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      The Epidemic Of The Metabolic Syndrome Among The Palestinians In The Gaza Strip

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          Abstract

          Background

          The metabolic syndrome (MetS) is a major public health and clinical challenge worldwide. However, limited data are available in the Gaza strip. This study was undertaken to evaluate the prevalence of MetS and its association with atherosclerotic risk factors and cardiovascular diseases among Gazan adults’ community.

          Methods

          A cross-sectional study was conducted in 2017, among all adults ≥25 years of age. Participants were selected by stratified cluster sampling method, in five governorates (urban, camps and rural) of Gaza strip. Questionnaires on socioeconomic status, lifestyle and cardiovascular risk factors were completed for 2107 participants. The cardiovascular diseases included clinical history of coronary artery disease (CAD), Lower extremity artery disease (LEAD diagnosed as ankle brachial index < 0.90) and history of stroke. MetS was defined based on the International Diabetes Federation criteria (IDF).

          Results

          Among participants, 864 (41%) fulfilled the definition of MetS higher in females than males (50% vs 39%). In both genders, MetS prevalence increased significantly with age (p<0.001). Subjects with MetS were more obese (73.0% vs 29.4%), hypertensive (49.9% vs 13.0%), diabetic (36.8% vs 5.8%) and had more often low physical activity (58.1% vs 41.3%). Additionally, lipids profiles disorders were more prevalent in cases with MetS. We found MetS significantly associated with all cardiovascular conditions with odd-ratio (95% CI) respectively at 2.4 (95% CI 1.8–3.4) for CAD, 1.5 (95% CI1.1–1.9) for LEAD and 2.1 (95% CI 1.3–3.5) for stroke.

          Conclusion

          The MetS is highly prevalent in the Palestinian population, particularly among women. Subjects with MetS are at significantly elevated risk for cardiovascular diseases.

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          Most cited references16

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          Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies.

          Apoor Gami, Brandi Witt, Daniel E. Howard … (2007)
          The purpose of this research was to assess the association between the metabolic syndrome (MetSyn) and cardiovascular events and mortality by meta-analyses of longitudinal studies. Controversy exists regarding the cardiovascular risk associated with MetSyn. We searched electronic reference databases through March 2005, studies that referenced Reaven's seminal article, abstracts presented at meetings in 2003 to 2004, and queried experts. Two reviewers independently assessed eligibility. Longitudinal studies reporting associations between MetSyn and cardiovascular events or mortality were eligible. Two reviewers independently used a standardized form to collect data from published reports. Authors were contacted. Study quality was assessed by the control of selection, detection, and attrition biases. We found 37 eligible studies that included 43 cohorts (inception 1971 to 1997) and 172,573 individuals. Random effects meta-analyses showed MetSyn had a relative risk (RR) of cardiovascular events and death of 1.78 (95% confidence interval [CI] 1.58 to 2.00). The association was stronger in women (RR 2.63 vs. 1.98, p = 0.09), in studies enrolling lower risk (<10%) individuals (RR 1.96 vs. 1.43, p = 0.04), and in studies using factor analysis or the World Health Organization definition (RR 2.68 and 2.06 vs. 1.67 for National Cholesterol Education Program definition and 1.35 for other definitions; p = 0.005). The association remained after adjusting for traditional cardiovascular risk factors (RR 1.54, 95% CI 1.32 to 1.79). The best available evidence suggests that people with MetSyn are at increased risk of cardiovascular events. These results can help clinicians counsel patients to consider lifestyle interventions, and should fuel research of other preventive interventions.
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            Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence.

