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

Predicting metabolic syndrome by obesity- and lipid-related indices in mid-aged and elderly Chinese: a population-based cross-sectional study

Objective

To predict the optimal cut-off values for screening and predicting metabolic syndrome(MetS) in a middle-aged and elderly Chinese population using 13 obesity and lipid-related indicators, and to identify the most suitable predictors.

Methods

The data for this cross-sectional investigation came from the China Health and Retirement Longitudinal Study (CHARLS), including 9457 middle-aged and elderly people aged 45-98 years old. We examined 13 indicators, including waist circumference (WC), body mass index (BMI), waist-height ratio (WHtR), visceral adiposity index (VAI), a body shape index (ABSI), body roundness index (BRI), lipid accumulation product index (LAP), conicity index (CI), Chinese visceral adiposity index (CVAI), triglyceride-glucose index (TyG-index) and their combined indices (TyG-BMI, TyG-WC, TyG-WHtR). The receiver operating characteristic curve (ROC) was used to determine the usefulness of indicators for screening for MetS in the elderly and to determine their cut-off values, sensitivity, specificity, and area under the curve (AUC). Association analysis of 13 obesity-related indicators with MetS was performed using binary logistic regression analysis.

Results

A total of 9457 middle-aged and elderly Chinese were included in this study, and the overall prevalence of the study population was 41.87% according to the diagnostic criteria of NCEP ATP III. According to age and gender, the percentage of males diagnosed with MetS was 30.67% (45-54 years old: 30.95%, 55-64 years old: 41.02%, 65-74 years old: 21.19%, ≥ 75 years old: 6.84%). The percentage of females diagnosed with MetS was 51.38% (45-54 years old: 31.95%, 55-64 years old: 39.52%, 65-74 years old: 20.43%, ≥ 75 years old: 8.10%). The predictive power of Tyg-related parameters was more prominent in both sexes. In addition, LAP and CVAI are also good at predicting MetS. ABSI had a poor prediction ability.

Conclusions

Among the middle-aged and elderly population in China, after adjusting for confounding factors, all the indicators except ABSI had good predictive power. The predictive power of Tyg-related parameters was more prominent in both sexes. In addition, LAP and CVAI are also good at predicting MetS.

Association between anxiety and metabolic syndrome: An updated systematic review and meta-analysis

Objective

Previous studies have demonstrated an association between anxiety and metabolic syndrome (MetS). However, the association is still controversial. This updated meta-analysis aimed to reanalyze the association between anxiety and MetS.

Methods

We comprehensively searched PubMed, Embase and Web of Science for all related studies published before January 23, 2023. Observational studies that informed effect size with 95% confidence interval (CI) for the association between anxiety and MetS were included. According to heterogeneity between studies, fixed or random effects models were applied to calculate the pooled effect size. Publication bias was examined by funnel plots.

Results

The research included 24 cross-sectional studies: 20 studies used MetS as the dependent variable with a pooled OR of 1.07 (95% CI: 1.01-1.13) and four studies used anxiety as the dependent variable with a pooled OR of 1.14 (95% CI: 1.07-1.23). Three cohort studies were found: two studies detected the association of baseline anxiety with the risk of MetS, one of the studies demonstrated a significant association, but a similar result was not found in another study; one study showed no significant association between baseline MetS and the risk of anxiety.

Conclusion

Cross-sectional studies indicated an association between anxiety and MetS. The results from cohort studies are still inconsistent and limited. More large-scale prospective studies are needed to further reveal the causal relationship of anxiety with MetS.

Socio demographic and lifestyle factors of metabolic syndrome among adult rural indigenous Malaysian population from Perak State, Malaysia

Metabolic syndrome (MetS) is defined as a cluster of known disorders that increase the risk for morbidity and mortality from cardiovascular diseases (CVD) and type 2 diabetes mellitus. This cross sectional study was carried out to estimate the prevalence of MetS using Adult Treatment Panel 3 (ATP 3) classification and socio-demographic and lifestyle factors contributing to metabolic syndrome among rural indigenous Malaysian population from Perak state, Malaysia which included 148 rural Malay and 145 Orang Asli(OA) individuals. This community based cross-sectional study revealed that the prevalence of MetS was significantly higher among Malays (27.7%) as compared to Orang Aslis (13.8%). Overall Prevalence of Metabolic syndrome in the rural indigenous Malaysian population was 20.8%. Prevalence of abdominal obesity and high blood pressure were significantly higher among Malays as compared to OA population. Metabolic syndrome was significantly higher among those above 45 years of age group in overall rural indigenous Malaysian population and among OA. The prevalence of MetS was significantly higher among those who were obese and overweight and among Malays who were regularly taking snacks between meals. There was no significant association between other dietary risk factors, smoking, alcohol use or physical activity with metabolic syndrome.

