The implications of anthropometric, inflammatory and glycaemic control indices in the epidemiology of the metabolic syndrome given by different definitions: a classification analysis

BACKGROUND: Individuals with the metabolic syndrome (MS) are at high risk for coronary heart disease. In this study, we evaluated the levels of inflammatory, lipidaemic and glycaemic control markers in subjects with and without MS, as given by different definitions. METHODS: During 2001-2002, we randomly enrolled 1,514 men (18-87 years old) and 1,528 women (18-89 years old), without any clinical evidence of cardiovascular disease, from the Attica area, Greece. Among several variables, we also measured inflammatory markers, total antioxidant capacity, glucose and insulin levels and various lipids. MS was defined according to either the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III criteria or the International Diabetes Federation (IDF) Epidemiology Task Force group. In all the analyses, subjects with diabetes were excluded. RESULTS: The prevalence of the MS was 17.9% according to the NCEP definition and 48.9% according to the IDF definition (p < 0.001). The prevalence of MS was higher in men compared with women according to both definitions (p for gender differences <0.001). Moreover, 3.9% of the total study sample fulfilled only the NCEP criteria, but not the IDF, while 38.6% fulfilled only the IDF criteria. Subjects who were defined as having MS using the IDF criteria were younger, had higher body mass index, C-reactive protein, fibrinogen, tumour necrosis factor-alpha levels, total antioxidant capacity and lower glucose and insulin levels. CONCLUSIONS: Prevalence of the MS is very high among Greek adults when the IDF definition is used, while it is still considerable when we adopt the NCEP criteria. It is evident that subjects who fulfilled the IDF criteria showed increased levels of inflammatory markers compared with those who fulfilled the NCEP ATP III criteria.     

Impact of weight loss on the metabolic syndrome

Aim: Individuals with the metabolic syndrome (MS), a clustering of risk factors [triglycerides, glucose, high-density lipoprotein cholesterol, blood pressure (BP), abdominal obesity] defined by the National Cholesterol Education Program (NCEP), are at high risk for coronary heart disease and type 2 diabetes mellitus, and may benefit from aggressive lifestyle modification.
Methods: We reviewed 1 year of consecutive patients' charts to determine the prevalence of the MS in obese individuals enrolled in a medically supervised rapid weight loss programme, the correlation of weight change with the components of the MS, and response to diet-induced weight loss.
Results: Out of 185 individuals, 125 (68%) met the NCEP definition of the MS. A moderate decrease in weight (6.5%) induced by a very low calorie diet (VLCD) resulted in substantial reductions of systolic (11.1 mmHg) and diastolic (5.8 mmHg) blood pressure (BP), glucose (17 mg/dl), triglycerides (94 mg/dl) and total cholesterol (37 mg/dl) at 4 weeks (all p < 0.001). These improvements were sustained at the end of active weight loss (average 16.7 weeks; total weight loss 15.1%), with further significant reductions in BP and triglycerides. Weight loss was related to the changes in each criterion of the metabolic syndrome.
Conclusions: The MS is prevalent in two-thirds of obese individuals enrolling in a structured weight loss programme. Moderate weight loss with a VLCD markedly improved all aspects of the MS.     

The metabolic syndrome and incidence of cardiovascular disease in non-diabetic subjects--a population-based study comparing three different definitions.

