ATPIII Definition Research Articles

Grip strength and the metabolic syndrome: findings from the Hertfordshire Cohort Study

Sarcopenia, the loss of muscle mass and strength with age, is significantly associated with type 2 diabetes in older people. To determine whether there is a relationship between grip strength and features of the metabolic syndrome. Cross-sectional study. Data were collected on grip strength, fasting glucose, triglycerides and HDL cholesterol, blood pressure, waist circumference and 2 h glucose after an oral glucose tolerance test, in a population-based sample of 2677 men and women aged 59-73 years. In men and women combined, a standard deviation (SD) decrease in grip strength was significantly associated with higher: fasting triglycerides (0.05 SD unit increase, 95%CI 0.02-0.09, p = 0.006); blood pressure (OR 1.13, 95%CI 1.04-1.24, p = 0.004); waist circumference (0.08 SD unit increase, 95%CI 0.06-0.10, p < 0.001); 2 h glucose (0.07 SD unit increase, 95%CI 0.03-0.11, p = 0.001) and HOMA resistance (0.05 SD unit increase, 95%CI 0.01-0.09, p = 0.008), after adjustment for gender, weight, age, walking speed, social class, smoking habit and alcohol intake. Lower grip strength was also significantly associated with increased odds of having the metabolic syndrome according to both the ATPIII (OR 1.18, 95%CI 1.07-1.30, p < 0.001) and IDF definitions (OR 1.11, 95%CI 1.01-1.22, p = 0.03). Our findings suggest that impaired grip strength is associated with the individual features, as well as with the overall summary definitions, of the metabolic syndrome. The potential for grip strength to be used in the clinical setting needs to be explored.

Predictive Values of HOMA and Metabolic Syndrome by Different Definitions in Identifying NASH and Liver Fibrosis in a Population with High Prevalence of Obesity and Diabetes

Purpose: Insulin resistance and related metabolic syndrome (MS) have been closely linked to nonalcoholic fatty liver disease (NAFLD). The progression from NAFLD to nonalcoholic steatohepatitis (NASH) occurs in substantial but yet-to-be determined percentage of patients. This study analyzes which definition of the metabolic syndrome (MS) is more predictive of NASH and liver fibrosis in population with high prevalence of obesity and diabetes. Methods: Our cohort consisted of 65 consecutive patients referred for liver biopsy with clinical suspicion of NAFLD. Histology was assessed blindly by a pathologist and the clinical data was also collected in blinded fashion. MS was assessed based on WHO, ATP III, and IDF definitions. Results: Of 65 subjects, 37 (56.9%) had NASH, 17 (26.2%) had simple steatosis and 11(16.9%) had normal biopsy. In relation to NASH, the strongest correlation was observed with WHO definition of MS (r= 0.386, P < 0.001) > ATPIII (r= 0.371, P= 0.002) > HOMA (r= 0.332, P < 0.001) > IDF (r= 0.283, P= 0.021). However, in association with fibrosis, HOMA index was most strongly correlated with degree of fibrosis (r= 0.493, P < 0.001) as compared to the established definitions of MS. Of the three, WHO showed the strongest correlation with fibrosis (r= 0.411, P < 0.001) as compared to ATPIII (r= 0.36, P < 0.001) and IDF (r= 0.279, P= 0.013). After adjusting for age, AST, ALT, AST/ALT ratio and diabetes, HOMA index remained significantly associated with NASH as well as degree of fibrosis (OR: 7.3(2.2–24.4) P= 0.001 and 13.1(2.5–69) P < 0.001 respectively). All three definitions of the MS remained significant in relation to fibrosis [OR (95% CI) ATPIII: 9.1(1.8–45.0) P= 0.007; WHO: 6.9(1.7–27.7) P= 0.007 and IDF: 3.9(1.03–14.4) P= 0.044)]. While WHO and ATPIII remained significantly associated with NASH [OR: 8.4(2.0–34.5) P= 0.003; and 6.3(1.8–22.0, P= 0.004 respectively], IDF failed to remain significant [OR = 3.1(1.0–10.0) P= 0.057] after adjusting for confounding factors. Conclusion: HOMA and MS are significantly associated with NASH and liver fibrosis in patients with suspected NAFLD. While the WHO and ATPIII definitions were strongly predictive of NASH, IDF seemed inappropriate in identifying the likelihood of having NASH in patients with NAFLD.