The IDF Definition Is Better Suited for Screening Metabolic Syndrome and Estimating Risks of Diabetes in Asian American Adults: Evidence from NHANES 2011-2016

OBJECTIVE

extensive effort has been made to better define metabolic syndrome (MetS). Whether current definitions accurately diagnose MetS and predict risk of cardiovascular disease (CVD) or diabetes in diverse ethnic groups remains largely unknown. The objective of this study was to compare the prevalence of MetS and risk of CVD and diabetes among Asian American adults using two MetS definitions, one proposed by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) and one by the International Diabetes Federation (IDF).

METHODS

we obtained a nationally representative sample of 2121 Asian American adults in the noninstitutionalized civilian population of the United States from the National Health and Nutrition Examination Survey (2011-2016). We computed age-adjusted, gender-specific MetS prevalence and each MetS component using ATP III and IDF definitions.

RESULTS

based on the IDF definition, MetS prevalence was 39.26% among Asian American men and 39.66% among Asian American women included in the study sample. Based on the ATP III definition, MetS prevalence in our sample was 39.38% among men and 36.11% among women. We found good concordance between the IDF and the ATP III definitions in identifying MetS in Asian American adults. Those with MetS defined only by the IDF definition had significantly higher body mass index (BMI) and waist circumference than those with MetS defined only by the ATP III definition. The IDF definition also better predicted elevated fasting insulin.

CONCLUSIONS

the IDF definition is more pertinent than the ATP III definition for screening and estimating risk of CVD and diabetes in Asian American adults. Future studies should examine differences in MetS prevalence across Asian ethnic groups to facilitate the development of culturally tailored strategies improve MetS prevention and detection in Asian Americans.

Cardiometabolic health, prescribed antipsychotics and health-related quality of life in people with schizophrenia-spectrum disorders: a cross-sectional study

BACKGROUND

People with schizophrenia-spectrum disorders (SSD) often have high levels of obesity and poor cardiometabolic health. Certain types of antipsychotics have been shown to contribute towards weight gain and there is some equivocal evidence that obesity is related to poor health-related quality of life (HRQoL) in people with SSD. It is also still uncertain if antipsychotic polypharmacy/higher doses of antipsychotics are linked with HRQoL and/or increased risk of obesity/Cardiovascular Disease (CVD). Therefore, this study aimed to examine potential relationships between prescribed antipsychotic medication regimens, cardiometabolic health risks and HRQoL in community-based Chinese people with SSD.

METHOD

This cross-sectional study reports the results of baseline measurements of a random sample of patients in an ongoing controlled trial of physical health intervention for people with severe mental illness. Data from these randomly-selected participants (n = 82) were analysed to calculate 10-year CVD relative-risk (using QRISK®2 score), estimate the prevalence of metabolic syndrome and contextualize patients' prescribed antipsychotics (types, combinations and Daily Defined Dose equivalent). Patients self-reported their HRQoL (SF12v2) and their obesity condition was assessed by waist-circumference and Body Mass Index (BMI).

RESULTS

Two-thirds of patients had a BMI ≥23 kg/m², almost half were centrally obese and 29% met the criteria for metabolic syndrome. The individual relative-risk of CVD ranged from 0.62 to 15, and 13% had a moderate-to-high 10-year CVD risk score. Regression models showed that lower physical HRQoL was predicted by higher BMI and lower mental HRQoL. Higher Defined Daily Dose, clozapine, younger age and male gender were found to explain 40% of the variance in CVD relative risk.

CONCLUSION

The findings indicate that cardiometabolic health risks in people with SSD may be more common than those reported in the general Hong Kong population. The results also provide further support for the need to consider antipsychotic polypharmacy and higher doses of antipsychotics as factors that may contribute towards cardiometabolic risk in Chinese patients with SSD. Clinicians in Hong Kong should consider using routine CVD risk screening, and be aware that younger male patients who are taking clozapine and prescribed higher Defined Daily Dose seem to have the highest relative-risk of CVD.

TRIAL REGISTRATION

Clinicaltrials.gov NCT02453217 . Prospectively registered on 19^th May 2015.

