Abstract
Cardiovascular disease (CVD) and type 2 diabetes remain significant public health concerns. Targeting of prevention efforts by geographical location has been suggested by the Institute of Medicine to coincide with the presence of area-based risk. The metabolic syndrome (MetS) is a stronger risk factor than is obesity for the prediction of future CVD and diabetes, yet its prevalence has not previously been described geographically. Our objective is to determine geographical variation in the prevalence of obesity, MetS, and diabetes among US adults. We assessed the prevalence of obesity, MetS, and diabetes by US census division, and the prevalence of obesity, MetS, and diabetes for each sex and racial/ethnic group by US region among 9826 US non-Hispanic white, non-Hispanic black, and Hispanic adults aged 20–65 years participating in the National Health and Nutrition Examination Survey 1999–2014. We also compared a sex- and race/ethnicity-specific MetS severity score by geographical area. The prevalence of obesity, MetS, and diabetes varied by US census division and region, with overall similarity by geographical area in the prevalence of each of these conditions. The prevalence of MetS was particularly high (≥35%) in the West North Central, West South Central, and East South Central and low (30%) in the Pacific, New England, and Mid-Atlantic divisions. Some of the geographical variation appeared due to differences among non-Hispanic white females, who had a high prevalence of MetS (>32%) in the Midwest and South and a low prevalence of MetS (24%) in the West and Northeast. Geographical differences in MetS imply variation in the risk for future CVD and diabetes, with more elevated risk in the center of the United States. As MetS is a stronger risk factor for prediction of CVD and T2DM than is obesity, these differences are potentially important for prompting public health efforts toward surveillance and prevention in high-risk areas.
Highlights
The epidemic of obesity in the United States and worldwide has raised public health alarm because of associations with multiple comorbidities, including cardiovascular disease (CVD) and type 2 diabetes
While some geographical assessments report the geographical distribution of CVD and diabetes themselves; prevalence of these is strongly influenced by access to medical care, which varies widely by region[2]
We looked at regional differences in sex- and race/ ethnicity-specific metabolic syndrome (MetS) severity z-scores, given known racial/ethnic discrepancies of ATP-III MetS in its relationship with insulin resistance and risk[12,13,14,15,16]
Summary
The epidemic of obesity in the United States and worldwide has raised public health alarm because of associations with multiple comorbidities, including cardiovascular disease (CVD) and type 2 diabetes. One well-described condition potentially in the causative pathway between obesity and CVD and diabetes is the metabolic syndrome (MetS)[5,6,7], a cluster of CVD risk factors including central obesity, high blood pressure (BP), high triglycerides, low HDL-cholesterol, and high fasting blood glucose[8]. These abnormalities appear to be produced by underlying processes of systemic inflammation, oxidative stress, and cellular dysfunction[9]. Prior studies demonstrated that individuals with MetS have 2–20-year odds ratios of Nutrition and Diabetes
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