Aims Between 1998 and 2005, a number of definitions of the metabolic syndrome (MetS) have been proposed. The aim of this population‐based cohort study was to compare prevalence rates and the prediction of cardiovascular disease (CVD) using different definitions of MetS. Methods A total of 5047 non‐diabetic subjects (66% women), from the city of Malmö, Sweden, were followed. The incidence of fatal and non‐fatal CVD (cardiac events, n = 176, and stroke, n = 171) was monitored over 11 years of follow‐up. MetS was defined in three different ways [by International Diabetes Federation (IDF), National Cholesterol Education Program—Adult Treatment Panel III (NCEP‐ATPIII), or European Group for the study of Insulin Resistance (EGIR) criteria] based on data on waist circumference, blood pressure, serum triglycerides, High‐density lipoprotein cholesterol and fasting blood glucose. The IDF definition identified 21.9% of the subjects having the MetS. Corresponding figures for the NCEP‐ATPIII and EGIR definitions were 20.7 and 18.8%, respectively. Results After taking age, gender, low‐density lipoprotein cholesterol and lifestyle factors into account, the hazard ratio (HR) for CVD event according to the IDF, NCEP‐ATPIII and EGIR definitions were HR 1.11 (95% CI: 0.86–1.44), 1.59 (1.25–2.03) and 1.35 (1.05–1.74), respectively. The results were largely similar for cardiac and stroke events. Conclusions The prevalence of Mets according to the IDF definition was higher in comparison with NCEP‐ATPIII and EGIR definitions, but the IDF definition was not superior to these definitions for prediction of CVD events. This was true for both genders and questions the usefulness of the current IDF criteria of MetS in a North‐European, Caucasian population. In addition, single risk factors such as smoking had an equal prediction as the metabolic syndrome.     

All-cause mortality risk predictors in a preventive cardiology clinic cohort-examining diabetes and individual metabolic syndrome criteria: a PRECIS database study

Aim:  It is unclear if metabolic syndrome (MS) is equal to type 2 diabetes mellitus (DM) in predicting cardiovascular disease (CVD) risk and mortality, and its prognostic value compared to Framingham risk model is controversial. We assessed mortality, CVD risk and prevalence in patients with DM and those without DM who met National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) MS criteria compared to patients without DM or MS. We analysed which component(s) of NCEP MS criteria had greatest predictive value for mortality.
Methods:  Retrospective cohort analysis of 1189 DM, 1241 MS (fasting glucose < 126 mg/dl and ≥3 components NCEP-ATP III criteria) and 3023 non-DM/non-MS patients presented for baseline visit to Preventive Cardiology clinic between 1995 and 2006, whose subsequent vital status was determined for a median of 5.2 years. The association with mortality was determined by Cox proportional hazards models. The incremental predictive value of MS components was performed by concordance indexes.
Results and conclusion:  DM group had highest mortality and CVD prevalence vs. MS and non-DM/non-MS groups respectively (all p ≤ 0.001). Patients with MS criteria had increased CVD prevalence and 1.5-fold increased mortality vs. non-DM/non-MS group (all p < 0.02). In NCEP MS criteria, only fasting glucose significantly predicted mortality in MS group (p = 0.05). MS criteria predicted CVD prevalence in a parallel manner to Framingham risk score assessment. In a cohort of patients at high risk for CVD whose risk factors are being treated, presence of diabetes in addition to plasma glucose within NCEP MS criteria strongly predicts all-cause mortality.     

Relationship between nonalcoholic fatty liver disease and metabolic syndrome

OBJECTIVE: The aim of this study was to investigate the prevalence of nonalcoholic fatty liver disease (NAFLD) and metabolic syndrome (MS) in subjects who underwent a routine health checkup. We intended to establish a clinical association between NAFLD and MS as well as to compare the diagnostic criteria of MS based on the definitions set forth by the International Diabetes Federation (IDF), the US National Cholesterol Education Program Adult Treatment Panel III (2001) (NCEP/ATP‐III) and the Metabolic Syndrome Study Group of Chinese Diabetes Society (CDS). METHODS: Weight, height, waist circumference, hip circumference, percentage of body fat, blood pressure and ultrasound of liver were performed on subjects undergoing routine health checkup. Serum triglyceride, total cholesterol, high density lipoprotein cholesterol and fasting plasma glucose level were measured. RESULTS: A total of 2394 subjects were included in this analysis and 437 had NAFLD. The prevalence of MS in the whole sample according to IDF, NCEP/ATP‐III and CDS definitions was 11.11%, 8.48% and 5.30%, respectively. The total degree of agreement between IDF, NCEP/ATP‐III and CDS definition was 87.76%. The prevalence of MS in NAFLD subjects is much higher than that in non‐NAFLD subjects. The prevalence of NAFLD in MS subjects is also much higher than that in non‐MS subjects. CONCLUSION: The prevalence of MS varied depending on the diagnostic criteria used. NAFLD was strongly associated with the MS, although it remains unknown whether NAFLD is a cause or effect of MS.     