Cardiovascular Risk Factors and Ethnicity Are Independent Factors Associated with Lower Urinary Tract Symptoms

Objectives

To determine the lower urinary tract symptoms (LUTS) profile and factors affecting its degree of severity including cardiovascular risk profile, age, ethnicity, education level and prostate volume in a multiethnic Asian setting.

Materials and Methods

We conducted a cross-sectional study of 1021 men aged 40–79 years with no clinical evidence of prostate cancer, prostate surgery or 5α-reductase inhibitor treatment of known prostate conditions. The severity of LUTS was assessed using the International Prostate Symptom Score (IPSS). Potential factors associated with LUTS including age, ethnicity, education, history of hypertension, diabetes and hypercholesterolemia, height, weight, and prostate volume were evaluated using univariable and multivariable analyses.

Results

There were 506 (50%) men found to have moderate-to-severe LUTS attaining an IPSS above 7. Overall, nocturia (45.5%) was the most frequently reported symptom. Multivariable analysis showed that age, ethnicity, prostate volume and history of hypertension and hypercholesterolemia were independent factors associated with severity of LUTS (p < 0.05). Considering individual lower urinary tract symptoms, we found a strong association of storage symptom with history of hypertension and hypercholesterolemia. Malay men were significantly bothered by post micturition symptom compared to their Chinese and Indian counterparts. Stratified analyses of LUTS demonstrated a mutually exclusive cardiovascular risk factors profile defined by ethnicity.

Conclusion

Severity of LUTS varies between different ethnicities across all age groups. In addition to age and prostate volume, ethnicity and cardiovascular risk factors including hypertension and hypercholesterolemia may also need to be taken into account in managing men with LUTS.

The prevalence of metabolic syndrome amongst patients with severe mental illness in the community in Hong Kong--a cross sectional study

BACKGROUND

Patients with severe mental illness are at increased risk of developing metabolic disorders. The risk of metabolic syndrome in the Hong Kong general population is lower than that observed in western countries; however the prevalence of metabolic syndrome in patients with severe mental illness in Hong Kong is unknown.

METHOD

This cross-sectional study aimed to estimate the prevalence of metabolic syndrome in patients with severe mental illness in Hong Kong and to identify the relationships between metabolic syndrome and socio-demographic, clinical and lifestyle factors.

RESULTS

A total of 139 patients with a diagnosis of severe mental illness participated in the study. The unadjusted prevalence of metabolic syndrome was 35%. The relative risk of metabolic syndrome in comparison with the general Hong Kong population was 2.008 (95% CI 1.59-2.53, p < 0.001). In a logistic regression model sleep disruption and being prescribed first generation antipsychotics were significantly associated with the syndrome, whilst eating less than 3 portions of fruit/vegetables per day and being married were weakly associated.

CONCLUSION

The results demonstrate that metabolic syndrome is highly prevalent and that physical health inequalities in patients with severe mental illness in Hong Kong are similar to those observed in western countries. The results provide sufficient evidence to support the need for intervention studies in this setting and reinforce the requirement to conduct regular physical health checks for all patients with severe mental illness.

Predictors of ischaemic heart disease in a Malaysian population with the metabolic syndrome

AIMS

Cardiovascular disease is the foremost cause of mortality in Malaysia but little is known about the prevalence of the metabolic syndrome and its associations with other known cardiovascular risk markers. We undertook a population-based study to examine these.

METHODS

For the study, 4341 subjects were selected using a multistage stratified sampling method. Subjects were interviewed for personal and past medical history. Biomedical markers and anthropometric indices were measured. The metabolic syndrome was defined using the harmonized criteria. The associations between the metabolic syndrome and cardiovascular risk markers, including high-sensitivity C-reactive protein, microalbuminuria and HbA(1c) were examined.

RESULTS

The prevalence of the metabolic syndrome was 42.5%. Subjects with the metabolic syndrome are significantly more likely to have higher BMI (> 25 kg/m(2)), HbA(1c) [≥ 42 mmol/mol (6.0%)], LDL (≥ 2.6 mmol/l), elevated albumin:creatinine ratio (> 2.5 μg/mmol creatinine for men, 3.5 μg/mmol creatinine for women) and high-sensitivity C-reactive protein (> 3 mg/l); odds ratio 5.48, 6.14, 1.44, 3.68 and 1.84, respectively, P < 0.001. The presence of an elevated albumin:creatinine ratio and high-sensitivity C-reactive protein are strong predictors for the presence of a higher number of positive criteria of the metabolic syndrome. HbA(1c) > 48 mmol/mol (6.5%) is associated with increased relative risk of elevated albumin:creatinine ratio, high-sensitivity C-reactive protein and LDL (relative risk 3.10, 2.46 and 1.65 respectively, P < 0.001).

