Metabolic syndrome in the Military Health System based on electronic health data, 2009-2012

Gender Differences in the Prevalence of Metabolic Syndrome Among Taiwanese Air Force Personnel: A Population-Based Study

BACKGROUND

Authors of several studies have reported differences in the prevalence of metabolic syndrome (MetS) between men and women. However, information is lacking on gender difference among military personnel.

OBJECTIVE

The aim of this study was to examine the prevalence of MetS and its component abnormalities among Taiwanese Air Force personnel by gender and age groups.

METHODS

A population-based study was conducted including 14 872 Taiwanese Air Force personnel. Data were retrieved from the military's Health Management Information System. Analyses were performed using Student t test, χ test, and linear-by-linear χ test. Statistical significance was defined as P < .05.

RESULTS

The MetS prevalence was 14.0% (15.1% in men and 5.3% in women). Metabolic syndrome was associated with age for both men and women (both Ptrend < .001), with a greater prevalence of MetS in men aged 18 to 44 years than in women, but not in the age group of 45 years or older. In men, MetS was most prevalent in those with increased waist circumference (78.2%), followed by those with elevated blood pressure (75.6%). By contrast, in women, it was most prevalent in those with increased waist circumference (86.5%), followed by those with reduced high-density lipoprotein cholesterol (84.3%).

CONCLUSIONS

Our findings suggest that military nurses and other health providers should consider the gender- and age-based MetS prevalence trend among Taiwanese Air Force personnel when designing interventions to identify vulnerable subgroups at a high risk of MetS. Health management programs should be adapted to minimize metabolic risks.

Metabolic Syndrome Prevalence among Armed Forces Personnel (Military Personnel and Police Officers): A Systematic Review and Meta-Analysis

INTRODUCTION

Metabolic syndrome (MetS) is closely linked to type 2 diabetes and cardiovascular disease. Various studies have reported the prevalence of MetS in different armed forces personnel in different countries. However, performing a systematic review and meta-analysis on this subject seems necessary. The aim of this study was to estimate the pooled prevalence of MetS among armed forces personnel including members of the military and police forces.

MATERIALS AND METHODS

A systematic review was carried out on all associated papers published in PubMed, Scopus, Web of Science and Cochrane Library, encompassing the timeframe: November, 2018 to January 2000. The overall prevalence of MetS, and its prevalence based on different diagnostic criteria [National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III), American Heart Association (AHA) and International Diabetes Federation (IDF)] were pooled using a random-effects model.

RESULTS

Twenty five eligible studies were selected for the meta-analysis. Among all police officers contained in this study group, the overall prevalence of MetS was 26.2% (95% CI: 19.7-34%; Q = 229.45, p = 0.00). Among different military personnel contained in this study group, the overall estimation of MetS prevalence was 8.3% (95% CI: 6.3-11%; Q = 540.88, p = 0.00) the prevalence of MetS was 8.0% (95% CI: 5.7-11%; Q = 409.76, p = 0.00) according to the NCEP-ATP III criterion.

CONCLUSION

The findings from the present meta-analyses displayed a low prevalence of metabolic syndrome in armed forces in general. These findings will allow healthcare providers and policy-makers to find solutions in order to take action to reduce MetS risks on a wider scale, especially among police officers.

Global prevalence of cardiometabolic risk factors in the military population: a systematic review and meta-analysis

BACKGROUND

Although there are numerous studies on the global prevalence of cardiometabolic risk factors (CMRFs) in military personnel, the pooled prevalence of CMRFs in this population remains unclear. We aimed to systematically review the literature on the estimation of the global prevalence of CMRFs in the military population.

METHODS

We simultaneously searched PubMed and NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS with using standard keywords. All papers published up to March 2018 were reviewed. Two independent reviewers assessed papers and extracted the data. Chi-square-based Q test was used to assess the heterogeneity of reported prevalence among studies. The overall prevalence of all CMRFs, including overweight, obesity, high low-density lipoprotein (LDL), high total cholesterol (TC), high triglyceride (TG), low high-density lipoprotein (HDL), hypertension (HTN) and high fasting blood sugar (FBS) was estimated by using the random effects meta-analysis. A total of 37 studies met the eligibility criteria and were included in the meta-analysis.

RESULTS

According the random effect meta-analysis, the global pooled prevalence (95% confidence interval) of MetS, high LDL, high TC, high TG, low HDL and high FBS were 21% (17-25), 32% (27-36), 34% (10-57), 24% (16-31), 28% (17-38) and 9% (5-12), respectively. Moreover, global pooled prevalence of overweight, generalized obesity, abdominal obesity and HTN were estimated to be 35% (31-39), 14% (13-16), 29% (20-39) and 26 (19-34), respectively.