How many components for the metabolic syndrome? Results of exploratory factor analysis in the FIBAR study

Background and aimsFactor analysis can be used as a basis for the determination of diagnostic criteria for the metabolic syndrome (MS). This approach can be used as a basis for the determination of diagnostic criteria for MS.Methods and resultsExploratory factor analysis of Adult Treatment Panel (ATP)-III and International Diabetes Federation (IDF) criteria for MS, entered as dichotomic variables, was performed on 2945 patients enrolled in a screening programme for diabetes. The ability of calculated factors to identify patients with MS-related conditions (glucose intolerance, hyperuricaemia, and elevation of alanine aminotransferase; ALT) was assessed through Receiver Operator Characteristics (ROC) curve analysis. Alternative sets of criteria based on ATP-III and IDF definitions of MS were also assessed. A two-factor structure was found for both ATP-III and IDF criteria. Factor 1 (associated with fasting hyperglycaemia, hypertension, and elevated waist circumference) was capable of identifying subjects with MS-related conditions to a greater extent than factor 2 (low HDL-cholesterol and hypertriglyceridaemia). When a composite variable (low HDL-cholesterol and/or hypertriglyceridaemia) was used for dislipidaemia, a single factor structure was obtained both for ATP-III and IDF definitions; this factor structure was retained when hyperuricaemia was added as a fifth component of MS. Such a modified definition of MS was not inferior to original ATP-III and IDF criteria in the identification of subjects with glucose intolerance and elevated ALT.ConclusionsA modification of current ATP-III or IDF criteria is necessary in order to obtain a single-factor structure. Alternative definitions of MS, including additional features, such as hyperuricaemia, can maintain a monofactorial structure, and an association with related conditions not inferior to that of original criteria.     

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

OBJECTIVE: The new definitions for metabolic syndrome (MS) proposed by the IDF and revised NCEP have caused some confusion because patients have emerged that have satisfied the revised NCEP but not the IDF criteria. We performed this study to compare the prevalence of these criteria and to investigate the characteristics of discrepant cases. RESEARCH DESIGN AND METHODS: A total of 7962 individuals aged >or= 20 years (3597 men; 4365 women) who participated in the 1998 Korean NHANES were included. We assessed the agreement between the revised NCEP and IDF criteria and investigated the characteristics of cases satisfying the revised NCEP criteria but not the IDF criteria. RESULTS: The prevalence of MS by the revised NCEP (25.7% of men and 31.9% of women) was higher than that according to the IDF (14.2% of men and 26.6% of women). The IDF criteria failed to identify 44.9% of men and 16.6% of women identified as having MS according to the revised NCEP criteria. The discrepant group showed more adverse metabolic profiles and unfavorable lifestyles despite lower waist circumference as compared with those having MS by both the IDF and revised NCEP criteria. The prevalence of discrepant cases was higher among the elderly. CONCLUSIONS: The IDF criteria were inferior to the revised NCEP criteria in identifying the metabolically abnormal but nonobese groups known to be predisposed to type 2 diabetes and cardiovascular disease. Further research regarding the appropriateness of central obesity as an obligatory criterion proposed by the IDF seems to be warranted.     

Differences in traditional and emerging cardiovascular risk factors of subjects discordantly classified by metabolic syndrome definitions of the International Diabetes Federation and the National Cholesterol Education Program

Background and aimSeveral working definitions of metabolic syndrome have been proposed for clinical use. However, individuals can be discordantly classified as having or not having metabolic syndrome depending on the choice of one or another definition. This study compared the cardiovascular risk profile of subjects concordantly and discordantly diagnosed by the criteria of the National Cholesterol Education Program (NCEP) and the criteria of the International Diabetes Federation (IDF).Methods and resultsNine hundred and twenty-nine non-diabetic adult subjects belonging to a cross-sectional population-based study in Gran Canaria island (Spain) were assessed. Participants completed a questionnaire and underwent physical examination, fasting blood analyses, and a standardized oral glucose tolerance test.Two hundred and four subjects (22%) had metabolic syndrome according to both definitions, 31 (3.3%) only by the IDF criteria, and 5 (0.5%) only by the NCEP criteria. Participants fulfilling both proposals showed more adverse age and sex-adjusted measures of BMI, waist, HDL cholesterol, triglycerides, post-load glucose, HOMA-IR and plasminogen inhibitor activator-1 (PAI-1) than individuals exclusively satisfying the IDF criteria. Moreover, in contrast to subjects meeting both criteria, those that fulfilled only the IDF criteria had levels of BMI, waist, total and HDL cholesterol, post-load glucose, glycated HbA1c, C-reactive protein, PAI-1 and fibrinogen not significantly different from those observed in subjects without metabolic syndrome.ConclusionThe IDF definition identifies a surplus of individuals whose cardiovascular risk profile, particularly regarding to some non-traditional cardiovascular risk factors, is less adverse than that observed in subjects also diagnosed by the NCEP definition.     