Prognostic value of International Diabetes Federation and Adult Treatment Panel III definitions of metabolic syndrome in Type 2 diabetic patients: What makes the difference?

The International Diabetes Federation (IDF) proposed new diagnostic criteria for metabolic syndrome (MS), lowering glucose and waist thresholds, and rendering abdominal adiposity necessary for diagnosis. In Type 2 diabetic patients, IDF-defined MS has a lower prognostic value than Adult Treatment Panel III (ATP-III) criteria; this could depend either on lower thresholds for waist, or on the fact that adiposity was made necessary for diagnosis. Information on 3-yr all-cause mortality of a consecutive series of 882 Caucasian Type 2 diabetic outpatients was obtained by the City of Florence Registry Office. Two different modifications of ATP-III criteria were tested: low waist threshold (LWT), with same threshold as IDF, but with abdominal adiposity not considered a necessary condition; and elevated waist as necessary condition (EWNC), with the older ATP-III threshold. Over the follow-up period, 115 (13.6%) deaths were recorded. A significantly higher mortality rate was observed in patients with LWT-, but not EWNC-defined MS, in comparison with the rest of the sample (14.2% vs 13.3%, p=0.705, and 14.7% vs 8.9%, p=0.050, for EWNC and LWT, respectively). Lowering the waist threshold did not reduce prognostic value in comparison with ATP-III definition of MS; conversely, when elevated waist circumference was considered a necessary condition for diagnosis, the predictive value for mortality decreased, irrespective of thresholds used. In Type 2 diabetic patients, modification of thresholds for waist circumference does not alter the prognostic value of MS. However, if abdominal adiposity is considered a necessary condition for diagnosis, the ability of MS to predict all-cause mortality is markedly reduced.

Une étude prospective de la prévalence du syndrome métabolique dans des familles françaises supposées saines: Importance du polymorphisme du TNF-alpha et de sa concentration plasmatique

Metabolic syndrome (MS) is a cluster of synergistically interacting cardiovascular risk factors which may have serious consequences for the development of cardiovascular disease and diabetes. In this study, we aimed to estimate the prevalence of MS within presumably healthy French families of the STANISLAS cohort, and to observe biological parameters involved in cardiovascular diseases among the offspring of MS subjects. 371 apparently healthy families (1366 individuals) were examined at two visits with a five-year interval (t0 and t+5). MS prevalence was assessed among parents following the ATP-III definition. Our results show that MS is present in presumably healthy adults of the STANISLAS cohort and increases with age. Moreover, low HDL-C and TNF-alpha may play an important role in the development of MS in childhood, at least in our population. Therefore, a systematic tracking of MS appears to be all the more important as it will permit early management of MS in parents and the installation of efficient preventive measures in children including specific advice for diet and physical activity.

How many components for the metabolic syndrome? Results of exploratory factor analysis in the FIBAR study

