The relation of metabolic syndrome according to five definitions to cardiovascular risk factors - a population-based study

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Abstract

Background

Although National Cholesterol Education Program (NCEP), International Diabetes Federation (IDF), American Heart Association and National Heart, Lung and Blood Institute (AHA/NHLBI), World Health Organization (WHO), and the European Group for the Study of Insulin Resistance (EGIR) definitions of metabolic syndrome (MetS) have been commonly used by studies, little is known about agreement among these five definitions. We examined the agreement among these five definitions and explored their relationship with risk factors of cardiovascular disease in a Taiwan population.

Methods

A total of 1305 subjects aged 40 years and over in Taiwan were analyzed. Biomedical markers and anthropometric indices were measured. Agreement among definitions was determined by the kappa statistic. Logistic regression models were fit to estimate the odds of a high cardiovascular risk group for five definitions of MetS.

Results

The agreement among the NCEP, IDF, and AHA/NHLBI definitions was from substantial to very good, and agreement between the WHO and EGIR definitions was also substantial. All MetS definitions were significantly associated prevalence of microalbuminuria, elevated highly sensitive CRP (hs-CRP), and arterial stiffness only in women. In men, MetS by NCEP and AHA/NHLBI was associated with elevated level of hs-CRP and arterial stiffness. MetS by WHO and EGIR were significantly associated with microalbuminuria. And MetS by WHO was the only MetS definition that significantly associated with prevalence of arterial stiffness (OR: 2.75, 95% CI: 1.22-6.19).

Conclusions

The associations of these five definitions with cardiovascular risk factors were similar in women, and it was evident that the five definitions performed better in women than in men, with higher ORs observed in relation to arterial stiffness, elevated hs-CRP, and higher Framingham risk scores.

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Most cited references 34

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Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp.

M. Matsuda, R DeFronzo (1999)

Several methods have been proposed to evaluate insulin sensitivity from the data obtained from the oral glucose tolerance test (OGTT). However, the validity of these indices has not been rigorously evaluated by comparing them with the direct measurement of insulin sensitivity obtained with the euglycemic insulin clamp technique. In this study, we compare various insulin sensitivity indices derived from the OGTT with whole-body insulin sensitivity measured by the euglycemic insulin clamp technique. In this study, 153 subjects (66 men and 87 women, aged 18-71 years, BMI 20-65 kg/m2) with varying degrees of glucose tolerance (62 subjects with normal glucose tolerance, 31 subjects with impaired glucose tolerance, and 60 subjects with type 2 diabetes) were studied. After a 10-h overnight fast, all subjects underwent, in random order, a 75-g OGTT and a euglycemic insulin clamp, which was performed with the infusion of [3-3H]glucose. The indices of insulin sensitivity derived from OGTT data and the euglycemic insulin clamp were compared by correlation analysis. The mean plasma glucose concentration divided by the mean plasma insulin concentration during the OGTT displayed no correlation with the rate of whole-body glucose disposal during the euglycemic insulin clamp (r = -0.02, NS). From the OGTT, we developed an index of whole-body insulin sensitivity (10,000/square root of [fasting glucose x fasting insulin] x [mean glucose x mean insulin during OGTT]), which is highly correlated (r = 0.73, P < 0.0001) with the rate of whole-body glucose disposal during the euglycemic insulin clamp. Previous methods used to derive an index of insulin sensitivity from the OGTT have relied on the ratio of plasma glucose to insulin concentration during the OGTT. Our results demonstrate the limitations of such an approach. We have derived a novel estimate of insulin sensitivity that is simple to calculate and provides a reasonable approximation of whole-body insulin sensitivity from the OGTT.

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Cardiovascular morbidity and mortality associated with the metabolic syndrome.