Metabolic syndrome and arterial stiffness: the Health 2000 Survey

Metabolic syndrome and its components have been associated with arterial stiffness and cardiovascular disease. The objective of this study was to examine the independent influences of metabolic syndrome, its components, and other cardiovascular risk factors on arterial stiffness as well as to compare 2 definitions for metabolic syndrome (National Cholesterol Education Program [NCEP] and International Diabetes Federation [IDF]) in their ability to identify subjects with arterial stiffness. The study population consisted of 401 Finnish men and women aged 45 years and older who participated in a substudy of the Finnish population-based Health 2000 Survey. Pulse wave velocity (PWV) measured by whole-body impedance cardiography was used as a marker of elevated arterial stiffness. In multivariate models, systolic blood pressure, age, waist circumference, and fasting blood glucose (P ≤ .001 for all) were independent determinants for PWV. In the models including metabolic syndrome instead of its components, the NCEP and IDF definitions were similarly associated with PWV (P ≤ .01 for both), the other independent determinants being age, sex (P < .001 for both) and plasma C-reactive protein concentration (P = .016 and P = .005 in models containing the NCEP and IDF definitions, respectively). Systolic blood pressure, age, waist circumference, and fasting blood glucose level were independently associated with increased arterial stiffness. Metabolic syndrome determined increased arterial stiffness independently of other known cardiovascular risk factors. The NCEP and IDF definitions did not differ in their ability to identify subjects with increased arterial stiffness.     

Glycated haemoglobin as a predictor for metabolic syndrome in non-diabetic Korean adults.

AIMS: With increasing prevalence of diabetes mellitus and metabolic syndrome (MS), the importance of early detection of insulin resistance is emphasized. However, a simple and practical method of measurement is not readily available. Therefore, we examined the sensitivity and specificity of HbA(1c) for predicting impaired fasting glucose (IFG) and MS and its association with cardiovascular risk factors, particularly in the normal range of HbA(1c) levels in non-diabetic Korean subjects. METHODS: In 40,155 participants (median age 40 years) participating in a medical check-up programme, analysis of the distribution of HbA(1c) and its association with various cardiovascular risk factors was performed. In 22,465 selected participants, an analysis was conducted of the ability of HbA(1c) to predict MS and IFG. Anthropometric measurements were made in all subjects and fasting glucose, lipid profiles and HbA(1c) were measured. The presence of MS was defined according to the definitions of the Adult Treatment Panel III (ATP III) guideline and the new International Diabetes Federation (IDF) guideline. Patients with diabetes were excluded from the study. RESULTS: The incidence of MS was 12.2% according to ATP III criteria and 7.6% according to IDF criteria. When subjects were grouped by quartile of HbA(1c), cardiovascular risk factors significantly increased as the HbA(1c) increased. An HbA(1c) of 5.45% predicted the presence of MS (ATP III: sensitivity/specificity 57.4/64.3%, area under the curve 64.8%; IDF: sensitivity 60.2/63.4%, area under the curve 66.1%) and fasting blood glucose > or = 5.6 mmol/l (sensitivity/specificity 53.7/70%, area under the curve 66.1%). When the analyses were done separately by gender, female subjects showed higher cut-off of HbA(1c) for the prediction of MS (5.55% for both ATP III and IDF criteria). CONCLUSIONS: HbA(1c) increased as cardiovascular risk factors increased and HbA(1c) of 5.45% predicted the presence of MS. HbA(1c) might be a predictive measure of IFG and MS, and also cardiovascular risk factors in the Korean population.     

