Abstract
BackgroundIn 2009, a unified definition of metabolic syndrome (MetS) was proposed, of which, the glycemic component is defined on the basis of fasting plasma glucose (FPG) level. Recently, the American Diabetes Association (ADA) recommended the use of glycated hemoglobin (HbA1c) as an alternative to FPG to define prediabetes. Hence, we aim to compare the performance of HbA1c and FPG in the definition of glycemic component of the MetS among Chinese adults.MethodsWe conducted a cross-sectional analysis of 7641 Chinese participants aged ≥18 years using data from the China Health and Nutrition Survey 2009. MetS was defined according to the consensus criteria in 2009. We compared the use of HbA1c versus FPG in the definition of the glycemic component of MetS. Increased HbA1c value was defined following the criterion of HbA1c cut-off point of ≥5.7% recommended by the ADA.ResultsOverall, 1136 (14.9%) had MetS according to FPG ≥ 5.6 mmol/l, and 1640 (21.5%) had MetS according to HbA1c ≥ 5.7%. Compared with individuals with FPG-based diagnosis of MetS, individuals with HbA1c-based diagnosis of MetS were older, had higher levels of LDL-C, magnesium, and transferrin, and lower levels of uric acid. Of those found to have MetS according to either FPG or HbA1c (n = 2008), overlap between HbA1c- and FPG-based diagnosis of MetS was limited (n = 768, 38.2%). The overlap index regarding MetS diagnosed by FPG or HbA1c persisted low in each evaluated subgroup (≤ 50.0%).ConclusionsWe note limited overlap and poor agreement between FPG- and HbA1c-based diagnosis of MetS. Screening MetS through introduction of HbA1c in addition to FPG could contribute to identification of more people with MetS.
Highlights
In 2009, a unified definition of metabolic syndrome (MetS) was proposed, of which, the glycemic component is defined on the basis of fasting plasma glucose (FPG) level
The proportion of FPG-based diagnosis of MetS remained stable between genders (15.0% in men and 14.8% in women, P = 0.63), while women had a significantly higher proportion of Glycated hemoglobin (HbA1c)-based diagnosis of MetS than men (19.7% in men and 23.0% in women, P < 0.001)
The prevalence of FPG- and HbA1c-based diagnosis of MetS increased with age (Table 1)
Summary
In 2009, a unified definition of metabolic syndrome (MetS) was proposed, of which, the glycemic component is defined on the basis of fasting plasma glucose (FPG) level. We aim to compare the performance of HbA1c and FPG in the definition of glycemic component of the MetS among Chinese adults. We took advantage of the large representative sample of Chinese adults who participated in the China Health and Nutrition Survey (CHNS) 2009 to compare the uses of HbA1c ≥ 5.7% or FPG ≥ 5.6 mmol/l in the definition of the glycemic component of MetS. As prior evidence provided mixed results as to whether the presence of MetS aggravates cardiovascular risk in diabetic patients [12,13,14], we repeated the analysis in participants without diabetes (FPG ≥7.0 mmol/l or HbA1c ≥6.5%)
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