CONCLUSIONS

We confirmed the high prevalence of the metabolic syndrome in Malaysia. Our study revealed a strong relationship between risk markers of elevated BMI, HbA(1c), LDL, albumin:creatinine ratio and high-sensitivity C-reactive protein with the presence of the metabolic syndrome, putting them at a statistically high risk for cardiovascular mortality.

Prevalence of the metabolic syndrome in a rural population in Ghana

BACKGROUND

The Metabolic syndrome (MS) which is a constellation of cardiometabolic risk factors including dyslipidaemia, hypertension, hyperglycaemia, central obesity, and endothelial dysfunction was hitherto relatively uncommon among Africans south of the Sahara. This study seeks to determine the prevalence of MS, its components and risk factors among a rural population in Ghana based on two popular international algorithms.

METHODS

This was a cross-sectional survey of a rural population in Ghana conducted between November and December, 2007. Two hundred and twenty-eight (228) settler farmers, families and staff associated with the GOPDC Ltd, between the ages of 35 and 64 years, were randomly selected for the study; pregnant women were excluded. The prevalence of MS was estimated using the IDF and ATPIII criteria.

RESULTS

The final subject pool included 102 males, and 104 females. The mean age of all subjects was 44.4 ± 6.9 years. The overall prevalence of MS by the IDF and ATPIII criteria were 35.9% and 15.0%, respectively, but there was an alarming female preponderance by both criteria {IDF: males = 15.7%, females =55.8%; ATPIII: males = 5.9%, females = 24.0%; sex differences p<0.001 for both criteria}. The most important determinants for IDF-defined MS were central obesity (55.3%), low High Density Lipoprotein (42.7%) and high Blood Pressure (39.5%).

CONCLUSION

The triad of central obesity, high blood pressure and low HDL were most responsible for the syndrome in this rural population.

Prevalence of metabolic syndrome and its risk factors in adult Malaysians: results of a nationwide survey

Aim: To report the national prevalence of metabolic syndrome (MetS) and its risk factors among adult Malaysians (>18 years old) based on World Health Organization (WHO), the National Cholesterol Education Program Expert Panel III (ATP III), International Diabetes Federation (IDF) and the 'Harmonized' criteria.Methods: A multi-stage stratified sampling method was used to select 4341 subjects from Peninsular and East Malaysia. Subjects underwent physical and clinical examinations.Results: Based on the WHO, ATP III, IDF and Harmonized definitions, the overall crude prevalences of MetS were 32.1, 34.3, 37.1 and 42.5%, respectively. Regardless of the criteria used, MetS was higher in urban areas, in females, in the Indian population and increased significantly with age. Risk factors also increased with age; abdominal obesity was most prevalent (57.4%), was higher in females (64.2%) and was highest in Indians (68.8%).Hypertension was higher in males (56.5%) and highest among Malays (52.2%). In contrast,the Chinese had the highest prevalence of hypertriglyceridemia (47.4%).Conclusions: Malaysia has a much higher prevalence of MetS compared with other Asian countries and, unless there is immediate intervention to reduce risk factors, this may pose serious implications on the country's healthcare costs and services.

Metabolic syndrome among obese Qataris attending primary health care centers in Doha, 2010

OBJECTIVES

To determine the prevalence of metabolic syndrome among obese patients using the IDF definition and to identify factors that are associated with it.

MATERIALS AND METHODS

A cross-sectional randomized study was conducted at four primary care centers inside Doha, Qatar. One hundred and thirty-six Adults, ≥ 18 Qatari obese patients, were chosen by systematic random sampling. They were interviewed and screened for the presence of metabolic syndrome, which was diagnosed according to the International Diabetes Federation criteria: An abdominal circumference ≥ 94 cm in males or ≥ 80 cm in females, plus any two of the following: HDL cholesterol < 1.03 mmol / mL (< 40 mg / dL) [males] or < 1.3 mmol / mL (< 50 mg / dL) [females], Triglycerides ≥ 1.7 mmol / mL (≥150 mg / dL), Blood pressure ≥ 130 / 85 mmHg or the patient receiving antihypertensive treatment and baseline glycemia > 5.6 mmol / mL (> 100 mg / dL), or previously-diagnosed type 2 diabetes mellitus.