Background and aims Factor analysis can be used as a basis for the determination of diagnostic criteria for the metabolic syndrome (MS). This approach can be used as a basis for the determination of diagnostic criteria for MS. Methods and results Exploratory factor analysis of Adult Treatment Panel (ATP)-III and International Diabetes Federation (IDF) criteria for MS, entered as dichotomic variables, was performed on 2945 patients enrolled in a screening programme for diabetes. The ability of calculated factors to identify patients with MS-related conditions (glucose intolerance, hyperuricaemia, and elevation of alanine aminotransferase; ALT) was assessed through Receiver Operator Characteristics (ROC) curve analysis. Alternative sets of criteria based on ATP-III and IDF definitions of MS were also assessed. A two-factor structure was found for both ATP-III and IDF criteria. Factor 1 (associated with fasting hyperglycaemia, hypertension, and elevated waist circumference) was capable of identifying subjects with MS-related conditions to a greater extent than factor 2 (low HDL-cholesterol and hypertriglyceridaemia). When a composite variable (low HDL-cholesterol and/or hypertriglyceridaemia) was used for dislipidaemia, a single factor structure was obtained both for ATP-III and IDF definitions; this factor structure was retained when hyperuricaemia was added as a fifth component of MS. Such a modified definition of MS was not inferior to original ATP-III and IDF criteria in the identification of subjects with glucose intolerance and elevated ALT. Conclusions A modification of current ATP-III or IDF criteria is necessary in order to obtain a single-factor structure. Alternative definitions of MS, including additional features, such as hyperuricaemia, can maintain a monofactorial structure, and an association with related conditions not inferior to that of original criteria.

The Metabolic Syndrome in Australia: Prevalence using four definitions

Objective To compare the prevalence of the Metabolic Syndrome (MetS) defined by four definitions and to determine which definition best identifies those at high cardiovascular disease (CVD) risk and with insulin resistance. Methods AusDiab is a population-based survey of 11,247 Australians. Participants had anthropometry, blood pressure, and fasting biochemistry. Ten-year CVD risk was calculated. Results The prevalence of the MetS using the ATPIII, WHO, IDF, and EGIR definitions was 22.1% (95%Cl: 18.8, 25.4), 21.7% (19.0, 24.3), 30.7% (27.1, 34.3), and 13.4% (11.8, 14.9), respectively. Comparing those with to those without the MetS, the odds ratios (95%CI) for having a 10 year CVD risk ≥15% were 6.6 (5.4, 8.2), 5.5 (4.7, 6.5), 5.6 (4.8, 6.6), and 3.5 (3.0, 4.1), for the WHO, ATPIII, IDF, and EGIR definitions, respectively. The population attributable risk (PAR) of high CVD risk due to the MetS was highest for the IDF (23.4%). Insulin resistance was detected in 56.1, 69.7, 50.9, and 91.1% of those meeting the ATPIII, WHO, IDF, and EGIR definitions, respectively. Conclusion The WHO definition was associated with the greatest CVD risk, but is not practical for clinical use. The higher PAR due to the IDF definition, with only slightly lower CVD risk than WHO, and clinical utility of the IDF definition, indicates that it may be a useful tool for CVD prevention.

Nueva definición del síndrome metabólico: ¿mismo riesgo cardiovascular?

The International Diabetes Federation (IDF) has recently published the new criteria for the diagnosis of metabolic syndrome. The aim of this study was to compare the clinical characteristics and cardiovascular risk of the new patients with MS compared to the previous National Cholesterol Education Program ATP III definition, its differential characteristics and cardiovascular risk. Cross sectional study in a hypertension clinic. Coronary risk was calculated (Framingham function NCEP-ATP III) and other cardiovascular markers, urinary albumin excretion (UAE in mg/24 hours) and high sensitivity C-reactive protein (CRP) were assessed. A total 2,404 patients were evaluated, 1,901 non-diabetic and 503 diabetic hypertensive subjects. The non-diabetics 726 (38.2%) had MS with the previous NCEP ATP-III definition, the number increasing sharply to 1,091 (57.4%) with the new IDF definition. The proportion did not increase in diabetics (93% vs. 92%). Concordance in the diagnosis was 78% in non-diabetics and 91% in diabetics. The new patients had a similar coronary risk (Framingham) but lower values of other cardiovascular markers: logUAE 1.00 (0.49) mg/24 hours vs. 1.06 (0.55) mg/24 hours (p = 0.003), and CRP 1.9 (2.7) mg/L vs. 2.5 (3.2) mg/L (median, interquartile range; p < 0.001). The new IDF definition of MS increases the number of patients with MS. The new patients have a similar coronary risk (Framingham) but the new parameters used to assess cardiovascular risk (UAE and CRP) were lower. The relationship of the new definition of MS and cardiovascular risk remains to be defined.

