of abdominal obesity: comparison with the criteria of the International Diabetes Federation

BACKGROUND

There are few studies that compare measures of diagnostic accuracy for selected waist cutoff points and the criteria of abdominal obesity given by the International Diabetes Federation (IDF) and the National Cholesterol Education Program (NCEP).

METHODS AND RESULTS

The present study utilized data from the Third Korean National Health and Nutrition Examination Survey. Analyses for receiver-operating characteristic (ROC) curve were performed with data for 4,677 men and women aged 20-80 years who reported being free of a physician-diagnosed cardiovascular disease or cancer. On the basis of measures of diagnostic accuracy, including minimum distance to ROC curve and Youden index, waist circumference of 84-86 cm for men and of 78-80 cm for women were found to be optimal cutoff points. The study also demonstrated that the use of smaller waist circumference for diagnosis of the metabolic syndrome decreases discrepancies between the prevalence of the IDF-defined metabolic syndrome and that of the NCEP-defined metabolic syndrome.

CONCLUSIONS

Waist circumference of 90 cm, the cutoff point given by the IDF for Asian men, may not be an appropriate value for Korean men, while its cutoff point for Asian women is appropriate for Korean women.

Prevalence of metabolic syndrome according to Adult Treatment Panel III and International Diabetes Federation criteria: a population-based study

OBJECTIVE

The objective of the study was to examine the prevalence of metabolic syndrome among adult Qatari population according to the revised criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) and the International Diabetes Federation (IDF), assess which component contributed to the increased risk of the metabolic syndrome, and identify the characteristics of the subjects with metabolic syndrome.

DESIGN

This was a cross-sectional study.

SETTING

The survey was carried out in urban and semiurban primary health-care centers.

SUBJECTS AND METHODS

The survey was conducted from January, 2007, to July, 2008, among Qatari nationals above 20 years of age. Of the 1496 subjects who were approached to participate in the study, 1204 (80.5%) gave their consent. Face-to-face interviews were conducted using a structured questionnaire followed by laboratory tests. Metabolic syndrome was defined using the NCEP ATP III as well as IDF criteria.

RESULTS

The overall prevalence of metabolic syndrome in studied subjects was 26.5% and 33.7% according to ATP III and IDF criteria (P < 0.001). The prevalence of metabolic syndrome by ATP III and IDF increased with age and body mass index (BMI), whereas it decreased with higher education and physical activity. Also, the prevalence of metabolic syndrome was more common in women. Among the components of metabolic syndrome, central obesity was significantly higher in the studied subjects. The IDF definition of metabolic syndrome gave a higher prevalence in all age groups. The overall prevalence of metabolic syndrome and its components according to IDF criteria was higher in the studied subjects than the estimates given by the ATP III. Multivariate logistics regression analysis (ATP III and IDF) showed that age and BMI were significant contributors for metabolic syndrome. Both definitions strongly supported age and obesity as associated factors for metabolic syndrome.

CONCLUSIONS

The current study found a high prevalence of metabolic syndrome among Qataris. There was a steady increase in the prevalence of metabolic syndrome through the decades, independent of the definition. Age and BMI were important significant predictors for metabolic syndrome.

Associations between metabolic syndrome and mortality from cardiovascular disease in Japanese general population, findings on overweight and non-overweight individuals. Ibaraki Prefectural Health Study

BACKGROUND

The impact of being overweight, as a component of the metabolic syndrome (MetS), for cardiovascular disease (CVD) mortality was investigated and compared with the predictive value of MetS by 2 different definitions.

METHODS AND RESULTS

A 12-year prospective study of 30,774 Japanese men and 60,383 women aged 40-79 years was conducted. The multivariate hazard ratio (HR; 95% confidence interval) of total CVD mortality for overweight subjects with >or=2 additional risk factors with reference to subjects with 0 of 4 MetS components was 1.83 (1.41-2.38) for men and 1.90 (1.45-2.49) for women, and for non-overweight subjects with >or=2 additional risk factors 1.75 (1.38-2.24) and 1.97 (1.52-2.55), respectively. The proportion of excess CVD deaths in the latter group was 1.5-fold higher than that in the former group. Multivariate HRs of coronary heart disease and total CVD mortality for MetS by the modified criteria of the American Heart Association/National Heart, Lung, and Blood Institute were 1.62 (1.31-2.00) and 1.23 (1.09-1.39), respectively, for men and 1.32 (1.05-1.65) and 1.12 (1.00-1.25), respectively, for women. The respective HRs for MetS by the International Diabetic Federation definition did not reach statistical significance, except for coronary heart disease in men.

CONCLUSIONS

Non-overweight individuals with metabolic risk factors, as well as overweight individuals with such factors, should be targeted to reduce the CVD burden in the general population.