            E. Ford (2005)
            In recent years, several major organizations have endorsed the concept of the metabolic syndrome and developed working definitions for it. How well these definitions predict the risk for adverse events in people with the metabolic syndrome is only now being learned. The purpose of this study was to summarize the estimates of relative risk for all-cause mortality, cardiovascular disease, and diabetes reported from prospective studies in samples from the general population using definitions of the metabolic syndrome developed by the National Cholesterol Education Program (NCEP) and World Health Organization (WHO). The author reviewed prospective studies from July 1998 through August 2004. For studies that used the exact NCEP definition of the metabolic syndrome, random-effects estimates of combined relative risk were 1.27 (95% CI 0.90-1.78) for all-cause mortality, 1.65 (1.38-1.99) for cardiovascular disease, and 2.99 (1.96-4.57) for diabetes. For studies that used the most exact WHO definition of the metabolic syndrome, the fixed-effects estimates of relative risk were 1.37 (1.09-1.74) for all-cause mortality and 1.93 (1.39-2.67) for cardiovascular disease; the fixed-effects estimate was 2.60 (1.55-4.38) for coronary heart disease. These estimates suggest that the population-attributable fraction for the metabolic syndrome, as it is currently conceived, is approximately 6-7% for all-cause mortality, 12-17% for cardiovascular disease, and 30-52% for diabetes. Further research is needed to establish the use of the metabolic syndrome in predicting risk for death, cardiovascular disease, and diabetes in various population subgroups.
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              Metabolic syndrome and risk of cardiovascular disease: a meta-analysis.

              Andrea Galassi, Kristi Reynolds, Jiang Ping He (2006)
              The use of different definitions of the metabolic syndrome has led to inconsistent results on the association between the metabolic syndrome and risk of cardiovascular disease. We examined the association between the metabolic syndrome and risk of cardiovascular disease. A MEDLINE search (1966-April 2005) was conducted to identify prospective studies that examined the association between the metabolic syndrome and risk of cardiovascular disease. Information on sample size, participant characteristics, metabolic syndrome definition, follow-up duration, and endpoint assessment was abstracted. Data from 21 studies met the inclusion criteria and were included. Individuals with the metabolic syndrome, compared to those without, had an increased mortality from all causes (relative risk [RR] 1.35; 95% confidence interval [CI], 1.17-1.56) and cardiovascular disease (RR 1.74; 95% CI, 1.29-2.35); as well as an increased incidence of cardiovascular disease (RR 1.53; 95% CI, 1.26-1.87), coronary heart disease (RR 1.52; 95% CI, 1.37-1.69) and stroke (RR 1.76; 95% CI, 1.37-2.25). The relative risk of cardiovascular disease associated with the metabolic syndrome was higher in women compared with men and higher in studies that used the World Health Organization definition compared with studies that used the Adult Treatment Panel III definition. This analysis strongly suggests that the metabolic syndrome is an important risk factor for cardiovascular disease incidence and mortality, as well as all-cause mortality. The detection, prevention, and treatment of the underlying risk factors of the metabolic syndrome should become an important approach for the reduction of the cardiovascular disease burden in the general population.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Diabetes Metab Syndr Obes
                Journal ID (iso-abbrev): Diabetes Metab Syndr Obes
                Journal ID (publisher-id): DMSO
                Journal ID (pmc): dmso
                Title: Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy
                Publisher: Dove
                ISSN (Electronic): 1178-7007
                Publication date (Electronic): 22 October 2019
                Publication date Collection: 2019
                Volume: 12
                Pages: 2201-2208
                Affiliations
                [1 ]Tropical Neuroepidemiology, Inserm UMR 1094 , Limoges, France
                [2 ]School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, University of Limoges , Limoges, France
                [3 ]Department of Cardiology, Ministry of Health , Palestine
                [4 ]Department of Cardiology, Dupuytren University Hospital , Limoges, France
                [5 ]Department of Thoracic and Vascular Surgery – Vascular Medicine, Dupuytren University Hospital , Limoges, France
                Author notes
                Correspondence: Amal Shahwan Jamee School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, University of Limoges , 2 rue du Dr Marcland, Limoges87025, FranceTel +33754139112 Email dr_amal08@yahoo.fr
                Author information
                http://orcid.org/0000-0002-0322-9818
                Article
                Publisher ID: 207781
                DOI: 10.2147/DMSO.S207781
                PMC ID: 6815210
                SO-VID: 98adfbcf-6964-423a-9ea4-da2c7a2bbcd7
                Copyright © © 2019 Jamee et al.
                License:

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                Date received : 06 March 2019
                Date accepted : 09 August 2019
                Page count
                Figures: 2, Tables: 4, References: 31, Pages: 8
                Categories
                Subject: Original Research

                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: metabolic syndrome,risk factors,cardiovascular disease,palestine
                Data availability:
                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: metabolic syndrome, risk factors, cardiovascular disease, palestine

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