Prevalence of Metabolic Syndrome by different definitions,and its association with type 2 diabetes,pre-diabetes,and cardiovascular disease risk in Brazil

Background and aimsMetabolic Syndrome (MS) is increasing in developing countries. Different definitions of MS lead to discrepancies in prevalence estimates and applicability. We assessed the prevalence of MS as defined by the International Diabetes Federation (IDF), modified National Cholesterol Education Program Adult Treatment Plan III (Modified NCEP) and Joint Interim Statement (JIS); compared the diagnostic performance and association of these definitions of MS with pre-diabetes, type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) risk.MethodsA total of 714 randomly selected subjects from Northeastern Brazil were investigated in a cross-sectional study. Sociodemographic, anthropometric, and clinical data were recorded. Diagnostic test performance measures assessed the ability of the different MS definitions to identify those with pre-diabetes, T2DM and increased CVD risk.ResultsThe adjusted prevalence of MS was 36.1% applying the JIS criteria, 35.1% the IDF and 29.5% Modified NCEP. Women were more affected by MS according to all definitions. MS was significantly associated with pre-diabetes, T2DM and CVD risk following the three definitions. However, the JIS and IDF definitions showed higher sensitivity than the Modified NCEP to identify pre-diabetes, T2DM and CVD risk. The odds ratios for those conditions were not significantly different when comparing the definitions.ConclusionsMS is highly prevalent in Brazil, particularly among those with pre-diabetes, T2DM, and high CVD risk. The IDF and JIS criteria may be better suited in the Brazilian population to identify pre-diabetes, T2DM and CVD risk. This may also signify the importance of the assessment of MS in clinical practice.     

The NCEP‐ATPIII but not the IDF criteria for the metabolic syndrome identify Type 2 diabetic patients at increased risk of chronic kidney disease

Aim To examine the association between chronic kidney disease (CKD) and the metabolic syndrome (MetS) using both International Diabetes Federation (IDF) and National Cholesterol Education Program's Adult Treatment Panel III (NCEP‐ATPIII) definitions in Chinese subjects with Type 2 diabetes. Methods Subjects with Type 2 diabetes were categorized according to the presence or absence of MetS by IDF or NCEP‐ATPIII criteria. CKD was considered present if glomerular filtration rate, calculated using the abbreviated equation developed by the Modification of Diet in Renal Disease study with Chinese modification, was < 60 ml/min per 1.73 m². Multivariate logistic regression analysis of the association between CKD and MetS by either definition was performed. Results Of 6350 subjects (mean age 55.1 ± 13.3 years), 3439 (54.2%) and 3204 (50.5%) had MetS by IDF and NCEP‐ATPIII definitions, respectively. Using the IDF definition, the presence of MetS was not associated with CKD [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.71, 1.29, P = 0.784]. In contrast, the association with CKD was significant when MetS was defined by the NCEP‐ATPIII definition (OR 1.75, 95% CI 1.37, 2.24, P < 0.001). In subjects who did not have MetS (n = 2911) as defined by IDF criteria, 997 fulfilled the MetS criteria of NCEP‐ATP III. The association with CKD was stronger, after adjustment for covariates, in these subjects (OR 1.42, 95% CI 1.03, 1.97, P = 0.032) compared with subjects who met IDF criteria of MetS. Conclusion In Type 2 diabetes, NCEP‐ATPIII, but not the IDF definition of MetS, identifies a subgroup of patients who have a higher risk of CKD.     

