Urban, semi-urban and rural difference in the prevalence of metabolic syndrome in Shaanxi province, northwestern China: a population-based survey

Prevalence of metabolic syndrome and components in rural, semi-urban and urban areas in the littoral region in Cameroon: impact of physical activity

BACKGROUND

Living areas in developing countries impact seriously lifestyle by modifying energy consumption and energy expenditure. Thus, urbanization is associated with less practice of physical activity (PA), a leading cause of metabolic syndrome (MetS) which prevalence vary in African countries. The present study aimed to assess the effect of PA on MetS according to urbanization level in the littoral region, Cameroon.

METHODS

A cross-sectional study was conducted in three geographical settings (urban, semi-urban, and rural) in the littoral region in Cameroon. A total of 879 participants were included (urban: 372, semi-urban: 195 and rural: 312). MetS was defined according to the International Federation of Diabetes 2009. The level of PA was assessed using the Global Physical Activity questionnaire.

RESULTS

Low level of PA was (P < 0.0001) reported in urban (54.5%), semi-urban (28.7%) and rural (16.9%) and high level in rural area (77.9%). The prevalence of MetS was higher in urban areas (37.2%), then rural (36.8%) and finally semi-urban (25.9%). Hyperglycemia (p = 0.0110), low HDL-c (p < 0.0001) and high triglyceridemia (p = 0.0068) were most prevalent in urban residents. Participants with low level of PA were at risk of MetS (OR: 1.751, 95% CI 1.335-2.731, p = 0.001), hyperglycemia (OR: 1.909, 95% CI 1.335-2.731, p = 0.0004) abdominal obesity(OR: 2.007, 95% CI 1.389-2.900, p = 0.0002), low HDL-c (OR: 1.539, 95% CI 1.088-2.179, p = 0.014) and those with moderate level of PA were protected against high blood pressure(OR: 0.452, 95% CI 0.298-0.686, p = 0.0002) and compared to those with high level of PA. Urban dwellers were at the risk of MetS compared to rural residents (OR: 1.708, 95% CI. 1.277-2.285, p = 0.003) and protected against high blood pressure (OR:0.314, 95% CI 0.212-0.466, p < 0.0001), abdominal obesity (OR: 0.570, 95% CI 0.409-0.794, p = 0.0009), and low HDL-c (OR: 0.725, 95% CI 0.534-0.983, p = 0.038) compared to rural residents.

CONCLUSIONS

MetS was more prevalent in urban dwellers and was associated with a low level of PA.

The 6-Month Efficacy of an Intensive Lifestyle Modification Program on Type 2 Diabetes Risk Among Rural Women with Prior Gestational Diabetes Mellitus: a Cluster Randomized Controlled Trial

This study aimed to evaluate the efficacy of an intensive lifestyle modification program tailored to rural Chinese women with prior gestational diabetes mellitus compared with usual care. In a cluster randomized controlled trial, 16 towns (clusters) in two distinct rural areas in China were randomly selected (8 towns per district); and 320 women with prior gestational diabetes mellitus were recruited from these towns. With stratification for the two study districts, eight towns (160 women) were randomly assigned to the intervention group of a tailored intensive lifestyle modification program and 8 towns (160 women) to the control group. Process measures were collected on attendance, engagement, fidelity, and satisfaction. Primary efficacy outcomes included glycemic and weight-related outcomes, while secondary efficacy outcomes were behavioral outcomes and type 2 diabetes risk score, which were collected at baseline, 3-month, and 6-month follow-up. Generalized estimation equations were used to analyze the data. High attendance (72% of sessions), engagement (67% of interactive activities and group discussions), fidelity (98%), and satisfaction (92%) with the tailored intensive lifestyle modification program were achieved. There were significant reductions in fasting blood glucose, oral glucose tolerance test 2 h, waist circumference, and type 2 diabetes risk score of participants in the intervention group compared to the control group (p < .05). There was no significant intervention effect on body mass index or behavioral outcomes (p > .05). In this study, we demonstrate the successful efficacy of an Intensive Lifestyle Modification Program in reducing type 2 diabetes risk among younger women with prior gestational diabetes mellitus. This tailored program delivered by local healthcare providers is a promising approach for diabetes prevention in rural China, reducing health disparities in rural communities about diabetes prevention. Registered in the Chinese Clinical Trial Registry (ChiCTR2000037956) on 3rd Jan 2018.

