Abstract
BackgroundThe metabolic syndrome (MetSyn) places individuals at increased risk for type 2 diabetes and cardiovascular disease. Prevalence rates of the population of the MetSyn are still scarce. Moreover, the impact of different definitions of the MetSyn on the prevalence is unclear. Aim here is to assess the prevalence of the MetSyn in primary health care and to investigate the impact of four different definitions of the MetSyn on the determined prevalence with regard to age, gender and socio-economic status.MethodsThe German-wide cross-sectional study was conducted during two weeks in October 2005 in 1.511 randomly selected general practices. Blood samples were analyzed, blood pressure and waist circumference assessed, data on lifestyle, medication, chronic disorders, and socio-demographic characteristics collected. MetSyn prevalence was estimated according to the definitions of NCEP ATP III (2001), AHA/NHLBI (2004, 2005), and IDF (2005). Descriptive statistics and prevalence rate ratios using the PROG GENMOD procedure, were calculated. Cohen's kappa was used as measure for interreliability between the different prevalence estimates.ResultsData of 35,869 patients (age range: 18–99, women 61.1%) were included. The prevalence was lowest using the NCEP ATP III- (all: 19.8%, men 22.7%, women: 18.0%), highest according to the IDF-definition (32.7%, 40.3%, 28.0%). The increase in prevalence with recent definitions was more pronounced for men than for women, and was particularly high for men and women aged 60–79 years. The IDF-definition resulted in a higher prevalence especially in those with the highest educational status. Agreement (kappa) between the NCEP ATP III- and IDF-definition was 0.68 (men 0.61, women 0.74), between the updated the AHA/NHLBI- (2005) and IDF-definition 0.85 (men 0.79, women 0.89).ConclusionThe prevalence of metabolic syndrome is associated with age, gender, and educational status and increases considerably with each newly published definition. Our data highlight the need for a better evidence regarding thresholds of the components of the metabolic syndrome, especially with regard to the IDF-definition – according to which in some populations a majority of subjects are diagnosed with the metabolic syndrome.
Highlights
The metabolic syndrome (MetSyn) places individuals at increased risk for type 2 diabetes and cardiovascular disease
Since numerous studies using the NCEP ATP IIIdefinition included hypertensive treatment, explicitly not mentioned in the original definition (Tab. 2), we considered subjects using hypertensive medication as having MetSyn
A history of diabetes was reported by 17% of all men
Summary
The metabolic syndrome (MetSyn) places individuals at increased risk for type 2 diabetes and cardiovascular disease. The impact of different definitions of the MetSyn on the prevalence is unclear. Aim here is to assess the prevalence of the MetSyn in primary health care and to investigate the impact of four different definitions of the MetSyn on the determined prevalence with regard to age, gender and socio-economic status. Over the past decade the Metabolic syndrome (MetSyn) has been granted increased attention due to its postulated impact on cardiovascular diseases, especially if linked to the increasing problem of (central) adiposity. In contrast to the definition of the World Health Organization (WHO) [2], it does not require the determination of insulin levels, thereby facilitating prevalence assessment. In 2004 and 2005, the NCEP ATP III-definition has been modified by the American Heart Association and the National Heart, Lung, and Blood Institute (AHA/NHLBI) [3,4]. In 2005, the major adjustment to the AHA/NHLBI 2004 definition was to include persons reporting a history of current antihypertensive drug or lipid lowering medication use regardless of measured values (Tab. 2)
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