An evaluation of the International Diabetes Federation definition of metabolic syndrome in Chinese patients older than 30 years and diagnosed with type 2 diabetes mellitus

The objective of the study was to determine the most accurate metabolic syndrome (MS) definition among the definitions proposed by the International Diabetes Federation (IDF), the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III [ATPIII]), and the World Health Organization (WHO) and to evaluate the cutoff point of waist circumference using the IDF definition for optimally defining MS in the Chinese population. One thousand thirty-nine Chinese patients older than 30 years and diagnosed with type 2 diabetes mellitus were investigated by randomized cluster sampling in the Shanghai downtown, and 1008 patients were analyzed in this study. Body mass measurements, resting blood pressure, fasting blood measures, and carotid atherosclerotic measurements including common carotid artery intima-media thickness (IMT) and carotid plaque were investigated. The IDF definition was compared with the other 2 definitions, and the carotid atherosclerosis was evaluated among the patients according to these definitions. (1) The MS prevalence was 50.0%, 55.7%, and 70.0% under the IDF, ATPIII, and WHO definitions, respectively. (2) The percentage of all the participants categorized as either having or not having the MS was 69.9% (under the IDF and ATPIII definitions) and 70.2% (under the IDF and WHO definitions). (3) Common carotid artery IMT of patients with MS determined by the IDF definition was thicker than those determined by the WHO and ATPIII definitions, and the percentage of carotid plaque of patients with MS determined by the IDF definition was greater than those determined by the WHO and ATPIII definitions. (4) When the cutoff point of waist circumference in men determined by the IDF definition was modified from 90 to 85 cm, common carotid artery IMT of the emerging male patients with MS was thicker than that of the male patients with MS determined by the original IDF definition. In conclusion, the prevalence of MS was 50.0%, 55.7%, and 70.0% under the IDF, ATPIII, and WHO definitions, respectively. The preferable IDF definition served as a better predictor of cardiovascular disease risk in the Chinese patients diagnosed with type 2 diabetes mellitus compared with the ATPIII and WHO definitions. The modified cutoff point of waist circumference in men under the IDF definition specific for the Chinese population (from 90 to 85 cm) might be more suitable for predicting atherosclerosis.

Metabolic syndrome traits in long-term survivors of pediatric sarcoma at a single institution

9041 Multi-modality therapy (MMT) for pediatric sarcoma (SARC) may result in late endocrine abnormalities and increased cardiovascular morbidity. Metabolic syndrome (MS; NCEP ATPIII definition), a cluster of obesity, dyslipidemia, hyperglycemia and hypertension, conveys an increased risk of type 2 diabetes and cardiovascular disease. This cross-sectional study investigated the prevalence of the MS traits (MST) in long-term survivors of MMT for SARC. 32 survivors of SARC (predominantly Ewing’s; median age 36.5 years, range 17–54; f:m = 15:17; median age at MMT of 15 years, range 7–34; median time since completion of MMT 18 years, range 3–33) completed CT evaluation of abdominal obesity, DEXA scan for body mass composition, fasting serum lipid profile (FLP), the Human Activity Profile (HAP) and PAI and beta 2 microglobulin (B2M) analysis. Results, compared to appropriate controls were considered statistically significant if the p-value &lt; 0.01. SARC survivors were more likely to have one or more MST (common OR 4.04, CI:[1.52, 13.55], p=0.0045). Subjects aged 20–39 had a higher pooled prevalence of the MS (common OR 4.29 [1.50, 11.21], p=0.0077), defined as 3 or more traits, compared to controls stratified by gender. Analysis of individual MST demonstrated higher prevalence of hypertension (common OR 2.61,[1.20, 5.59], p=0.015), hypertriglyceridemia (common OR 3.63, [1.75, 7.60], p=0.0006), and male abdominal obesity (common OR 4.52, [1.57, 13.39], p=0.0046). SARC survivors had a higher prevalence of hypercholesterolemia than healthy adults (p=0.012). PAI antigen (p=0.043), PAI activity (p=0.018) and B2M levels (p=0.043) increased with an increasing number of MST. In male subjects, total testosterone declined (p=0.008) as the number of MST increased. Average (p=0.028) and maximum (p=0.041) activity levels decreased as the number of MST increased. After a median follow up of 18 years, adult SARC survivors of MMT have an increased prevalence of MST, especially between ages 20–39 years. The development of MST may be associated with decreased testosterone and decreased activity level. Younger male adult SARC survivors may be at particular risk for type 2 diabetes and cardiovascular disease and should be monitored. No significant financial relationships to disclose.