Regional Differences in Metabolic Risk in the Elderly in Korea

Lifestyle and dietary differences in urban and rural environments have different impacts on elderly health. We aimed to evaluate the nutritional intakes and metabolic risks in the urban and rural elderly. We analyzed 3018 elderly individuals (1358 men, 1660 women) who were aged 65 years and older using the Korea National Health and Nutrition Examination Survey data (2013-2016). Anthropometric data, blood pressure, and blood profiles were collected using health examinations. Daily dietary intakes were analyzed by the 24-h dietary recall method. Rural elderly women had significantly higher triglycerides (TG) levels and lower high-density lipoprotein (HDL)-cholesterol levels than urban elderly women (p = 0.014, p = 0.005). The rural elderly had higher carbohydrate intake and percentage of carbohydrate energy intake and lower intakes of fat, vitamin A, vitamin B₂, and vitamin C and percentage of fat energy intake than the urban elderly for both men and women (p < 0.05). The odds of high TG and low HDL-cholesterol were 1.66 (95% confidence interval [CI] 1.23-2.23) and 1.33 (95% CI 1.01-1.77), respectively, in elderly women living in rural areas compared to their urban counterparts, after adjusting for confounding factors. Therefore, nutritional intervention might be needed to improve the nutritional status of the elderly in rural areas and to manage low HDL-cholesterol in rural women.

The burden of stroke and modifiable risk factors in Ethiopia: A systemic review and meta-analysis

BACKGROUND

The burden and contribution of modifiable risk factors of stroke in Ethiopia are unclear. Knowledge about this burden and modifying risk factors is pivotal for establishing stroke prevention strategies. In recent decades, the issue of lifestyle and behavioral modification is a key to improve the quality of life. The modifiable risk factors are an importance as intervention strategies aimed at reducing these factors can subsequently reduce the risk of stroke. So far, many primary studies were conducted to estimate the burden of stroke and modifiable risk factors in Ethiopia. However, the lack of a nationwide study that determines the overall pooled estimation of burden and modifiable risk factors of stroke is a research gap.

METHODS

To conduct this systemic review and meta-analysis, we are following the PRISMA checklist. Three authors searched and extracted the data from the CINAHL (EBSCO), MEDLINE (via Ovid), PubMed, EMcare, African Journals Online (AJOL), and Google scholar. The quality of the primary study was assessed using the Newcastle-Ottawa Scale (NOS) by two independent reviewers. The primary studies with low and moderate risk of bias were included in the final analysis. The authors presented the pooled estimated burden of stroke and its modifiable risk factors. The registered protocol number in PROSPERO was CRD42020221906.

RESULTS

In this study, the pooled burden of hemorrhagic and ischemic stroke were 46.42% (95%CI: 41.82-51.53; I2 = 91.6%) and 51.40% (95%CI: 46.97-55.82; I2 = 85.5%) respectively. The overall magnitude of modifiable risk factor of hypertension, alcohol consumption and dyslipidemia among stroke patients were 49% (95%CI: 43.59, 54.41), 24.96% (95CI%:15.01, 34.90), and 20.99% (95%CI: 11.10, 30.88), respectively. The least proportion of stroke recovery was in the Oromia region (67.38 (95%CI: 41.60-93.17; I2 = 98.1%). Farther more, the proportion of stroke recovery was decreased after 2017 (70.50 (56.80-84.20).

CONCLUSIONS

In our study, more than 90% of stroke patients had one or more modifiable risk factors. All identified modifiable stroke risk factors are major public health issues in Ethiopia. Therefore, strategy is designed for stroke prevention to decrease stroke burden through targeted modification of a single risk factor, or a cluster of multiple risk factors, used on a population, community, or individual level.

The element of family medicine in the mega journal of the family medicine specialty: A bibliometric analysis of the journal, Chinese General Practice

BACKGROUND

With the evolving specialization of modern medicine, family medicine (FM), also known as general practice, is relatively late in being recognized as a formal specialty in most countries of the world. Because many non-FM specialists were recruited into the new specialty in the early stages of FM specialization, the contents of FM specialty journals might, to an extent, reflect the development of the FM specialization.

METHODS

In this study, the voluminous journal, Chinese General Practice, which is regarded as the most representative specialty journal, was chosen and analyzed to illustrate the current situation of FM in China. A total of 878 articles, relating to the journal, Chinese General Practice in 2018, were retrieved from the publisher's web site and the original articles were categorized into FM- and non-FM- related articles by 3 board-certified FM doctors. Furthermore, the first authors, as well as the institutions and regions where the first authors worked, and their related specialties, were also analyzed.

RESULTS

Of the 634 original articles, 252 (39.7%) articles were FM related. Only 41 FM-related articles were written by authors working at FM departments: 3 at community health service centers, 29 at hospitals, and 9 at universities. Of the 382 non-FM related articles, 159 articles dealt with the topic of internal medicine, followed by traditional Chinese medicine (36), obstetrics and gynecology (28), neurology (27), pediatrics (27), and surgery (21).

CONCLUSION

In conclusion, FM publications in China in the study year, as exemplified by Chinese General Practice, were mostly contributed by non-FM authors dealing with non-FM topics. A transition to more FM-oriented development might be anticipated in the near future.

