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      The prevalence of metabolic syndrome and its association with body fat distribution in middle-aged individuals from Indonesia and the Netherlands: a cross-sectional analysis of two population-based studies

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          Abstract

          Background

          The prevalence of metabolic syndrome varies among populations with different ethnicities. Asian populations develop metabolic complications at lower amounts of adiposity than western populations. The role of abdominal obesity in the metabolic differences between the two populations is poorly understood.

          Objectives

          Our objectives were to estimate the prevalence of metabolic syndrome and the relative contribution of its components in the Indonesian and the Dutch population, as well as to examine the associations of overall and abdominal obesity with metabolic syndrome.

          Methods

          In this cross-sectional study of middle-aged adults in the Netherlands Epidemiology of Obesity Study (n = 6602) and the Indonesian National Health Surveillance (n = 10,575), metabolic syndrome was defined by the unified IDF and AHA/NHLBI criteria. We performed logistic and linear regressions to examine associations of BMI and waist circumference with the metabolic syndrome, mutually adjusted for waist circumference and BMI.

          Results

          The prevalence of metabolic syndrome was 28% and 46% in Indonesian men and women, and 36% and 24% in Dutch men and women. The most prominent components were hypertension (61%) and hyperglycemia (51%) in the Indonesian, and hypertension (62%) and abdominal obesity (40%) in the Dutch population. Per SD in BMI and waist circumference, odds ratios (ORs, 95% CI) of metabolic syndrome were 1.5 (1.3–1.8) and 2.3 (1.9–2.7) in Indonesian men and 1.7 (1.2–2.5) and 2.9 (2.1–4.1) in Dutch men. The ORs of metabolic syndrome were 1.4 (1.2–1.6) and 2.3 (2.0–2.7) in Indonesian women and 1.0 (0.8–1.3) and 4.2 (3.2–5.4) in Dutch women.

          Conclusion

          More Indonesian women than men have metabolic syndrome, whereas the opposite is true for the Dutch population. In both the Indonesian and the Dutch populations, hypertension is the primary contributor to the prevalence of metabolic syndrome. In both populations, abdominal adiposity was more strongly associated with metabolic syndrome than overall adiposity.

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          Most cited references29

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          Associations of visceral and abdominal subcutaneous adipose tissue with markers of cardiac and metabolic risk in obese adults

          Ian Neeland, Colby Ayers, Anand K. Rohatgi … (2013)
          Visceral (VAT) and abdominal subcutaneous (SAT) adipose tissues contribute to obesity but may have different metabolic and atherosclerosis risk profiles. Among obese participants in the Dallas Heart Study, we examined the cross-sectional associations of abdominal VAT and SAT mass, assessed by magnetic resonance imaging (MRI) and indexed to body surface area (BSA), with circulating biomarkers of insulin resistance, dyslipidemia, and inflammation (n=942); and with aortic plaque and liver fat by MRI and coronary calcium by computed tomography (n=1200). Associations of VAT/BSA and SAT/BSA were examined after adjustment for age, sex, race, menopause, and body mass index. In multivariable models, VAT significantly associated with the homeostasis model assessment of insulin resistance (HOMA-IR), lower adiponectin, smaller LDL and HDL particle size, larger VLDL size, and increased LDL and VLDL particle number (p<0.001 for each). VAT also associated with prevalent diabetes, metabolic syndrome, hepatic steatosis, and aortic plaque (p<0.001 for each). VAT independently associated with C-reactive protein but not with any other inflammatory biomarkers tested. In contrast, SAT associated with leptin and inflammatory biomarkers, but not with dyslipidemia or atherosclerosis. Associations between SAT and HOMA-IR were significant in univariable analyses but attenuated after multivariable adjustment. In conclusion, VAT associated with an adverse metabolic, dyslipidemic, and atherogenic obesity phenotype. In contrast, SAT demonstrated a more benign phenotype, characterized by modest associations with inflammatory biomarkers and leptin, but no independent association with dyslipidemia, insulin resistance, or atherosclerosis in obese individuals. These findings suggest that abdominal fat distribution defines distinct obesity sub-phenotypes with heterogeneous metabolic and atherosclerosis risk.
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            The ratio of visceral to subcutaneous fat, a metric of body fat distribution, is a unique correlate of cardiometabolic risk.