CONCLUSIONS

The overall prevalence of some cardio-metabolic risk factors was estimated to be higher in military personnel. Therefore, the necessary actions should be taken to reduce risk of developing cardiovascular diseases.

SYSTEMATIC REVIEW REGISTRATION NUMBER IN PROSPERO

CRD42018103345.

Army Body Composition Program Study Results Concerning: Enrollees Are More Over Fat Than Expected

INTRODUCTION

Whether implementation of the Army Body Composition Program (ABCP) is meeting readiness objectives is unknown.

OBJECTIVE

This study sought to primarily describe the extent of Active Duty Soldiers' over-fatness when attending the initial ABCP nutrition class at an Army Nutrition clinic in Washington State; and secondarily to describe the proportion of these Soldiers meeting metabolic syndrome (MS) criteria.

METHODS

Soldiers (189) in this cross-sectional study completed the following: a questionnaire developed for this study, anthropometric measurements, body fat assessment via AR 600-9 standards, and a laboratory blood draw for fasting glucose and lipid panel.

RESULTS

Soldiers were predominantly male (76%), obese (BMI 32 kg/m2 for males and 30 kg/m2 for females), exceeded body fat standards by 3.8% for males and 7.3% for females, and 16% had three or more risk factors meeting MS diagnostic criteria. Waist circumference was the predominant MS risk factor for males and females.

CONCLUSION

Soldiers in this study had higher body fat percentages than expected with a majority of Soldiers classified as obese. Achieving and maintaining ABCP standards may be more challenging for obese Soldiers. To maintain Soldier readiness, commanders should consider intervening earlier when signs of weight gain are observed.

The Prevalence of Obesity and Metabolic Syndrome in the Korean Military Compared with the General Population

BACKGROUND

Obesity and related metabolic disorders are growing health challenges worldwide and individuals at military service are not exceptions. The purpose of this study was to examine the prevalence of obesity and metabolic syndrome (MS) in the Korean military and to compare with the general population.

METHODS

This was a cross-sectional study of 4,803 young military participants who underwent a corporal health-screening program between October 2013 and October 2014. The National Cholesterol Education Program Adult Treatment Panel III criteria was used to identify MS. We also sampled 1,108 men aged 19-29 years from the Korea National Health and Nutritional Examination Survey from 2010 to 2013 to compare with their military counterparts.

RESULTS

The mean age of military participants was 20.8 ± 1.1 years, and 20.6% (n = 988) were obese. The prevalence of MS was 0.8% in military participants, while 7.9% in general population. The risk factors of MS were less prominent among military participants relative to civilians, with the exception of high blood pressure, of which prevalence was higher among military participants (21.5% vs. 18.2%, respectively). In multiple logistic analysis, high physical activity conferred lower odds of MS and obesity in military participants (odds ratios, 0.19 and 0.81, respectively). Age older than 25 years increased risk of most components of MS among civilians.

CONCLUSION

The prevalence of obesity and MS is lower in military participants compared with civilians of similar age. Monitoring of high blood pressure and proper stress management are warranted in those at military service.

Monitoring Prevalence, Treatment, and Control of Metabolic Conditions in New York City Adults Using 2013 Primary Care Electronic Health Records: A Surveillance Validation Study

Introduction:

Electronic health records (EHRs) can potentially extend chronic disease surveillance, but few EHR-based initiatives tracking population-based metrics have been validated for accuracy. We designed a new EHR-based population health surveillance system for New York City (NYC) known as NYC Macroscope. This report is the third in a 3-part series describing the development and validation of that system. The first report describes governance and technical infrastructure underlying the NYC Macroscope. The second report describes validation methods and presents validation results for estimates of obesity, smoking, depression and influenza vaccination. In this third paper we present validation findings for metabolic indicators (hypertension, hyperlipidemia, diabetes).

Methods:

We compared EHR-based estimates to those from a gold standard surveillance source - the 2013–2014 NYC Health and Nutrition Examination Survey (NYC HANES) - overall and stratified by sex and age group, using the two one-sided test of equivalence and other validation criteria.

Results:

EHR-based hypertension prevalence estimates were highly concordant with NYC HANES estimates. Diabetes prevalence estimates were highly concordant when measuring diagnosed diabetes but less so when incorporating laboratory results. Hypercholesterolemia prevalence estimates were less concordant overall. Measures to assess treatment and control of the 3 metabolic conditions performed poorly.

Discussion:

While indicator performance was variable, findings here confirm that a carefully constructed EHR-based surveillance system can generate prevalence estimates comparable to those from gold-standard examination surveys for certain metabolic conditions such as hypertension and diabetes.

Conclusions:

Standardized EHR metrics have potential utility for surveillance at lower annual costs than surveys, especially as representativeness of contributing clinical practices to EHR-based surveillance systems increases.