All-cause and cardiovascular mortality using the different definitions of metabolic syndrome

The aim of the present study was to assess the risk of all-cause and cardiovascular disease (CVD) mortality in subjects identified as having metabolic syndrome (MS) using either the recent International Diabetes Federation (IDF) definition or the revised National Cholesterol Educational Program (NCEP-R) definition, but not the original NCEP (2001) definition. The study population was composed of 84,730 men and women without CVD aged > or =40 years who had a health checkup at the IPC Center. Follow-up for mortality was 4.7 +/-1.7 years. Prevalences of MS were 9.6%, 21.6%, and 16.5% according to the NCEP, IDF, and NCEP-R definitions, respectively. Compared with subjects without MS, risks of all-cause mortality associated with MS were 1.63 (95% confidence interval [CI] 1.38 to 1.93) with the NCEP, 1.25 (95% CI 1.09 to 1.45) with the IDF, and 1.32 (95% CI 1.13 to 1.53) with the NCEP-R, and risks of CVD mortality were 2.05 (95% CI 1.28 to 3.28), 1.77 (95% CI 1.18 to 2.64), and 1.64 (95% CI 1.08 to 2.50), respectively. In subjects with MS detected using the IDF and NCEP-R definitions, but not the NCEP definition, risks of all-cause mortality were 1.07 (95% CI 0.89 to 1.28) and 0.92 (95% CI 0.73 to 1.18) and 1.42 (95% CI 0.86 to 2.34) and 1.07 (95% CI 0.55 to 2.09) for CVD mortality, respectively. In conclusion, in a large French population, the recent definitions of MS almost double the prevalence compared with the original definition. Subjects identified as having MS using only the recent definitions and not the original definition did not have higher rates of all-cause and CVD mortality compared with subjects without MS during follow-up.     

IDF and ATP-III definitions of metabolic syndrome in the prediction of all-cause mortality in type 2 diabetic patients

AIM: The metabolic syndrome (MS) is associated with increased cardiovascular morbidity and mortality. Recently, the International Diabetes Federation (IDF) proposed to lower diagnostic thresholds for fasting glucose and waist circumference and to limit the diagnosis of MS only to subjects with abdominal adiposity. The aim of the present study was to assess the prognostic value of IDF criteria in diabetic patients, in comparison with previous ATP-III criteria. METHODS: An observational cohort study was performed on a consecutive series of 882 Caucasian type 2 diabetic outpatients, aged 65.3 +/- 10.9 years, with a duration of diabetes of 13.1 +/- 10.6 years. Information on 3-year all-cause mortality was obtained by the City of Florence Registry Office. RESULTS: The prevalence of MS was 68.4 and 73.7% using ATP-III and IDF criteria, respectively. Over the follow-up period, 115 (13.6%) deaths were recorded. Patients with ATP-III-defined MS showed a significantly higher mortality rate when compared with the rest of the sample (16.1% vs. 8.2%; p = 0.002), whereas a non-significant trend was observed using IDF classification (14.9% vs. 10.0%, p = 0.064). At Cox regression analysis, after adjustment for sex, age, and its individual components, diagnosis of MS with ATP-III criteria, but not with IDF criteria [OR (95% CI) 1.65 (0.99-2.72), p = 0.053], was significantly associated with higher mortality [OR (95%,CI) 2.38 [1.18-4.76]). CONCLUSION: In conclusion, in Caucasian type 2 diabetic patients the application of IDF criteria determines an increase of estimated prevalence of MS, without improving its prognostic value. Further studies are needed before the newer IDF criteria for MS are adopted on a larger scale.     

Association among metabolic syndrome, testosterone level and severity of erectile dysfunction

The purpose of this study was to determine the influence of metabolic syndrome (MS) and serum testosterone in patients with erectile dysfunction (ED) and their possible association. A total of 103 men with ED were enrolled. The International Index of Erectile Function (IIEF) questionnaire was used to assess erectile condition. MS was defined according to the criteria formulated by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) and the International Diabetes Federation (IDF). The mean age of the study population was 57.5 +/- 10.7 years, with an average IIEF of 14.7 +/- 6.7. The age and prevalence of MS using the NCEP ATP III criteria, but not the IDF criteria, were significantly different between mild and moderate/severe ED patients (p = 0.031 and 0.009, respectively). The percentage of hypertension (78.6% vs. 36.2%; p < 0.001) and raised fasting glucose levels (46.4% vs. 19.1%; p = 0.004) were significantly higher in the moderate/severe ED group, and both differences remained significant in multivariate analysis (p = 0.001 and 0.042, respectively). In addition, serum testosterone levels were significantly lower in ED patients with MS (p = 0.002). In summary, the presence of MS is associated with more severe ED. Among the components of MS, elevated blood pressure and fasting blood glucose were independent risk factors. NCEP ATP III criteria seem to correlate better with the degree of ED than the IDF definition. Our results also indicate that MS is associated with a lower testosterone level in patients with ED.     