RESULTS

The overall prevalence of the metabolic syndrome among obese patients was 46.3%. The prevalence was higher in females (50%) than in males (42.4%). It was seen to increase with increasing body mass index class, from class 1 to class 2. The prevalence of metabolic comorbidities of abnormal waist circumference, raised blood pressure, raised fasting blood glucose, high triglycerides, and reduced high density lipoprotein was 88.2, 42.6, 32.4, 31.6, and 27.9%, respectively. Based on the logistic regression multivariable analysis, increasing age and being diabetic were the only significant associated factors that influenced the risk of having the metabolic syndrome.

CONCLUSION

The prevalence of the metabolic syndrome was high, and the highest comorbidities were abnormal waist circumference and high blood pressure. Diabetes and increasing age were the only significant risk factors of having this syndrome.

Prevalence of Metabolic Syndrome Defined by the International Diabetes Federation and National Cholesterol Education Program Criteria Among Thai Adults

This study determines the prevalence of metabolic syndrome (MetS) according to the International Diabetes Federation (IDF) and National Cholesterol Education Program III (NCEP) criteria in Thai adults. Data from a national representative sample, InterASIA study, including a total of 5305 Thai adults 35 years and older were analyzed. Overall, the age-standardized prevalence of MetS by IDF and NCEP criteria were 24.0% (men 16.4%, women 31.6%) and 32.6% (men 28.7%, women 36.4%), respectively. The difference in prevalence of MetS between genders was much greater for the IDF compared with the NCEP definition. The age-standardized prevalence rates distributed by geographic region were relatively uniform with a lowest prevalence in the northeast. Among all possible sets of components for MetS, the most common combinations were a set of low high-density lipoprotein cholesterol, high triglyceride, and hyperglycemia in men (3.9%) and a set of abdominal obesity, low high-density lipoprotein cholesterol, and high triglycerides in women (6.7%). MetS is common in Thai adults and NCEP definition captures more cases of MetS compared with the IDF definition. Implementation of programs to prevent obesity and metabolic factors along with future periodic survey to monitor the problem is crucial.

Prevalence of metabolic syndrome in rural and urban Chinese population in Qingdao

AIMS

To investigate the prevalence of metabolic syndrome and its components in both rural and urban Chinese population.

SUBJECTS AND METHODS

A population-based crosssectional survey was conducted in Qingdao, China in 2006 with 6100 Chinese aged 35-74 yr invited and 5355 who attended; 3357 subjects, 1562 urban (46.5%) and 1795 rural residents (53.5%) met the inclusion criteria for the current data analysis. The metabolic syndrome definitions of National Cholesterol Education Program Adult Treatment Expert Panel III (NCEPATPIII) 2004, NCEP 2005 and International Diabetes Federation (IDF) were used.

RESULTS

The age-standardized prevalences of metabolic syndrome were 16.2%, 32.2%, and 28.3% in men and 26.8%, 37.2%, and 34.6%in women, according to the definitions of the NCEP 2004, NCEP 2005, and IDF, respectively. Urban men have more risk factors and higher prevalence of the metabolic syndrome than rural men, but the differences in women were not that striking. Elevated blood pressure (62.6%) was, among risk factors, most common in the study population, followed by central obesity (53.4%), and hyperglycemia (52.2%) defined using the NCEP 2005 criteria.

CONCLUSIONS

Metabolic disorders were common among adult Chinese in both rural and urban areas in Qingdao.

Prevalence of metabolic syndrome and its risk factors in adult Malaysians: results of a nationwide survey

AIM

To report the national prevalence of metabolic syndrome (MetS) and its risk factors among adult Malaysians (>18 years old) based on World Health Organization (WHO), the National Cholesterol Education Program Expert Panel III (ATP III)(,) International Diabetes Federation (IDF) and the 'Harmonized' criteria.

METHODS

A multi-stage stratified sampling method was used to select 4341 subjects from Peninsular and East Malaysia. Subjects underwent physical and clinical examinations.