B Isomaa, M-R Taskinen, B Forsén … (2001)

To estimate the prevalence of and the cardiovascular risk associated with the metabolic syndrome using the new definition proposed by the World Health Organization A total of 4,483 subjects aged 35-70 years participating in a large family study of type 2 diabetes in Finland and Sweden (the Botnia study) were included in the analysis of cardiovascular risk associated with the metabolic syndrome. In subjects who had type 2 diabetes (n = 1,697), impaired fasting glucose (IFG)/impaired glucose tolerance (IGT) (n = 798) or insulin-resistance with normal glucose tolerance (NGT) (n = 1,988), the metabolic syndrome was defined as presence of at least two of the following risk factors: obesity, hypertension, dyslipidemia, or microalbuminuria. Cardiovascular mortality was assessed in 3,606 subjects with a median follow-up of 6.9 years. In women and men, respectively, the metabolic syndrome was seen in 10 and 15% of subjects with NGT, 42 and 64% of those with IFG/IGT, and 78 and 84% of those with type 2 diabetes. The risk for coronary heart disease and stroke was increased threefold in subjects with the syndrome (P < 0.001). Cardiovascular mortality was markedly increased in subjects with the metabolic syndrome (12.0 vs. 2.2%, P < 0.001). Of the individual components of the metabolic syndrome, microalbuminuria conferred the strongest risk of cardiovascular death (RR 2.80; P = 0.002). The WHO definition of the metabolic syndrome identifies subjects with increased cardiovascular morbidity and mortality and offers a tool for comparison of results from diferent studies.

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Prevalence of the metabolic syndrome defined by the International Diabetes Federation among adults in the U.S.

Earl S. Ford (2005)

The International Diabetes Federation (IDF) has proposed a new definition of the metabolic syndrome that emphasizes central adiposity as determined by ethnic group-specific thresholds of waist circumference. The objective of this study was to estimate the prevalence of this syndrome using the IDF definition among U.S. adults and to compare it with the prevalence estimated using the definition of the National Cholesterol Education Program (NCEP). A total of 3,601 men and women aged > or =20 years from the National Health and Nutrition Examination Survey 1999-2002 were included in the analyses. Based on the NCEP definition, the unadjusted prevalence of the metabolic syndrome was 34.5 +/- 0.9% (percent +/- SE) among all participants, 33.7 +/- 1.6% among men, and 35.4 +/- 1.2% among women. Based on the IDF definition, the unadjusted prevalence of the metabolic syndrome was 39.0 +/- 1.1% among all participants, 39.9 +/- 1.7% among men, and 38.1 +/- 1.2% among women. The IDF definition led to higher estimates of prevalence in all of the demographic groups, especially among Mexican-American men. The two definitions similarly classified approximately 93% of the participants as having or not having the metabolic syndrome. In the U.S., the use of the IDF definition of the metabolic syndrome leads to a higher prevalence estimate of the metabolic syndrome than the estimate based on the NCEP definition.

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Author and article information

Journal

Journal ID (nlm-ta): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central

ISSN (Electronic): 1471-2458

Publication date Collection: 2009

Publication date (Electronic): 23 December 2009

Volume: 9

Page: 484

Affiliations

[1 ]Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan

[2 ]Department of Family Medicine, College of Medicine, China Medical University, Taichung, Taiwan

[3 ]Medical Research, China Medical University Hospital, Taichung, Taiwan

[4 ]Institute of Health Care Administration, College of Health Science, Asia University, Taichung, Taiwan

[5 ]School and Graduate Institute of Health Care Administration, College of Public Health, China Medical University, Taichung, Taiwan

[6 ]Administration Center, China Medical University Hospital, Taichung, Taiwan

[7 ]Lilly Taiwan, Eli Lilly and Company, Taipei, Taiwan

[8 ]Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung, Taiwan

[9 ]Institute of Health Care Administration, College of Public Health, China Medical University, Taichung, Taiwan

[10 ]Department of Medicine, China Medical University, Taichung, Taiwan

[11 ]Institute of Biostatistics, China Medical University, Taichung, Taiwan

[12 ]Biostatistics Center, China Medical University, Taichung, Taiwan

Article

Publisher ID: 1471-2458-9-484

DOI: 10.1186/1471-2458-9-484

PMC ID: 2805641

PubMed ID: 20028565

SO-VID: 11c0ed1a-322e-4fca-93b5-c142c7ef5ea0

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The relation of metabolic syndrome according to five definitions to cardiovascular risk factors - a population-based study

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Abstract

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Most cited references 34

Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp.

Cardiovascular morbidity and mortality associated with the metabolic syndrome.

Prevalence of the metabolic syndrome defined by the International Diabetes Federation among adults in the U.S.

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