Triglyceride glucose (TyG) index as a predictor of incident type 2 diabetes among nonobese adults: a 12-year longitudinal study of the Korean Genome and Epidemiology Study cohort

The rate of undiagnosed type 2 diabetes tends to increase in lean Koreans, while the triglyceride glucose (TyG) index has been proposed as a surrogate marker of peripheral insulin resistance. We investigated the longitudinal relationship between TyG and incident type 2 diabetes among apparently healthy Korean adults. We assessed 4285 lean adults without diabetes aged 40-69 years from the Korean Genome and Epidemiology Study. Participants were divided into 4 groups according to quartiles of TyG index, calculated as ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2]. We prospectively assessed the hazard ratios (HRs) with 95% confidence intervals (CIs) for incident type 2 diabetes, based on the American Diabetes Association criteria, using multivariate Cox proportional hazards regression models, over 12 years after the baseline survey. During the follow-up period, 631 (14.7%) participants had newly developed type 2 diabetes. The HRs of incident type 2 diabetes in each TyG index quartile were 1.00, 1.63 (95%CI, 1.18-2.24), 2.30 (95%CI, 1.68-3.14), and 3.67 (95%CI, 2.71-4.98), respectively, after adjusting for age, sex, body mass index, waist circumference, smoking status, alcohol intake, and physical activity. Higher TyG index precedes and significantly predicts type 2 diabetes among community-dwelling middle aged and elderly lean Koreans.

The Relationship Between the Metabolic Syndrome and the Place of Residence in the Local Community on the Example of the Janów Lubelski District in Eastern Poland: A Population-Based Study

PURPOSE

The aim of this study was to estimate the incidence concerning metabolic syndrome (MetS) in a local community with a low socioeconomic status and a medium and high cardiovascular risk on the example of residents of Janów Lubelski district, eastern Poland. The second goal of the research was to analyze the relationship between residence and the occurrence of MetS.

METHODS

We conducted a cross-sectional study of 4040 people living in eastern Poland. A group of 3046 people with medium and high cardiovascular risk was selected among the respondents and included in further analyzes. The research adopted the definition criteria proposed by the National Cholesterol Education Program - Third Adult Treatment Panel (NCEP ATP III) to implement diagnostic evaluation of MetS.

RESULTS

It was observed that metabolic syndrome was significantly more frequent among the inhabitants of rural areas (40.56%; n=810) compared to those living in the city (35.27%; n=370) p=0.005. Among the inhabitants of rural areas, the percentage of people with elevated glucose levels was significantly higher, fasting blood glucose (FGB) p<0.001, elevated blood pressure (HBP) p<0.001, elevated serum triglycerides (TGs) p=0.01, and abnormal waist circumference (WC) p=0.003 compared to urban inhabitants. After adjusting for potential confounding variables (age, education, smoking, marital status, and level of physical activity), in both women and men, the odds of developing metabolic syndrome were approximately 30% higher in rural areas compared to urban residents (women: odds ratio (OR)=1.25, 95% confidence intervals (CI)=1.01-1.56; men: OR=1.30, 95% CI=1.01-1.67).

CONCLUSION AND RECOMMENDATIONS

A higher incidence of metabolic syndrome was observed among respondents living in rural areas than those living in cities. Similarly, across the gender strata, metabolic syndrome is more commonly diagnosed among men and women living in rural areas. Healthcare workers, especially in rural areas, should engage in education, prevention, and the promotion of a healthy lifestyle.

Metabolic syndrome associated with the onset of depressive symptoms among women but not men in rural Northeast China

BACKGROUND

The present study aimed to assess the cumulative incidence of major depressive disorder (MDD) among rural Chinese residents. Furthermore, we intended to estimate whether metabolic syndrome (MetS) was associated with MDD by both cross-sectional and prospective analysis.

METHOD

Data of 11,675 residents (46.3% men) was used for cross-sectional analysis. The residents were followed up with median 4.66 years. MDD was diagnosed using the Patient Health Questionnaire-9 (PHQ-9). The data of 2796 individuals without any depressive symptoms was used for prospective analysis.

RESULT

With median of 4.66 years follow-up, the cumulative incidence of MDD among rural residents was 3.9%. Women had significantly higher cumulative incidence of MDD than men (5.3% for women and 2.9% for men, P < 0.01). The incidence of MDD was significantly higher among women with MetS (7.3% vs. 3.8%, P < 0.001), hypertriglyceridemia (7.0% vs. 4.5%, P < 0.001) or elevated blood pressure (6.4% vs. 3.4%, P < 0.001) at baseline compared with those without them. There was no incidence difference of MDD among men with or without baseline metabolic disorders. In prospective study, after adjusting possible confounders, baseline MetS was associated with higher incidence of MDD (OR: 1.82, 95%CI: 1.01, 3.27, P = 0.045) in women but not men (OR: 1.84, 95%CI: 0.88, 3.83, P = 0.104).

CONCLUSION

Cumulative incidence of MDD in rural China was higher among women than among men. Baseline MetS was associated with higher cumulative incidence of MDD in women but not men. More concern should be put on women with MetS in case of onset depressive symptom in future.

Prevalence and characteristics of risk factors for non-communicable diseases in semi-urban communities

Purpose

The purpose of this research aimed to identify the risk factors for non-communicable diseases (NCDs) and determine their prevalence and characteristics in a semi-urban community in Thailand.