Prevalence of metabolic syndrome using WHO, ATPIII and IDF definitions in Asian Indians: the Chennai Urban Rural Epidemiology Study (CURES‐34)

To compare the prevalence of metabolic syndrome (MS) using the World Health Organisation (WHO), Adult Treatment Panel III (ATPIII) and International Diabetes Federation (IDF) criteria of MS in an urban south Indian population, and their ability to identify coronary artery disease (CAD) in males and females. Chennai Urban Rural Epidemiology Study (CURES) is one of the largest epidemiological studies on diabetes carried out in India, in which 26 001 individuals aged >or=20 years were screened using systematic random sampling method. Every tenth subject recruited in Phase 1 of CURES was requested to participate in Phase 3, and the response rate was 90.4%. An oral glucose tolerance test (OGTT) was performed in all individuals except self-reported diabetic subjects. Anthropometric measurements and lipid estimations were done in all subjects and the prevalence of MS estimated using the three criteria. Diagnosis of CAD, made by resting 12 lead ECG, was compared by the three criteria of MS. MS was identified in 546 subjects (23.2%) by WHO criteria, 430 subjects (18.3%) by ATPIII criteria and 607 subjects (25.8%) by IDF criteria. Only 224 of these subjects were identified by all the three criteria. There was an increased risk of probable CAD in MS subjects diagnosed by WHO criteria (odds ratio (OR) 3.86, 95% Confidence Interval (CI), 2.37-6.29, p < 0.001), compared to ATPIII criteria (OR 2.19, 95% CI 1.30-3.67, p < 0.05) and IDF criteria (OR 1.90, 95% CI 1.16-3.12, p < 0.05). The WHO criteria marked out a much higher population for CAD risk compared to ATPIII and IDF criteria in males, but not in females. In Asian Indians, the WHO, ATPIII and IDF criteria of MS identify different individuals. The WHO criteria identify a greater number of CAD subjects in males, but not in females.

Accuracy of atpiii and idf definitions of metabolic syndrome in identifying insulin resistance

Accuracy of atpiii and idf definitions of metabolic syndrome in identifying insulin resistance

Adult Treatment Panel III 2001 but Not International Diabetes Federation 2005 Criteria of the Metabolic Syndrome Predict Clinical Cardiovascular Events in Subjects Who Underwent Coronary Angiography

The International Diabetes Federation (IDF) has recently established a worldwide consensus definition of the metabolic syndrome. No prospective data are available on the cardiovascular risk associated with this new metabolic syndrome definition. In a prospective study of 750 coronary patients, we recorded vascular events over 4 years. From our patients, 37.3% (n = 280) had the metabolic syndrome according to the Adult Treatment Panel III (ATPIII) definition and 45.5% (n = 341) according to the IDF definition. The metabolic syndrome as defined by the ATPIII criteria significantly predicted vascular events (adjusted hazard ratio 1.745 [95% CI 1.255-2.427]; P = 0.001), but the metabolic syndrome as defined by IDF criteria did not (1.189 [0.859-1.646]; P = 0.297). Accordingly, event-free survival was significantly lower among patients who fulfilled the ATPIII but not the IDF criteria than among those who met the IDF but not the ATPIII criteria (P = 0.012). The metabolic syndrome as defined by ATPIII criteria remained significantly predictive of vascular events after adjustment for type 2 diabetes but not after additional adjustment for the metabolic syndrome components high triglycerides and low HDL cholesterol. These lipid traits in turn proved significantly predictive of vascular events even after adjustment for the metabolic syndrome. The ATPIII definition of the metabolic syndrome confers a significantly higher risk of vascular events than the IDF definition. However, among angiographied coronary patients, even the ATPIII definition of the metabolic syndrome does not provide prognostic information beyond its dyslipidemic features.