Metabolic syndrome by the international diabetes federation definition in Hong Kong Chinese

In this report, we aimed to examine the impact of the new International Diabetes Federation (IDF) definition on the prevalence and clinical characteristics of subjects with metabolic syndrome (MES). Data were obtained from a prevalence survey for cardiovascular risk factors in a Hong Kong Chinese working population. There were 1513 subjects well representing all occupational groups from managers to general laborers [910 (60.1%) men and 603 (39.9%) women (mean age 37.5+/-9.2, median 37.0, range 18-66 years)]. The crude prevalence of MES defined by the IDF criterion was 7.4% (compared to other criteria: NCEP, 9.6%; WHO, 13.4% and EGIR, 8.9%). The age-standardized prevalence of MES by the IDF criterion was 8.8% in women and 7.3% in men. Subjects with MES defined by IDF criterion had higher body mass index and waist compared to those with MES defined by NCEP or WHO criteria, and lower triglyceride compared to those with MES defined by NCEP criterion after adjustment for age, gender and smoking. Non-MES subjects defined by IDF criterion had higher 2h glucose and insulin resistance compared to non-MES subjects defined by WHO. In conclusion, the new IDF criterion for MES is easy to implement in clinical practice. It may be potentially more 'specific' in identifying subjects with MES although compared to the NCEP criterion, it may have missed a proportion of subjects, especially men, who have metabolic derangement. Prospective and interventional studies are needed to validate the prognostic values of this new definition in comparison with other existing definitions.     

Comparison of the prevalence of metabolic syndrome and its association with diabetes and cardiovascular disease in the rural population of Bangladesh using the modified National Cholesterol Education Program Expert Panel Adult Treatment Panel III and International Diabetes Federation definitions

Aims/Introduction

To compare the prevalence of metabolic syndrome (MS) using the modified National Cholesterol Education Program Adult Treatment Plan III (NCEP) and the International Diabetes Federation (IDF) definitions and, using both definitions, determine and compare the association of MS, prediabetes, type 2 diabetes, hypertension (HTN) and cardiovascular disease risk (CVD).

Materials and Methods

A total of 2,293 randomly selected participants (aged ≥20 years) in a rural community in Bangladesh were investigated in a population-based cross-sectional study. Sociodemographic and anthropometric characteristics, blood pressure, blood glucose, and lipid profiles were studied. Age-adjusted data for MS and cardiometabolic risk factors were assessed, and their relationships were examined.

Results

The age-adjusted prevalence of MS was 30.7% (males 30.5%; females 30.5%) using the NCEP definition, and 24.5% (males 19.2%, females 27.5%) using the IDF definition. The prevalence of MS using the NCEP definition was also higher in study participants with prediabetes, type 2 diabetes, HTN and CVD risk. The agreement rate between both definitions was 92% (k = 0.80). The NCEP definition had a stronger association with type 2 diabetes and HTN (odds ratio 12.4 vs 5.2; odds ratio 7.0 vs 4.7, respectively) than the IDF definition. However, the odds ratios for prediabetes and CVD risk were not significantly different.

Conclusions

The prevalence of MS was higher using the NCEP definition, and was more strongly associated with prediabetes, type 2 diabetes, HTN and CVD in this Bangladeshi population.     

The metabolic syndrome in an Arab population: a first look at the new International Diabetes Federation criteria.