Design/methodology/approach

The survey was designed to determine the type and prevalence of risk factors for NCDs among populations in semi-urban areas in the Takianleurn subdistrict of Nakhonsawan, Thailand. A stratified random sampling design was used to select 352 subjects, aged over 15 years and living in this region. Data were collected by questionnaire and analyzed to show frequency, percentage, mean, standard deviation, chi-squared, prevalence rate and prevalence rate ratio with significance indicated by p-value < 0.05 and confidence interval 95 percent.

Research limitations/implications

The implications for the future study are as follows: (1) a comparative study between rural and urban or rural and semi-urban or urban and semi-urban should be studied to understand how risk factors cause NCDs and (2) Participatory action research should be introduced to assess the effectiveness of the decrease in NCDs risk factors management in the community.

Practical implications

(1) To scale up public health interventions measures to promote and prevent NCDs should be focused on behavioral risk factors of NCDs such as eating habits, physical activity, smoking and alcohol consumption. (2) Health promotion and disease prevention for decrease in NCDs should consist of reducing alcohol consumption and enhancing healthy eating habits and (3) To manage unmodified risk factors such as age, gender, educational level, etc. should be focused on surveillance and physical health examination yearly.

Findings

The results revealed a prevalence of NCDs of 14.8 percent. The main unmodifiable risk factors affecting NCD prevalence were gender, age, low level of education and poverty; behavioral risk factors included not eating enough fruit and vegetables, high alcohol consumption, a high-fat fast-food diet and smoking.

Originality/value

The prevention of NCDs requires more focus on changing the eating behavior of high-risk groups and providing easily accessible health care information and services. The entire family should be involved in the process of maintaining good health and disease prevention for all family members.

Prevalence and risk factors for dyslipidemia among adults in rural and urban China: findings from the China National Stroke Screening and prevention project (CNSSPP)

Background

Dyslipidemia is a modifiable risk factor for cardiovascular disease (CVD). We investigated the prevalence and associated risk factors of dyslipidemia- raised total cholesterol (TC), raised triglycerides (TG), raised low-density lipoprotein (LDL-C), low high-density lipoprotein (HDL-C), and raised non-high-density lipoprotein (non-HDL-C) in rural and urban China.

Methods

We analyzed data from 136,945 participants aged 40–100 years of the CNSSPP project for 2014. Dyslipidemia was defined by the NCEP-ATP III and the 2016 Chinese guidelines for the management of dyslipidemia in adults. Complete data on demographic, metabolic and lifestyle characteristics were used. Chi-square tests and multivariable logistic regression were used to obtain age- and sex-adjusted prevalence and risk factors for dyslipidemia among participants.

Results

A total of 53.1% participants lived in rural areas. The prevalence of dyslipidemia was similar among rural and urban participants (43.2% vs. 43.3%). Regarding the components of dyslipidemia: urban compared with rural participants had a higher prevalence of low HDL-C (20.8% vs. 19.2%), whereas the prevalence of raised LDL-C (7.8% vs. 8.3%), raised TC (10.9% vs.11.8%) and raised non-HDL-C (10.0% vs. 10.9%) were lower in urban residents, (all p < 0.001). Women were more likely to have raised TC than men (adjusted OR [AOR] =1.83, 95% confidence interval [CI]:1.75–1.91), raised LDL-C (AOR = 1.55, 95% CI: 1.47–1.63) and high non-HDL-C (AOR = 1.52 95% CI: 1.45–1.59) (all p < 0.001). Compared with rural, urban participants had higher odds of dyslipidemia: low HDL-C (AOR = 1.04, 95% CI: 1.01–1.07), and raised TG (AOR = 1.06, 95% CI: 1.04–1.09). Hypertension and current drinker were less likely to get low HDL-C with AOR 0.93 (95% CI: 0.90–0.96) and AOR 0.73 (95% CI: 0.70–75), respectively. Overweight, obesity, central obesity and diabetes had higher odds of all dyslipidemias (p < 0.001).

Conclusions

Low HDL-C was higher in urban areas, whereas the remaining dyslipidemia types were more common in rural areas. Dyslipidemia was more common in women in both areas of residence. Overweight, obesity, central obesity and diabetes were associated with dyslipidemias. The need to intensify intervention programs to manage dyslipidemia and risk factors should be prioritized.

Urban-rural differences in the association between blood lipids and characteristics of the built environment: a systematic review and meta-analysis

Introduction

The built environment defines opportunities for healthy eating and physical activity and may thus be related to blood lipids. The aim of this study is to systematically analyse the scientific evidence on associations between built-environment characteristics and blood lipid levels in adults.

Methods

PubMed, EMBASE and Web of Science were searched for peer-reviewed papers on population-based studies up to 9 October 2017. We included studies that reported on built-environment characteristics and blood lipid levels in adult populations (≥18 years). Two reviewers independently screened titles/abstracts and full-texts of papers and appraised the risk of bias of included studies using an adapted version of the Quality Assessment Tool for Quantitative Studies. We performed meta-analyses when five or more studies had sufficient homogeneity in determinant and outcome.

