Comparison between three different diagnostic criteria in evaluating metabolic syndrome: An experience from college students of Kolkata, India

Abstract

Background: Metabolic syndrome (MS) is gradually surging particularly among Asian Indians. Documented data on comparative studies based on different definitions with respect to MS prevalence among college students are few. Aim: The aim of this is to find the validity and degree of agreement between three different diagnostic criteria recommended by the International Diabetes Federation (IDF), the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III), and the Consensus definition for Asian Indians (CDAI). Materials and Methods: A cross-sectional study was conducted among 477 college students aged 18–24 years of Kolkata selected by systematic random sampling from August 2011 to December 2014. Three different criteria, i.e., IDF, NCEP-ATP III, and CDAI, were used. Individuals signed a consent form before the study. Using IDF as a reference standard, validity of other criteria was measured by sensitivity and specificity. Cohen's kappa (κ) coefficient was used to identify the degree of agreement between three different definitions. Statistical analysis was performed using SPSS software, version 19.0. P ≤ 0.05 was considered statistically significant. Results: The prevalence of MS among college students was highest using the CDAI criteria (5.7%), followed by the IDF criteria (4.5%) and the NCEP-ATP III criteria (2.9%) being significantly higher in females (P ≤ 0.05). Using IDF as a reference standard, the sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio of positive test for CDAI were 100%, 98.9%, 81.5%, 100%, and 90.9, respectively; whereas, for the NCEP-ATP III criteria, these were 45.5%, 99.1%, 71.4%, 97.4%, and 50.56, respectively. IDF presented “almost perfect” agreement in relation to the CDAI with κ of 0.892 (95% CI: 0.798–0.986, P = 0.000) and “moderate” agreement with respect to the NCEP-ATP III criteria with κ of 0.539 (95% CI: 0.339–0.739, P = 0.000). Conclusion: At least 2.9% of the Kolkata college students studied had MS. The CDAI criteria were superior to the NCEP-ATP III criteria for predicting MS in this population, when compared with the IDF criteria.