            J Murabito, Nick Fox, Timothy Pedley … (2012)
            The anatomic location of excess body fat has an impact on associated cardiometabolic morbidity, and visceral adipose tissue (VAT) is more pathogenic than subcutaneous adipose tissue (SAT). However, VAT or SAT alone provides little information regarding the relative distribution of body fat. We hypothesised that the propensity to store energy in VAT relative to SAT depots may be a correlate of cardiometabolic risk, and tested this hypothesis using the VAT/SAT ratio as a metric of fat distribution. We investigated associations of the VAT/SAT ratio with cardiometabolic traits in 3,223 participants (48% women) from the Framingham Heart Study. Fat depots were quantified by multidetector computed tomography (CT) scanning. In women and men, higher VAT/SAT ratio was associated (p < 0.05) with most assessed cardiovascular risk factors reflecting blood pressure, dyslipidaemia and insulin resistance. Additional adjustment for BMI did not materially change the findings in women, and generally strengthened associations in men. Further adjustment for VAT attenuated some associations in women, but those with lower HDL-cholesterol, higher triacylglycerol (both p < 0.0001) and higher prevalence of hypertension (p = 0.02), diabetes (p = 0.01) and the metabolic syndrome (p = 0.005) remained significant. Similarly, in men, associations with higher systolic (p = 0.006) and diastolic blood pressure (p = 0.03), higher fasting glucose (p = 0.0005), lower HDL-cholesterol and higher triacylglycerol (both p < 0.0001) and higher prevalence of diabetes (p = 0.006) remained significant. VAT/SAT ratio is a correlate of cardiometabolic risk, above and beyond BMI and VAT. The propensity to store fat viscerally versus subcutaneously may be a unique risk factor independent of absolute fat volumes.
            Article 0 comments Cited 121 times – based on 0 reviews     Review now
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              Why might South Asians be so susceptible to central obesity and its atherogenic consequences? The adipose tissue overflow hypothesis.

              Nizal Sarrafzadegan, Dorairaj Prabhakaran, André Tchernof … (2007)
              The rates of coronary disease have accelerated dramatically amongst South Asians, driven to an important extent by the atherogenic dyslipidemia and type 2 diabetes that have become so common amongst them. These precursors of vascular disease appear at lower absolute amounts of adipose tissue in South Asians than in whites. In this paper, we set out a new hypothesis--the adipose tissue overflow hypothesis--to account for these findings. The adipose tissue mass within our bodies can be divided into three different compartments: superficial subcutaneous adipose tissue, deep subcutaneous adipose tissue and visceral adipose tissue. The superficial subcutaneous adipose tissue compartment is the primary compartment, is present throughout the body, and constitutes the vast majority of the adipose tissue in the lower limb. With energy excess, the secondary adipose tissue compartments--the deep subcutaneous (mainly upper body) and the visceral adipose tissue compartments--become more prominent. Superficial subcutaneous adipose tissue is relatively inert metabolically, whereas the other two compartments are characterized by higher transmembrane fatty acid flux rates and thus are more closely linked to dyslipidemia and dysglycemia. We hypothesize that the superficial subcutaneous adipose tissue compartment is larger in whites than in South Asians. If so, as obesity develops, South Asians exhaust the storage capacity of their superficial subcutaneous adipose tissue compartment before whites do and that is why they develop the metabolic complications of upper body obesity at lower absolute masses of adipose tissue than white people.
              Article 0 comments Cited 96 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Fathimah S. Sigit: f.s.sigit@lumc.nl
                Journal
                Journal ID (nlm-ta): Diabetol Metab Syndr
                Journal ID (iso-abbrev): Diabetol Metab Syndr
                Title: Diabetology & Metabolic Syndrome
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1758-5996
                Publication date (Electronic): 7 January 2020
                Publication date PMC-release: 7 January 2020
                Publication date Collection: 2020
                Volume: 12
                Electronic Location Identifier: 2
                Affiliations
                [1 ]ISNI 0000000089452978, GRID grid.10419.3d, Department of Clinical Epidemiology, , Leiden University Medical Center, ; Albinusdreef 2, 2333 ZA Leiden, The Netherlands
                [2 ]ISNI 0000000120191471, GRID grid.9581.5, Metabolic, Cardiovascular, and Aging Cluster, The Indonesian Medical Education and Research Institute, , Faculty of Medicine-Universitas Indonesia, ; Jalan Salemba Raya No 6, Jakarta, 10430 Indonesia
                [3 ]ISNI 0000000120191471, GRID grid.9581.5, Department of Internal Medicine, Dr. Cipto Mangunkusumo National Referral Hospital, , Faculty of Medicine-Universitas Indonesia, ; Jalan Salemba Raya No 6, Jakarta, 10430 Indonesia
                [4 ]ISNI 0000000089452978, GRID grid.10419.3d, Department of Internal Medicine, , Leiden University Medical Center, ; Albinusdreef 2, 2333 ZA Leiden, The Netherlands
                [5 ]ISNI 0000000089452978, GRID grid.10419.3d, Department of Parasitology, , Leiden University Medical Center, ; Albinusdreef 2, 2333 ZA Leiden, The Netherlands
                [6 ]ISNI 0000000089452978, GRID grid.10419.3d, Department of Human Genetics, , Leiden University Medical Center, ; Albinusdreef 2, 2333 ZA Leiden, The Netherlands
                Article
                Publisher ID: 503
                DOI: 10.1186/s13098-019-0503-1
                PMC ID: 6947940
                PubMed ID: 31921359
                SO-VID: 3ccab63f-c821-48a3-ad06-e51f81650cb2
                Copyright © © The Author(s) 2020
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 27 September 2019
                Date accepted : 9 December 2019
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2020

                ScienceOpen disciplines: Nutrition & Dietetics
                Keywords: metabolic syndrome,abdominal obesity,bmi,waist circumference
                Data availability:
                ScienceOpen disciplines: Nutrition & Dietetics
                Keywords: metabolic syndrome, abdominal obesity, bmi, waist circumference

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