Results

After screening 6902 titles/abstracts and 141 potentially relevant full-text articles, we included 50 studies. Forty-seven studies explored associations between urban versus rural areas with blood lipid levels. Meta-analyses on urban versus rural areas included 133 966 subjects from 36 studies in total. Total cholesterol levels were significantly and consistently higher in urban areas as compared with rural areas (mean difference 0.37 mmol/L, 95% CI 0.27 to 0.48). Urban/rural differences in high density lipoprotein cholesterol were inconsistent across studies and the pooled estimate showed no difference (0.00 mmol/L 95% CI −0.03 to 0.04). Low density lipoprotein (LDL) cholesterol and triglyceride levels were higher in urban than in rural areas (mean difference 0.28, 95% CI 0.17 to 0.39 and 0.09, 95% CI 0.03 to 0.14, respectively).

Conclusions

Total and LDL cholesterol levels and triglycerides were consistently higher in residents of urban areas than those of rural areas. These results indicate that residents of urban areas generally have less favourable lipid profiles as compared with residents of rural areas.

Prospero registration number

CRD42016043226.

Prevalence of cardiovascular risk factors in schoolchildren from a rural and urban area in Colombia

Introduction: Cardiovascular risk factors (CVRF) have their origin in childhood. Several studies have shown differences in the prevalence of CVRFs between rural and urban areas, probably related to lifestyle behaviors. Objective: To describe the CVRFs identified in children from a rural and urban population in Colombia. Materials and methods: A cross-sectional study was conducted between March and June 2013 in schoolchildren from an urban and a rural area in Colombia. Weight, height, blood pressure, triglycerides, fasting glucose, and total cholesterol were measured, and a survey covering nutrition, physical activity, and passive smoking was applied. The prevalence of CVRFs was calculated with a 95% CI. Results: A total of 1,055 schoolchildren (833 urban, 222 rural) participated; their mean age was 6.71 years. The prevalence of CVRFs in the rural and the urban study population, respectively, was 68.69%/90.16% for sedentary lifestyle, 97.18%/95.44% for unhealthy diet, 11.16%/14.52% for passive smoking, 0%/5.64% for obesity, 6.31%/11.28% for hypertension, 0%/0% for diabetes, and 18.28%/16.31% for total cholesterol. A total of 99.15% of the study population had at least one CVRF, with an average of 3.14 for the urban area (SD:1.12), and of 2.76 for the rural one (SD: 1.1). Overweight children had a higher prevalence of hypertension (15.21%; 95% CI:11.04%-20.59%) and sedentary lifestyle (90.69%), compared to those without this risk factor (8.98% and 84.32%, respectively). Conclusions: Our results showed a high prevalence of CVRFs in children, especially in the urban area. Public health strategies adapted to the rural and urban populations should be implemented.

Multi-group Causal Model of Health Literacy and Behaviors on Family Well-being among Thai Adults at Risk of Non-Communicable Diseases (NCDs)

BACKGROUND

We aimed to develop a causal model of family well-being with health literacy (HL) as a mediator and to compare models between male and female spouses in urban and rural communities.

STUDY DESIGN

A cross-sectional study.

METHODS

The samples included 2000 spouses at risk of non-communicable diseases (NCDs) by stratified randomly sampled in 2018. Data were collected Likert questionnaires with reliability of 0.79-0.93, and analyzed via confirmatory factor analysis (CFA), and multi-group structural equation modeling (MSEM).

RESULTS

A causal model for the overall group was consistent with the data. Causal factors had direct effects on health behavior including social norms, positive attitude toward health, psychological capital, and HL (β=0.11, 0.14, 0.30, and 0.41, P<0.05 respectively). Health behavior and positive attitudes towards health had direct effects on family well-being (β=0.36 and 0.42, P<0.05, respectively). All factors could predict health behavior and family well-being with variance of 70% and 50%. Invariance analysis of models showed no difference between male and female spouses. In addition, the mean comparison of latent variables showed that the positive attitudes towards health were lower in women than men. HL and positive attitudes towards health of spouses in urban were lower than in rural communities.

CONCLUSION

Thai adult families in cities were at higher risk with NCDs. Therefore, health providers need to address HL and positive attitude toward health which were the main causal factors.

Rural-urban disparities in family physician practice patterns: A nationwide survey in Taiwan

INTRODUCTION

In a world with increasing urbanization, rural-urban disparities in health care utilization have been a long-term concern. However, the details regarding the practice patterns of family physicians in Taiwan have not received sufficient attention thus far.

METHODS

The National Health Insurance Research Database of Taiwan offered 0.2% of the total ambulatory visit records for Taiwan in 2013. Records from community clinics of family medicine were collected, with the clinics categorized as rural, suburban, or urban area clinics according to their locations.