The metabolic syndrome in an Arab population: a first look at the new International Diabetes Federation criteria

To report the prevalence of the metabolic syndrome in Arab men and women using the new International Diabetes Federation (IDF) criteria, and to compare this with the prevalence using the 1999 World Health Organization (WHO) and 2001 National Cholesterol Education Program Adult Treatment Panel III (NECP ATPIII) definitions. The study involved 863 subjects (343 men and 520 women) aged > or = 40 years living in Tunis, Tunisia, taken from an initially randomized, population sample. The prevalence of the metabolic syndrome using the IDF criteria was found to be 45.5%; 55.8% in women and 30.0% in men (P < 0.001), higher than the rates of 28.7% (WHO) and 24.3% (NECP ATPIII) using the previous definitions. Using all the definitions, the prevalence was higher in women than in men predominantly because of significant differences in central obesity and high-density lipoprotein (HDL) cholesterol and, to a lesser extent, hypertension. The increased prevalence using the IDF criteria compared with the 1999 WHO criteria and the 2001 NCEP ATPIII definitions is striking and has huge implications for public health worldwide. The major reason for the higher rate using the new definition seems to be the predominant focus placed on central obesity. Using tighter criteria for fasting glycaemia has also played a factor. The question remains as yet unanswered as to whether the new IDF criteria are better at predicting hard outcomes such as diabetes mellitus and cardiovascular diseases.

Metabolic Syndrome and Prediabetes

This is a systematic review of the distribution of cardiometabolic syndrome (CMS) in Nigeria, the clinical definitions widely used and how it affects the proposition of a national prevalence of CMS that will advise management interventions.Systematic review of literature.To present a comprehensive report of the distribution of CMS in Nigeria, extensive searches was carried out on PubMed, African Journals Online (AJOL), SCOPUS, EBSCOhost (CINAHL Plus), Google Scholar and Science Direct using terms: Nigeria, metabolic syndrome, cardio-metabolic syndrome, syndrome X, World Health Organization, International Diabetic Federation, National Cholesterol Education Program Adult Treatment Panel III, European Group for study on Insulin Resistance, American Association of Clinical Endocrinologist, American Heart Association/National Heart, Lung and Blood Institute. All published data between January 2002 and December 2013 were collated into a database. Information gathered and recorded for each source were the population sampled, age and number of population, locality, clinical definition used, longitude and latitude, and period of the study.Out of 32 studies, 9 (28.1%) adopted the WHO classification, 19 (59.4%) used the ATPIII definition, while the remaining 10 (31.3%) studies used the IDF definitions. Twenty (62.5%) were hospital-based studies on diabetic, hypertensive, HIV, asthmatic and thyroid disorder patients. The remaining 12 (37.5%) studies were population-based studies in urban, suburb and rural settings. The mean overall prevalence of CMS in Nigeria is 31.7%, 27.9% and 28.1% according to the WHO, ATPIII and IDF definitions, respectively. Most of the studies were from the Southern region. Age groups mostly studied were those from ≥35 years.The report of this review provides an essential overview on the current distribution of CMS in Nigeria. It provides an insight to direct future studies such as the need to (1) study rural communities where lifestyles are not westernized as in the urban areas, and (2) young adults, as well as (3) develop a consensus on the definition of CMS among the Sub-Saharan African populations.