RESULTS

Based on the WHO, ATP III, IDF and Harmonized definitions, the overall crude prevalences of MetS were 32.1, 34.3, 37.1 and 42.5%, respectively. Regardless of the criteria used, MetS was higher in urban areas, in females, in the Indian population and increased significantly with age. Risk factors also increased with age; abdominal obesity was most prevalent (57.4%), was higher in females (64.2%) and was highest in Indians (68.8%). Hypertension was higher in males (56.5%) and highest among Malaysians (52.2%). In contrast, the Chinese had the highest prevalence of hypertriglyceridaemia (47.4%).

CONCLUSIONS

Malaysia has a much higher prevalence of MetS compared with other Asian countries and, unless there is immediate intervention to reduce risk factors, this may pose serious implications on the country's healthcare costs and services.

Association Between Elevated Liver Enzymes and Metabolic Syndrome Among Thai Adults

BACKGROUND

To examine the relation between elevated liver marker concentrations (alanine aminotransferase [ALT], aspartate aminotransferase [AST], and alkaline phosphatase [ALP]) and risk of metabolic syndrome (MetS).

METHODS

This cross-sectional study was comprised of 1,391 Thai participants (451 men and 940 women) receiving annual health check-ups. Multivariable logistic regression procedures were used to estimate odds ratios (OR) and 95% confidence intervals (95%CI) of MetS risk according to quartiles of each liver marker concentration with the lowest quartile specified as the referent group.

RESULTS

Overall, mean concentrations of AST, ALT and ALP increased and mean AST:ALT ratio decreased with increasing presence of metabolic abnormalities (p-value=0.059 for AST in men, all other p-values <0.001). After adjusting for confounders, men with ALT concentrations in the extreme quartiles (>40 units/L), had a 2.77-fold increased risk of MetS (95%CI: 1.18-6.53), as compared with men who had values in the lowest quartile (≤21 units/L). The OR for extreme quartiles of ALP concentrations was 3.72 (95%CI: 1.49-9.29). In women, elevated ALT concentrations were also associated with MetS risk. Those with the highest ALT concentrations (>23 units/L) had a 2.55-fold increased risk of MetS (95%CI: 1.22-5.35) compared to women with concentrations ≤13 units/L.

CONCLUSIONS

These findings add to an emerging body of literature that suggests elevated liver enzymes may be related with MetS risk. However, prospective studies are needed to more fully determine the practical value of elevated liver enzymes as a clinical risk predictor of MetS and related disorders among Thai adults.

Perturbed autonomic nervous system function in metabolic syndrome

The metabolic syndrome is characterized by the clustering of various common metabolic abnormalities in an individual and it is associated with increased risk for the development of type 2 diabetes and cardiovascular diseases. Its prevalence in the general population is approximately 25%. Central fat accumulation and insulin resistance are considered as the common denominators of the abnormalities of the metabolic syndrome. Subjects with metabolic syndrome have autonomic nervous system dysfunction characterized by predominance of the sympathetic nervous system in many organs, i.e. heart, kidneys, vasculature, adipose tissue, and muscles. Sympathetic nervous system activation in metabolic syndrome is detected as increased heart rate and blood pressure, diminished heart rate variability, baroreceptor dysfunction, enhanced lipolysis in visceral fat, increased muscle sympathetic nerve activity, and high urine or plasma catecholamine concentrations as well as turnover rates. The augmented sympathetic activity in individuals with metabolic syndrome worsens prognosis of this high-risk population. The mechanisms linking metabolic syndrome with sympathetic activation are complex and not clearly understood. Whether sympathetic overactivity is involved in the development of the metabolic syndrome or is a consequence of it remains to be elucidated since data from prospective studies are missing. Intervention studies have demonstrated that the autonomic disturbances of the metabolic syndrome may be reversible.

National Cholesterol Educational Program and International Diabetes Federation diagnostic criteria for metabolic syndrome in an Italian cohort: results from the FIBAR Study

BACKGROUND

The adoption of the International Diabetes Federation (IDF) criteria for metabolic syndrome (MS), in comparison with the National Cholesterol Educational Program (NCEP) criteria, produces different changes in estimates of prevalence in diverse populations. Few data are available in Caucasian non-diabetic subjects.

PATIENTS AND METHODS

The prevalence of NCEP- and IDF-defined MS was assessed in a sample of 2,945 individuals, aged 55.2+/-11.5 yr, enrolled in a screening program for diabetes. Association of different definitions of MS with glucose intolerance (120-min glucose 7.8 mmol/l after a 75 g-oral glucose load) and hyperuricemia (>0.38 mmol/l) was also assessed.