RESULTS

Among 100 334 visits to family medicine clinics, the median patient age was 50 years for urban clinics, 51 for suburban clinics, and 58 for rural clinics. The distributions of patient ages differed in the three areas (P < 0.001). Four types of chronic diseases (cardiovascular diseases, diabetes, chronic respiratory diseases, and cancers) accounted for 10.8%, 11.3%, and 13.6%, of the visits to urban, suburban, and rural clinics, respectively. The most common procedure was wound treatment, and the pattern of the top 10 procedures was similar in the three areas.

CONCLUSION

Although rural patients in Taiwan were older and had more chronic diseases than urban and suburban patients, the pattern of procedures undertaken by rural family physicians did not differ from those of urban and suburban family physicians.

Agreement Between the JCDCG, Revised NCEP-ATPIII, and IDF Definitions of Metabolic Syndrome in a Northwestern Chinese Population

INTRODUCTION

The Joint Committee for Developing Chinese Guidelines (JCDCG) introduced the Chinese definition for metabolic syndrome (MS), which has been verified in southern Chinese people but not in northwestern Chinese people. We evaluated the MS definition proposed by the JCDCG in a northwestern Chinese population, in comparison with those of the revised National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) and the International Diabetes Federation (IDF).

METHODS

This population-based cross-sectional study was a part of the China National Diabetes and Metabolic Disorders Study conducted in Shaanxi province. We included 3243 participants aged ≥ 20 years. The age-adjusted MS prevalence was assessed per the 2007 Chinese population structure. The agreement between different definitions was assessed by the kappa statistic.

RESULTS

The standardized prevalence of JCDCG-MS, revised ATPIII-MS, and IDF-MS was 22.4%, 29.4%, and 24.9%, respectively. Among women, the agreement of the JCDCG definition with the revised ATPIII and the IDF definition was not good (κ = 0.599 and 0.601, respectively); 54.6% of the revised ATPIII-MS and 56% of the IDF-MS were defined as MS according to the JCDCG definition. Among men, the agreement of JCDCG definition with the revised ATPIII and IDF definitions was very good (κ = 0.863) and substantial (κ = 0.741), respectively.

CONCLUSION

The agreement of the JCDCG definition with the revised ATPIII and IDF definitions was insufficient in women. Compared with the other two definitions, the JCDCG definition underestimates MS prevalence in northwestern women.

Age and gender-specific distribution of metabolic syndrome components in East China: role of hypertriglyceridemia in the SPECT-China study

BACKGROUND

Chinese population are experiencing remarkably changes of economic and cultural environments. The present study was to examine the prevalence of metabolic syndrome (MetS) by age between genders and to investigate the current characteristics of MetS and its components in China.

METHODS

SPECT-China is a population-based cross-sectional survey on Chinese adults aged ≥18 years in East China. A total of 10,441 Chinese residents participated in anthropometric and laboratory measurements. Of these, 9969 subjects (females, 5868) were eligible for the data analysis reported here. Estimates of the prevalence of MetS and its components were calculated. Presence of MetS was defined based on the IDF/AHA harmonized criteria. MetS z-score was calculated to evaluate the degree of total metabolic disorder.

RESULTS

The age-standardized prevalence of the metabolic syndrome was 22.0% (21.9% in men and 22.0% in women). Unlike the continuous MetS rise with age in females, the MetS prevalence in males remained stable among 46-55, 56-65 and > 65 yrs. age groups (31.2%, 31.4%, 32.5%, p = 0.538). In the five components of MetS, contrary to the elevated BP and BG disorders, the frequency of TG disorders decreased with age in males (46.6%(46-55 yrs), 37.2% (56-65 yrs), 27.7%(> 65 yrs), p < 0.001). Multivariable logistic regression showed that in males, more TG disorders were associated with higher BMI, higher educational level and current nonsmoker. In the MetS subjects, the 3-factor combinations which included TG disorders decreased with age in both genders. The whole metabolic profile became better in older male MetS subjects, which was opposite to the female.

CONCLUSION

Our results showed a distinct age-related prevalence of MetS between genders in dramatically changed China, in which the TG disorders played an important role. More targeted measures need to be taken to meet the serious challenges of metabolic diseases.

TRIAL REGISTRATION

ChiCTR-ECS- 14005052 , Survey on Prevalence in East China for Metabolic Diseases and Risk Factors (SPECT-China).

