Ethnic Differences in the Prevalence of Metabolic Syndrome: Results from a Multi-Ethnic Population-Based Survey in Malaysia

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Abstract

Introduction

The prevalence of metabolic syndrome is increasing disproportionately among the different ethnicities in Asia compared to the rest of the world. This study aims to determine the differences in the prevalence of metabolic syndrome across ethnicities in Malaysia, a multi-ethnic country.

Methods

In 2004, we conducted a national cross-sectional population-based study using a stratified two-stage cluster sampling design (N = 17,211). Metabolic syndrome was defined according to the International Diabetes Federation/National Heart, Lung and Blood Institute/American Heart Association (IDF/NHLBI/AHA-2009) criteria. Multivariate models were used to study the independent association between ethnicity and the prevalence of the metabolic syndrome.

Results

The overall mean age was 36.9 years, and 50.0% participants were female. The ethnic distribution was 57.0% Malay, 28.5% Chinese, 8.9% Indian and 5.0% Indigenous Sarawakians. The overall prevalence of the metabolic syndrome was 27.5%, with a prevalence of central obesity, raised triglycerides, low high density lipoprotein cholesterol, raised blood pressure and raised fasting glucose of 36.9%, 29.3%, 37.2%, 38.0% and 29.1%, respectively. Among those <40 years, the adjusted prevalence ratios for metabolic syndrome for ethnic Chinese, Indians, and Indigenous Sarawakians compared to ethnic Malay were 0.81 (95% CI 0.67 to 0.96), 1.42 (95% CI 1.19 to 1.69) and 1.37 (95% CI 1.08 to 1.73), respectively. Among those aged ≥40 years, the corresponding prevalence ratios were 0.86 (95% CI 0.79 to 0.92), 1.25 (95% CI 1.15 to 1.36), and 0.94 (95% CI 0.80, 1.11). The P-value for the interaction of ethnicity by age was 0.001.

Conclusions

The overall prevalence of metabolic syndrome in Malaysia was high, with marked differences across ethnicities. Ethnic Chinese had the lowest prevalence of metabolic syndrome, while ethnic Indians had the highest. Indigenous Sarawakians showed a marked increase in metabolic syndrome at young ages.

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Most cited references 24

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Age and Sex Differences in the Clustering of Metabolic Syndrome Factors

Jennifer L. Kuk, Chris I. Ardern (2010)

OBJECTIVE The metabolic syndrome is a general term given to a clustering of cardiometabolic risk factors that may consist of different phenotype combinations. The purpose of this study was to determine the prevalence of the different combinations of factors that make up the metabolic syndrome as defined by the National Cholesterol Education Program and to examine their association with all-cause mortality in younger and older men and women. RESEARCH DESIGN AND METHODS A total of 2,784 men and 3,240 women from the Third National Health and Nutrition Examination Survey with public-access mortality data linkage (follow-up = 14.2 ± 0.2 years) were studied. RESULTS Metabolic syndrome was present in 26% of younger (aged ≤65 years) and 55.0% of older (aged >65 years) participants. The most prevalent metabolic syndrome combination was the clustering of high triglycerides, low HDL cholesterol, and elevated blood pressure in younger men (4.8%) and triglycerides, HDL cholesterol, and elevated waist circumference in younger women (4.2%). The presence of all five metabolic syndrome factors was the most common metabolic syndrome combination in both older men (8.0%) and women (9.2%). Variation existed in how metabolic syndrome combinations were associated with mortality. In younger adults, having all five metabolic syndrome factors was most strongly associated with mortality risk, whereas in older men, none of metabolic syndrome combinations were associated with mortality. In older women, having elevated glucose or low HDL as one of the metabolic syndrome components was most strongly associated with mortality risk. CONCLUSIONS Metabolic syndrome is a heterogeneous entity with age and sex variation in component clusters that may have important implications for interpreting the association between metabolic syndrome and mortality risk. Thus, metabolic syndrome used as a whole may mask important differences in assessing health and mortality risk.

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Body composition, visceral fat, leptin, and insulin resistance in Asian Indian men.