RESULTS

The prevalence of MS was 16.6% and 29.7% with NCEP and IDF definitions, respectively. The prevalence of NCEP-defined MS was higher than IDF-MS through all age ranges; among those aged >60 yr, the prevalence of IDF-MS reached 52.8% (vs 33.1% for NCEP-MS). Both NCEP- and IDF-MS were associated with glucose intolerance and hyperuricemia. Individuals fulfilling IDF, but not NCEP criteria for MS, showed a prevalence of glucose intolerance (22.7%) significantly (p<0.05) lower than those fulfilling NCEP criteria only (31.6%) or both sets of criteria (31.8%).

CONCLUSION

In Caucasian subjects without known diabetes, IDF criteria produce a relevant increase in estimates of prevalence of MS, particularly in older subjects, when compared with NCEP criteria. NCEP-MS seems to be more effective than IDF-MS in the identification of glucose intolerant subjects.

A comparison of two proposed definitions for metabolic syndrome in the Chinese adult population

BACKGROUND

The metabolic syndrome is a major risk factor for cardiovascular disease (CVD). We estimated the prevalence of the metabolic syndrome using the definitions proposed by the International Diabetes Federation (IDF) and the American Heart Association and the National Heart, Lung, and Blood Institute (revised ATP III), and compared the 2 definitions in the Chinese adult population.

METHODS

We conducted a cross-sectional study among a nationally representative sample of 15,838 Chinese adults ages 35 to 74 years in 2000 to 2001. Waist girth, blood pressure, and blood levels of HDL-cholesterol, triglycerides, and glucose were measured according to standard methods.

RESULTS

The overall age-standardized prevalence of the metabolic syndrome by the IDF and revised-ATP III definitions was 16.5% and 23.3%, respectively. The overall agreement of being classified as having or not having the metabolic syndrome was 93.2% for the 2 definitions, with a Kappa coefficient of 0.80. The prevalence significantly increased with age and was higher in women than in men by both definitions (23.3% vs 10.0% for IDF and 29.1% vs 17.7% for revised ATP III). Compared with men, women had a significantly higher prevalence of central obesity (37.6% vs 16.0%) and reduced HDL-cholesterol (46.5% vs 21.9%), whereas men had a significantly higher prevalence of raised blood pressure (44.2% vs 38.0%) compared with women.

CONCLUSIONS

The metabolic syndrome is very common in China regardless of the definition used. Prevention and treatment of the metabolic syndrome should become a public health priority to reduce the CVD-related burden in China.

Prevalence of metabolic syndrome in Iranian adult population, concordance between the IDF with the ATPIII and the WHO definitions

BACKGROUND

Different criteria have been proposed by the WHO, the ATPIII and the International Diabetes Federation (IDF) for the diagnosis of the metabolic syndrome (MES). The objective of this study was to estimate the prevalence of this syndrome using the IDF definition among Iranian adults and to compare it with the prevalence estimated using the two other definitions.

MATERIALS AND METHODS

The prevalence of the MES was determined according to the three different proposals in 10,368 men and women aged >/=20 years participated in the cross-sectional phase of the Tehran Lipid and Glucose Study. To assess the degree of agreement between different MES definitions, the k test was used.

RESULTS

The prevalence of MES (95% confidence interval) was 32.1% (31.2-33.0) by the IDF definition, 33.2% (32.3-34.1) by the ATPIII and 18.4% (17.6-19.2) according to the WHO definition. The sensitivity, specificity of the IDF definition for detecting MES were 91%, 89% for the ATPIII and 73%, 77% for the WHO definition, respectively. The k statistics for the agreement of the IDF definition was 66.3+/-0.01 with the ATPIII and 39.5+/-0.01 with the WHO definition.

CONCLUSION

In the Iranian population, the IDF definition for MES has a good concordance with the ATP III definition and a low concordance with the WHO definition.

Etiologies of chronic liver diseases in Hong Kong

BACKGROUND

In Hong Kong, chronic hepatitis B (CHB) is endemic with a prevalence rate of 8.8%. Data, however, on chronic hepatitis C infection and other nonviral causes of chronic liver disease (CLD) are limited.

AIM

To investigate the spectrum of CLDs in Hong Kong.

METHODS

Records of all patients attending the Hepatology Clinic of Queen Mary Hospital, Hong Kong, in 2004 were reviewed to identify those with CLDs and their underlying causes.