Prevalence of Pre-Diabetes across Ethnicities: A Review of Impaired Fasting Glucose (IFG) and Impaired Glucose Tolerance (IGT) for Classification of Dysglycaemia

Prediabetes can be defined by the presence of impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT), or glycated haemoglobin (Hb_A1c) to identify individuals at increased risk of developing type 2 diabetes (T2D). The World Health Organization (WHO, 1999) and the American Diabetes Association (ADA, 2003) utilise different cut-off values for IFG (WHO: 6.1–6.9 mmol/L; ADA: 5.6–6.9 mmol/L) but the same cut-off values for IGT (7.8–11.0 mmol/L). This review investigates whether there are differences in prevalence of IFG, IGT, and combined IFG&IGT between ethnicities, in particular Asian Chinese and European Caucasians. In total, we identified 19 studies using the WHO₁₉₉₉ classification, for which the average proportional prevalence for isolated (i)-IFG, i-IGT, and combined IFG&IGT were 43.9%, 41.0%, and 13.5%, respectively, for Caucasian and 29.2%, 49.4%, and 18.2%, respectively, for Asian. For the 14 studies using ADA₂₀₀₃ classification, the average proportional i-IFG, i-IGT, and combined IFG&IGT prevalences were 58.0%, 20.3%, and 19.8%, respectively, for Caucasian; 48.1%, 27.7%, and 20.5%, respectively, for Asian. Whilst not statistically different, there may be clinically relevant differences in the two populations, with our observations for both classifications indicating that prevalence of i-IFG is higher in Caucasian cohorts whilst i-IGT and combined IFG&IGT are both higher in Asian cohorts.

The prevalence of the metabolic syndrome in Portugal: the PORMETS study

Background

The PORMETS study was designed to estimate the prevalence of metabolic syndrome and its determinants in the overall and administrative regions of the Portuguese mainland.

Methods

A cross-sectional study of a representative sample of non-institutionalized Portuguese adults selected from primary health care centres lists including 1695 men and 2309 women was conducted from February 2007 to July 2009. A structured questionnaire was administered, collecting information on personal medical history and socio-demographic and behavioural characteristics. Anthropometrics, blood pressure, and venous blood samples were obtained. Metabolic syndrome was defined according to three operational definitions. The prevalence ratios and their respective 95% confidence intervals were calculated using binomial generalized linear regression, with the log link function.

Results

The prevalence rates of metabolic syndrome in this sample of Portuguese adults were 36.5%, 49.6%, and 43.1%, using the Adult Treatment Panel III, International Diabetes Federation and Joint Interim Statement definitions, respectively. The most prevalent feature of metabolic syndrome in this sample was high blood pressure (64.3%) and the lowest was high fasting glucose (24.9%). After adjustment for age and gender, significant differences were observed for the 18 districts of the Portugal mainland. Additionally, metabolic syndrome was significantly more frequent in non-urban areas than in urban ones (p = 0.001). The prevalence of metabolic syndrome was significantly higher in women (p˂0.001) and older participants (p˂0.001), as well as in those who reported being housewives (p = 0.010), retired (p = 0.046) or unemployed (p = 0.024).

Conclusions

This study showed that metabolic syndrome is highly prevalent in the Portuguese adult population. Regional differences in the prevalence of this syndrome were observed, and this condition was more common in non-urban areas and less favoured socio-economic categories.

The nine-year changes of the incidence and characteristics of metabolic syndrome in China: longitudinal comparisons of the two cross-sectional surveys in a newly formed urban community

Background

To assess the 9-year changes of the incidence and characteristics of metabolic syndrome (MetS) in Chinese community under the background of dramatically changed environment.

Methods

Two cross-sectional surveys of the general population were carried out in 2005 and 2014 in Dengmin and Hongnan villages of Fengcheng community, a newly formed urban community from rural area 10 years ago. All permanent adult residents aged 18–80 without active malignant tumors and pregnancy were invited to attend the study. They participated in clinical examinations for anthropometric and blood pressure measurements. Fasting blood samples were drawn for analysis of lipids and glucose. Presence of MetS was defined based on the IDF/AHA harmonized criteria. MetS z-score was calculated to evaluate the degree of total metabolic disorder.

Results

A total of 1042 subjects in 2005 and 1053 subjects in 2014 were included in the final analysis. The participants were stratified by gender. The incidence of MetS was higher in 2014 than 2005 in both genders (female, 48.28 vs 31.61 %; male, 41.12 vs 26.30 %; p value, both <0.001). Of the five MetS components, the FBG and TG levels were higher in 2014 than 2005 in both gender, however, the SBP and DBP values were even lower in 2014 than 2005. The differences of FBG, blood pressure and lipid levels between 2005 and 2014 still exist after ruling out recognized diabetic, hypertensive and dyslipidemic subjects, individually. In MetS subjects, MetS z-score showed the whole metabolic profile get worse in 2014 than 2005 in both sex (female, 1.97 ± 2.53 vs 1.74 ± 2.29; male, 2.51 ± 2.79 vs 1.01 ± 2.38. both P < 0.001). Using 3 abnormal components as a combination, we found the frequency of different kinds of combination also changed in MetS subjects. In female, the combination of WC + BP + HDL disorder decreased from 29.7 % (2005) to 11.0 % (2014) and WC + FBG + BP disorder became the most popular phenotype (18.8 %) in 2014.

Conclusions

The dramatically changed environments have extensive influence on metabolic parameters of local residents. More targeted measures need to be taken to meet the serious challenges of metabolic diseases.