AIMS: To report the prevalence of the metabolic syndrome in Arab men and women using the new International Diabetes Federation (IDF) criteria, and to compare this with the prevalence using the 1999 World Health Organization (WHO) and 2001 National Cholesterol Education Program Adult Treatment Panel III (NECP ATPIII) definitions. METHODS: The study involved 863 subjects (343 men and 520 women) aged > or = 40 years living in Tunis, Tunisia, taken from an initially randomized, population sample. RESULTS: The prevalence of the metabolic syndrome using the IDF criteria was found to be 45.5%; 55.8% in women and 30.0% in men (P < 0.001), higher than the rates of 28.7% (WHO) and 24.3% (NECP ATPIII) using the previous definitions. Using all the definitions, the prevalence was higher in women than in men predominantly because of significant differences in central obesity and high-density lipoprotein (HDL) cholesterol and, to a lesser extent, hypertension. CONCLUSION: The increased prevalence using the IDF criteria compared with the 1999 WHO criteria and the 2001 NCEP ATPIII definitions is striking and has huge implications for public health worldwide. The major reason for the higher rate using the new definition seems to be the predominant focus placed on central obesity. Using tighter criteria for fasting glycaemia has also played a factor. The question remains as yet unanswered as to whether the new IDF criteria are better at predicting hard outcomes such as diabetes mellitus and cardiovascular diseases.     

The Pro12Ala polymorphism of the PPARG gene is not associated with the metabolic syndrome in an urban population of middle‐aged Swedish individuals

Background To determine if the common Pro12Ala polymorphism (rs1801282) of the peroxisome proliferator‐activated receptor (PPARG) gene is associated with the metabolic syndrome (MetS) or with its individual components in middle‐aged Swedish individuals. Methods MetS was defined according to the National Cholesterol Education Program/Adult Panel III (NCEP/ATP III), the International Diabetes Federation (IDF) and the European Group for the Study of Insulin Resistance (EGIR) criteria in a population‐based sample of nearly 5000 subjects participating in the Malmö Diet and Cancer‐cardiovascular arm. Results Of the subjects included in the analysis, 21.8, 29.4 and 20.4% had MetS according to the NCEP/ATP III, IDF and EGIR (only in subjects without diabetes) definitions, respectively. The Pro12Ala was not associated with MetS or with its individual components. These results were similar when patients with diabetes were excluded. Hypertensive and obese ala‐carriers had lower fasting glucose and hypertensive ala‐carriers also had lower level triglycerides (P < 0.05). Conclusions Our data do not support a major role for the Pro12Ala variant of the PPARG gene in MetS and its individual components. The modest difference in triglyceride and glucose levels, restricted to hypertensive and obese subjects in our cohort, suggests that the polymorphism has a minor effect on glucose and lipid metabolism, particularly in individuals at risk for gluco‐metabolic disturbances.     

Defining the metabolic syndrome: Resolving unresolved issues?

BACKGROUND: Several definitions exist for the metabolic syndrome. In concert with the blood pressure and glucose criteria of the NCEP definition, it has now been suggested that the use of fibrates and nicotinic acid be incorporated into the dyslipidemia criteria. While statins are the drugs most widely prescribed for lowering LDL-cholesterol, they also affect triglyceride and HDL-cholesterol levels. The aims of the present study were (1) to investigate how adding lipid-lowering therapy to the NCEP definition might influence the prevalence of the metabolic syndrome and (2) to compare the characteristics of patients identified according to the newly proposed IDF definition with those identified according to the NCEP definition. METHODS: We conducted a cross-sectional study on 2373 patients with clinically manifest vascular disease. In order to allow for the influence of lipid-lowering therapy on the identification of patients with the metabolic syndrome, the NCEP definition was modified in two ways. In NCEP-rev1, the use of lipid-lowering agents fulfilled the hypertriglyceridemia criterion; in NCEP-rev2, triglycerides and HDL-cholesterol plasma concentrations were recalculated for lipid-lowering agents. RESULTS: The prevalence of the metabolic syndrome was 41% according to the NCEP definition, 50% according to the NCEP-rev1, 44% according to the NCEP-rev2, and 52% according to the IDF definition. Patients identified only with the NCEP definition had lower HDL-cholesterol, higher triglycerides, and higher fasting glucoses levels than patients only diagnosed with the IDF definition. CONCLUSION: Adding the use of lipid-lowering drugs to the NCEP definition may lead to the identification of an additional group of patients at an elevated risk for cardiovascular diseases and diabetes. The NCEP definition of the metabolic syndrome identifies patients with a worse cardiovascular risk profile than patients qualifying for the metabolic syndrome with the IDF definition in a cohort of patients with clinical manifestations of vascular disease.