Venkata Atluri, Harold Lebovitz, M Banerji … (1998)

There is a high prevalence of type 2 diabetes mellitus and coronary artery disease among urban and migrant Asian Indians despite the absence of traditional risk factors. Evidence exists that Asian Indians are more hyperinsulinemic than Caucasians and that hyperinsulinemia may be important in the development of these diseases. To test whether insulin action was related to total or regional adiposity and to explore the potential role of plasma leptin and lipids, we measured insulin-mediated glucose disposal by the euglycemic insulin clamp, adipose distribution and muscle volume using computed axial tomography, and fasting serum leptin and lipid levels in 20 healthy Asian Indian male volunteers (age, 36 +/- 10 yr). A mean body mass index of 24.5 +/- 2.5 kg/m2 was associated with an unusually high percentage of body fat (33 +/- 7%). The majority of the fat was sc, and 16% was visceral (intraabdominal) adipose tissue. The majority (66%) of these nonobese men were insulin resistant. The mean fasting serum leptin level was 7.6 +/- 3.3 ng/mL. Insulin action was inversely correlated with visceral adipose tissue, not total or abdominal sc adipose tissue. In contrast, leptin levels correlated with sc and total (not visceral) adipose tissue. Serum triglyceride and high density lipoprotein cholesterol levels were inversely correlated with each other and were directly related to insulin resistance and visceral (not subcutaneous) fat. Increased visceral fat in Asian Indians is associated with increased generalized obesity, which is not apparent from their nonobese body mass index. Increased visceral fat is related to dyslipidemia and increased frequency of insulin resistance and may account for the increased prevalence of diabetes mellitus and cardiovascular disease in Asian Indians.

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Metabolic implications of menopause.

Hanah N Polotsky, Alex Polotsky (2010)

The incidence of metabolic syndrome increases substantially during perimenopause and early menopause. Postmenopausal women are at a higher risk of hypertension, proatherogenic lipid changes, diabetes, and severe cardiovascular disease as compared with their premenopausal counterparts. Whether or not menopause has a causative contribution to the deteriorating metabolic profile that is independent of chronological aging has been a subject of many studies. Menopausal transition is associated with significant weight gain (2 to 2.5 kg over 3 years on average), which is not dissimilar to that in premenopausal women of like age. Concomitantly, there is an increase in abdominal adiposity and a decrease in energy expenditure, phenomena that have been postulated to explain the higher risk of metabolic syndrome and increases in cholesterol and triglycerides. Hypertension and diabetes become more prevalent with age and should be timely diagnosed and treated. Lifestyle changes including moderately decreased caloric intake and aerobic exercise could prevent proatherogenic changes and weight gain observed with aging. Accurate prediction of cardiovascular risk in midlife women is essential to help identify the subset of women who are likely to benefit from intensive management of metabolic risk factors. This review focuses on metabolic changes associated with menopausal transition, specifically alterations in weight, waist circumference, body fat distribution, energy expenditure, and circulating biomarkers including adipokines. © Thieme Medical Publishers.

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Author and article information

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: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Electronic): 1932-6203

Publication date Collection: 2012

Publication date (Electronic): 28 September 2012

Volume: 7

Issue: 9

Electronic Location Identifier: e46365

Affiliations

[1 ]Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

[2 ]Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America

[3 ]Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

[4 ]Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America

[5 ]Area of Cardiovascular Epidemiology and Population Genetics, National Center for Cardiovascular Research (CNIC), Madrid, Spain

[6 ]Ministry of Health, Putrajaya, Malaysia

[7 ]Faculty of Medicine and Health Sciences, Universiti Sarawak Malaysia, Sarawak, Malaysia

[8 ]Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia

The University of Queensland, Australia

Author notes

* E-mail: rampal@ 123456medic.upm.edu.my

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: SR RR MTA LR. Performed the experiments: LR SR RR MTA. Analyzed the data: SR SM EG LR. Contributed reagents/materials/analysis tools: LR. Wrote the paper: SR SM EG AB RM RR MTA LR.

Article

Publisher ID: PONE-D-12-18140

DOI: 10.1371/journal.pone.0046365

PMC ID: 3460855

PubMed ID: 23029497

SO-VID: 250bc3ff-55f2-4104-9c5b-28c2a61ec6d4

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 20 June 2012

Date accepted : 29 August 2012

Page count

Pages: 8

Funding

The authors are grateful to the Director General of Health, Ministry of Health Malaysia, all the State Directors of Medical and Health Services and their staff for their assistance. This study is part of the National study on Cardio-Vascular Disease Risk Factors and funded by Ministry of Science, Technology and Environment (MOSTE) IRPA Project Grant No. 06-02-04-0000-PR-0041/05-03. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Ethnic Differences in the Prevalence of Metabolic Syndrome: Results from a Multi-Ethnic Population-Based Survey in Malaysia

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Abstract

Introduction

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Conclusions

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Most cited references 24

Age and Sex Differences in the Clustering of Metabolic Syndrome Factors

Body composition, visceral fat, leptin, and insulin resistance in Asian Indian men.

Metabolic implications of menopause.

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