Causes of different estimates of the prevalence of metabolic syndrome in Korea

Association between lifestyle factors and the risk of metabolic syndrome in the South Korea

This study aimed to examine the association between lifestyle factors and metabolic syndrome risk in South Korean adults. Korea National Health and Nutrition Examination Survey 2016–2018 data were used. The study included 6,995 subjects (2835 male; 4,160 female). Multiple logistic regression was used to estimate the relationship between the lifestyle factors, including sedentary time, sleep duration, alcohol consumption, smoking status, and dietary intake. Metabolic syndrome prevalence in healthy adults was 25.6% and 12.4% in men and women, respectively. Male with over four lifestyle risk factors had a higher OR for metabolic syndrome risk (over four lifestyle factors: OR 1.97, CI 1.18–3.27). Female with more than one lifestyle risk factor had a higher OR for metabolic syndrome risk (one lifestyle factor: OR 1.58, CI 1.10–2.28; two lifestyle factors: OR 2.08, CI 1.39–3.11; three lifestyle factors: OR 1.94, CI 1.20–3.13). In particular, female with more lifestyle factors had increased likelihood of abdominal obesity, hypertension, and high triglycerides. Male with more lifestyle factors had increased likelihood of high triglycerides. Sedentary time was significantly associated with increased metabolic syndrome in male and female. This study found a significant association between the number of lifestyle risk factors and the risk of metabolic syndrome in Korean adults. The greater the number of lifestyle risk factors, the higher the risk of metabolic syndrome in both sexes. People with a greater number of poor lifestyle behaviors tended to exhibit increased likelihood of especially elevated triglyceride levels.

National trends in total cholesterol obscure heterogeneous changes in HDL and non-HDL cholesterol and total-to-HDL cholesterol ratio: a pooled analysis of 458 population-based studies in Asian and Western countries

BACKGROUND

Although high-density lipoprotein (HDL) and non-HDL cholesterol have opposite associations with coronary heart disease, multi-country reports of lipid trends only use total cholesterol (TC). Our aim was to compare trends in total, HDL and non-HDL cholesterol and the total-to-HDL cholesterol ratio in Asian and Western countries.

METHODS

We pooled 458 population-based studies with 82.1 million participants in 23 Asian and Western countries. We estimated changes in mean total, HDL and non-HDL cholesterol and mean total-to-HDL cholesterol ratio by country, sex and age group.

RESULTS

Since ∼1980, mean TC increased in Asian countries. In Japan and South Korea, the TC rise was due to rising HDL cholesterol, which increased by up to 0.17 mmol/L per decade in Japanese women; in China, it was due to rising non-HDL cholesterol. TC declined in Western countries, except in Polish men. The decline was largest in Finland and Norway, at ∼0.4 mmol/L per decade. The decline in TC in most Western countries was the net effect of an increase in HDL cholesterol and a decline in non-HDL cholesterol, with the HDL cholesterol increase largest in New Zealand and Switzerland. Mean total-to-HDL cholesterol ratio declined in Japan, South Korea and most Western countries, by as much as ∼0.7 per decade in Swiss men (equivalent to ∼26% decline in coronary heart disease risk per decade). The ratio increased in China.

CONCLUSIONS

HDL cholesterol has risen and the total-to-HDL cholesterol ratio has declined in many Western countries, Japan and South Korea, with only a weak correlation with changes in TC or non-HDL cholesterol.

The prevalence trend of metabolic syndrome and its components and risk factors in Korean adults: results from the Korean National Health and Nutrition Examination Survey 2008-2013

BACKGROUND

Abnormalities in the clinical markers of metabolic syndrome (MS) are associated with the development of cardiovascular disease, type 2 diabetes mellitus, and some cancers. MS prevalence in Korea increased between the mid-1990s and mid-2000s; however, no data on the recent trends of MS prevalence are available. Thus, we aimed to investigate the prevalence of MS, the five components of MS, and the related risk factors in Korean adults by using recent data.

METHODS

Data from the Korean National Health and Nutrition Examination Survey conducted between 2008 and 2013 were used. The revised National Cholesterol Education Program criteria were used for defining MS. A multivariate logistic regression analyses was used to estimate the relationship between the related risk factors including behaviors, dietary factors, and the prevalence of MS.

RESULTS

A total of 34,587 men and women were included in the analysis. Age-adjusted prevalence of MS in 2013 was 28.9% without a significant increasing or decreasing trend between 2008 and 2013. Among the five components of MS, abdominal obesity decreased in both men and women (annual percent change: -2.0 and -2.5%, respectively), the decrease being significant only in women, whereas blood pressure and blood glucose significantly increased in men (+1.9 and +2.7%, respectively). Age and obesity (odds ratio = 6.7, 95% confidence interval = 5.9-7.5 for body mass index ≥25 kg/m² vs. body mass index <25 kg/m²) were associated with increased MS risk in both men and women. Smoking and alcohol drinking were significantly associated with increased MS risk in men, and association between MS and vitamin D deficiency was at the edge of statistical significance. Higher education and income level were significantly associated with decreased MS risk in women. During this period, smoking rate and physical activity, sodium intake, and serum vitamin D level significantly decreased. Education level, calorie intake, and intake of carbohydrate, fat, protein and calcium significantly increased.

CONCLUSION

Several factors contribute to the stable MS prevalence-on the one hand, increased prevalence of high blood sugar, high blood pressure, calorie intake, and physical inactivity, and on the other hand, decreased prevalence of abdominal obesity and smoking. Lifestyle interventions to prevent and control non-communicable diseases should be implemented at the national level to reduce the burden of MS.

Metabolic syndrome criteria as predictors of subclinical atherosclerosis based on the coronary calcium score

BACKGROUND/AIMS

The aim was to determine which of three sets of metabolic syndrome (MetS) criteria (International Diabetes Federation [IDF], National Cholesterol Education Program Adult Treatment Panel III [ATP III], and European Group for the Study of Insulin Resistance [EGIR]) best predicts the coronary artery calcification (CAC) score in a cross-sectional study. This has not been evaluated in previous studies.

METHODS

A total of 24,060 subjects were screened for CAC by multi-detector computed tomography. The presence of CAC was defined as a CAC score > 0. The odds ratio for the presence of CAC was analyzed for three different sets of MetS criteria and according to number of MetS components.

RESULTS

CAC was observed in 12.6% (3,037) of the subjects. Patients with MetS, as defined by the IDF, ATP III, and EGIR criteria, had a CAC rate of 23.0%, 25.1%, and 29.5%, respectively (p < 0.001). Comparisons of C statistics for multivariate regression models revealed no significant difference among the three sets of criteria. After adjustment for risk factors, the ATP III criteria produced a slightly higher odds ratio for CAC compared with the other criteria, but this difference was not significant. The risk factor-adjusted odds ratio for the presence of CAC increased from 1 to 1.679 as the number of MetS components defined by ATP III increased from 0 to ≥ 3 (p for trend < 0.001).

CONCLUSIONS

The presence of MetS was associated with the presence of CAC. There was no significant difference among the three sets of MetS criteria in terms of the ability to predict CAC. An increase in the number of MetS components was associated with an increased odds of CAC.