The metabolic syndrome and changing relationship between blood pressure and insulin with age, as observed in Aboriginal and Torres Strait Islander peoples

To determine the prevalence of the metabolic syndrome (MS) among Aboriginal and Torres Strait Islander peoples. A further objective was to investigate the relationships between fasting insulin and blood pressure (BP) within these groups with increasing age. A cross-sectional population-based study included 369 Torres Strait Islanders (residing in Torres Strait and Far North Queensland), and 675 Aborigines from central Australia. Data necessary for classification of MS was collected, including fasting and 2-h glucose and insulin, urinary albumin and creatinine, anthropometric measurements, BP, serum lipids. The ATPIII criteria classified 43% of Torres Strait Islanders and 44% of Aborigines with MS, whereas 32 and 28%, respectively, had the MS according to WHO criteria. Agreement between the two criteria was only modest (kappa coefficient from 0.28 to 0.57). Factor analyses indicated no cluster including both insulin and BP in either population. Significant correlations (P < 0.05) [adjusted for gender, body mass index (BMI) and waist circumference] were observed between BP and fasting insulin: a positive correlation for Torres Strait Islanders aged 15-29 years, and an inverse correlation for Aborigines aged 40 years and older. Torres Strait Islanders and Aborigines had very high prevalences of the MS. Specific population characteristics (high prevalences of central obesity, dyslipidaemia, renal disease) may make the WHO definition preferable to the ATPIII definition in these population groups. The poor agreement between criteria suggests a more precise definition of the metabolic syndrome that is applicable across populations is required. This study showed an inverse relationship with age for the correlation of BP and fasting insulin.

Heritabilities of the metabolic syndrome and its components in the Northern Manhattan Family Study.

Growing evidence suggests that the traits comprising the metabolic syndrome have a genetic basis. However, studies of genetic contributions to the syndrome are sparse. Against this background, we sought to estimate the heritability of the metabolic syndrome and its component traits. We investigated 803 subjects from 89 Caribbean-Hispanic families who have enrolled to date in the current Northern Manhattan Family Study and for whom metabolic syndrome information was available. Metabolic syndrome was defined in accordance with the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATPIII) criteria. Variance component methods were used to estimate age and sex-adjusted heritability of the metabolic syndrome and its components. To obtain the structures underlying the metabolic syndrome, we performed principal component factor analyses using six quantitative phenotypes included in the ATPIII definition. The heritability for the metabolic syndrome was 24% (p=0.009), and ranged from 16 to 60% for its five components. Factor analysis yielded two independent factors (factor 1: lipids/glucose/obesity; factor 2: blood pressure). Heritability analysis revealed significant genetic effects on both factors (44% for lipids/glucose/obesity, and 20% for blood pressure). In the Caribbean-Hispanic families investigated, we demonstrated moderate and significant heritabilities for the metabolic syndrome itself, as well as for individual components and independent factors of the syndrome. These results provide evidence that could support future tasks of mapping susceptibility loci for this syndrome.

Second World Congress on the Insulin Resistance Syndrome

This is the second in a series of articles on the Second World Congress on the Insulin Resistance Syndrome, Universal City, California, 18–20 November 2004. Jacqueline Dekker (Amsterdam, the Netherlands) presented data from the Hoorn Study on the predictive power of insulin resistance syndrome diagnosis, pointing out that the public health role of identifying a person as having insulin resistance syndrome includes the ability to characterize populations to better understand the pathogenesis of adverse outcome, to allow comparison of characteristics of individuals in differing populations, and to serve a communications function in increasing risk awareness, particularly allowing identification of high-risk groups for cardiovascular disease (CVD), cancer, and diabetes. An important question is whether the existing definitions allow optimal diagnosis of high-risk groups. Comparing the Adult Treatment Panel (ATP)-III and American College of Endocrinology (ACE) definitions (1), she noted that the ACE definition starts with high-risk individuals, including non-Caucasian ethnicity, cigarette use, obesity, CVD, hypertension, polycystic ovarian syndrome (PCOS), nonalcoholic fatty liver disease, acanthosis nigricans, history of gestational diabetes or impaired glucose tolerance (IGT), and family history of type 2 diabetes, hypertension, or CVD. The Hoorn Study included 2,484 individuals aged 50–75 in 1989–1990, with follow-up examination in 1996–1998, and population registry ascertainment of morbidity and mortality. Of 2,162 without diabetes at baseline, there were 429 deaths, 145 with malignancy and 168 with CVD. Insulin resistance syndrome components for men and women included hypertension in 68 and 66%, abdominal obesity in 16 and 40%, impaired fasting glucose in 14 and 9%, IGT in 21 and 18%, high triglycerides in 35 and 29%, and low HDL cholesterol in 28 and 35%, respectively. Twenty-one and 29% of men and women, respectively, satisfied the ATP-III definition and 46 and 42% the ACE definition of insulin resistance syndrome. Despite the greater number satisfying the ACE …