Trial registration ChiCTR-ECS-14005052, http://www.chictr.org, Survey on Prevalence in East China for Metabolic Diseases and Risk Factors (SPECT-China)

Electronic supplementary material

The online version of this article (doi:10.1186/s12933-016-0402-9) contains supplementary material, which is available to authorized users.

Urban-Rural Differences in Cardiovascular Disease Risk Factors: A Cross-Sectional Study of Schoolchildren in Wuhan, China

Background

China’s rapid population growth and urban migration has developed healthcare inequity across the urban-rural divide. Past studies comparing cardiovascular disease (CVD) risk factor prevalence amongst urban-rural Chinese children are sparse and conflicting. We examined the association between urban-rural residence and risk of offspring CVD in Chinese children.

Methods

A cross-sectional study was conducted in Wuhan, China, during May and June 2010. CVD risk factors include; waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), triglycerides (TG), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, body mass index (BMI), cardiorespiratory fitness (CRF), metabolic syndrome (MetS), and metabolic risk score (MRS). Analysis of covariance and multivariable logistic regression were used to estimate associations between urban-rural residence and offspring CVD risks.

Findings

A total of 579 Chinese children (338 boys and 241 girls) aged 9.6 (0.7) years participated in this study. Rural boys had significantly lower CRF and higher FBG, TG, and MRS, while urban boys had significantly higher LDL and DBP. Rural girls had significantly higher BMI, FBG, and TG, as well as lower CRF. Rural children were at increased risks for decreased CRF, elevated MRS, and TG, (OR:2.04, 95%CI:1.29–3.25), (OR:2.33, 95%CI:1.50–3.62), and (OR:2.40, 95%CI:1.62–3.57), respectively. Rural girls and mothers were at increased risks for overweight(OR:7.19, 95%CI:1.64–31.6)/obesity (OR:1.683, 95%CI:1.01–2.82). However, rural boys and fathers were less likely to have overweight(OR:0.62, 95%CI:0.34–1.12)/obesity (OR:0.68, 95%CI:0.48–0.97).

Conclusions

Rural residence was significantly associated with increased CVD risks amongst Chinese children. It is important to provide interventions aiming at China’s urban-rural healthcare inequity and community-based approaches that reduce familial CVD risk.

A Descriptive Study of the Progression of the Metabolic Syndrome in Middle-Aged Chinese Population

This longitudinal study investigated the prevalence of the Metabolic Syndrome (MetS) in middle-aged (44–56 years) men and women in China. The presence of the components of the MetS was determined in a cohort of 643 persons born in 1956, 1960–1961, and 1964 in Shanxi Province China in 2008 and 2012. The rate of MetS in 2008 was 51.63% (95% CI [44.73, 58.48]) and 37.15% (95% CI [32.56, 41.92]) and in 2012 was 50.23% (95% CI [43.35, 57.10]) and 46.26% (95% CI [41.46, 51.11]) for men and women, respectively. Increased blood glucose and triglycerides and decreased high-density lipoprotein for women, and blood glucose and triglycerides for men were the components responsible for the development of MetS from 2008 to 2012. MetS develops differently between men and women. From age 44 to 56, the rate is unchanged among men and increasing among women.

Prevalence of metabolic syndrome: association with risk factors and cardiovascular complications in an urban population

Introduction

Metabolic syndrome (MS) is a set of cardiovascular risk factors and type 2 diabetes, responsible for a 2.5-fold increased cardiovascular mortality and a 5-fold higher risk of developing diabetes.

Objectives

1-to evaluate the prevalence of MS in individuals over 18 years associated with age, gender, socioeconomic status, educational levels, body mass index (BMI), HOMA index and physical activity; moreover, to compare it to other studies; 2-to compare the prevalence of elevated blood pressure (BP), high triglycerides and plasma glucose levels, low HDL cholesterol and high waist circumference among individuals with MS also according to gender; 3-to determine the number of risk factors in subjects with MS and prevalence of complications in individuals with and without MS aged over 40 years.

Methods

A cross-sectional study of 1369 Individuals, 667 males (48.7%) and 702 females (51.3%) was considered to evaluate the prevalence of MS and associated factors in the population.

Results

The study showed that 22.7% (95% CI: 19.4% to 26.0%) of the population has MS, which increases with age, higher BMI and sedentary lifestyle. There was no significant difference between genders until age ≥70 years and social classes. Higher prevalence of MS was observed in lower educational levels and higher prevalence of HOMA positive among individuals with MS. The most prevalent risk factors were elevated blood pressure (85%), low HDL cholesterol (83.1%) and increased waist circumference (82.5%). The prevalence of elevated BP, low HDL cholesterol and plasma glucose levels did not show significant difference between genders. Individuals with MS had higher risk of cardiovascular complications over 40 years.

Conclusion

The prevalence of MS found is similar to that in developed countries, being influenced by age, body mass index, educational levels, physical activity, and leading to a higher prevalence of cardiovascular complications after the 4th decade of life.