RESULTS

A total of 6106 patients were found to have CLD. CHB accounted for 89.4% of the cases, followed by chronic hepatitis C infection (5.1%). Nonviral causes accounted for the remaining 5.5% [alcoholic liver disease (ALD) (1.7%), nonalcoholic fatty liver disease (1.5%), primary biliary cirrhosis (PBC) (1.3%)]. Patients with CHB and Wilson's disease were significantly younger than patients with other causes (P<0.002). More than 90% of patients with autoimmune hepatitis and PBC were women. The prevalence of CHB infection was lower in patients with PBC than the general population. Among patients with ALD, the prevalence rate was higher for chronic hepatitis C but similar for CHB, as compared with the general population.

CONCLUSIONS

Despite universal HBV vaccination since 1988, CHB remains the commonest cause of CLD in Hong Kong. PBC and nonalcoholic fatty liver disease were not rare in the Chinese population, being important causes of nonviral liver disease. The prevalence of chronic viral infection among patients with PBC or ALD confirmed the findings of other published literatures.

The Prevalence of Metabolic Syndrome in Various Populations

The insulin resistance/metabolic syndrome is characterized by the variable co-existence of hyperinsulinemia, obesity, dyslipidemia (small dense low-density lipoprotein, hypertriglyceridemia, and decreased high-density lipoprotein cholesterol), and hypertension. The pathogenesis of the syndrome has multiple origins. However, obesity and sedentary lifestyle coupled with diet and still largely unknown genetic factors clearly interact to produce the syndrome. This multifactorial and complex trait of metabolic syndrome leads to increased risk of cardiovascular disease. The scope of this review is to examine the differences in prevalence of the metabolic syndrome in various groups (eg, according to age, sex, ethnicity, social status, or presence of obesity) that could help with the better understanding of the pathogenesis of this syndrome. This review also considers the impact of metabolic syndrome on cardiovascular disease.

Metabolic syndrome, or What you will: definitions and epidemiology

The metabolic syndrome is a clustering of risk factors which predispose an individual to cardiovascular morbidity and mortality. There is general consensus regarding the main components of the syndrome (glucose intolerance, obesity, raised blood pressure and dyslipidaemia [elevated triglycerides, low levels of high-density lipoprotein cholesterol]) but different definitions require different cut points and have different mandatory inclusion criteria. Although insulin resistance is considered a major pathological influence, only the World Health Organization (WHO) and European Group for the study of Insulin Resistance (EGIR) definitions include it amongst the diagnostic criteria and only the International Diabetes Federation (IDF) definition has waist circumference as a mandatory component. The prevalence of metabolic syndrome within individual cohorts varies with the definition used. Within each definition, the prevalence of metabolic syndrome increases with age and varies with gender and ethnicity. There is a lack of diagnostic concordance between different definitions. Only about 30% of people could be given the diagnosis of metabolic syndrome using most definitions, and about 3540% of people diagnosed with metabolic syndrome are only classified as such using one definition. There is currently debate regarding the validity of the term metabolic syndrome, but the presence of one cardiovascular risk factor should raise suspicion that additional risk factors may also be present and encourage investigation. Individual risk factors should be treated.

The metabolic syndrome and chronic kidney disease in a Southeast Asian cohort

US adults with metabolic syndrome, as defined by National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria, have been shown to be at increased risk of chronic kidney disease (CKD), but there is limited information in other populations. The relationship between metabolic syndrome and CKD (defined as estimated glomerular filtration rate <60 ml/min/1.73 m(2)) was examined in a Southeast Asian cohort. This relationship was examined when the subjects (n=3195) were initially recruited in a cross-sectional analysis. The risks of developing new CKD associated with metabolic syndrome were also examined prospectively in a subgroup (n=2067) without CKD at entry after 12 years follow-up. Metabolic syndrome was defined according to both NCEP ATP III and the new International Diabetes Federation (IDF) criteria. The prevalence of CKD was 1.6%, and the incidence of new CKD was 6.3%. Metabolic syndrome by NCEP ATP III definition was associated with the increased risk of CKD at baseline (adjusted odds ratio (OR) 2.48 and 95% confidence interval 1.33-4.62), and of developing new CKD at follow-up (adjusted OR 1.62 and 95% confidence interval 1.00-2.61). There was a significant graded relationship between the number of metabolic syndrome components present and risk of CKD. By contrast, metabolic syndrome by IDF definition was not associated with increased risk of CKD. These results suggest the relationship between CKD and metabolic syndrome in a Southeast Asian population is highly dependent on the criteria used to define metabolic syndrome.