Nonalcoholic Fatty Liver Disease and Atherosclerosis

To the Editor: I read with interest the article by Brea et al1 regarding the strong relationship between nonalcoholic fatty liver disease (NAFLD) and carotid atherosclerosis (as measured by intima-media thickness [IMT] and plaque prevalence) in a sample of predominantly obese and hypertensive subjects. Notably, they reported substantially similar results to those recently published by our group in a sample of nonobese healthy men,2 thus further supporting the notion that people with NAFLD are at increased risk of CVD. However, I partly disagree with the authors’ conclusions suggesting that NAFLD is a strong risk factor for carotid atherosclerosis beyond its association with the metabolic syndrome (MetS). In both studies, patients with NAFLD had, other than several features resembling MetS, a marked increase in carotid IMT values compared with those without NAFLD. However, in the study by Brea et al1 the increase in carotid IMT (but not that in the prevalence of carotid plaques) remained statistically significant after adjustment for the presence of MetS (as defined by ATP-III or WHO criteria). On the contrary, in our study the increase in carotid IMT was largely mediated by the extent of visceral fat accumulation, as measured by computed tomography (CT).2 It is known that WHO and ATP-III definitions of …

Diferencias en la prevalencia del síndrome metabólico según las definiciones del ATP-III y la OMS

The objective of the study is to know the prevalence of the metabolic syndrome (MS), as well as to know the differences in its prevalence according to the Adult Treatment Panel of the National Cholesterol Education Program (ATP-III) and World Health Organization (WHO) criteria. Cross-sectional descriptive study performed in primary care in population of both sexes aged between 40 and 74 years. Variables studied were risk factors as well as each one of the components of MS, according to both definitions. We studied 358 patients, 161 (45%) men and 197 women. The prevalence of MS using the WHO criteria was 17.9% and according with the ATP-III criteria it was 23.5%. The prevalence increased with age and the body mass index. Both definitions agreed in the classification of MS in 80% of cases (kappa = 0.38). If we considered the definition of MS according to the WHO taken as the "gold standard", the ATP-III definition displays a sensitivity of 59.4%, specificity of 84.4% and negative predictive value of 90.5%. The agreement is greater in women and older than 60 years. The prevalence of MS is smaller with the WHO criteria. The agreement between both methods is scarce and the clinical application of the ATP-III criteria in primary care needs its homologation with clinic-epidemiological studies.

An Evaluation of Candidate Definitions of the Metabolic Syndrome in Adult Asian Indians

We aimed to evaluate eight candidate definitions of the metabolic syndrome (MS) against the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) definition as the reference for optimally defining MS in adult Asian Indians. We used clinical and biochemical data from our previous cross-sectional epidemiological studies. Candidate definitions of MS were proposed by modifying the NCEP ATPIII definition. These modifications included the following: waist circumference cutoffs as >90 cm in men and >80 cm in women, BMI cutoff as >23 kg/m(2), and a measure of truncal subcutaneous fat (subscapular skinfold thickness [SST] >18 mm). The highest prevalence (29.9%) of MS was observed by the inclusion of modified cutoffs of waist circumference and BMI and SST in place of the existing cutoffs of waist circumference in the NCEP ATPIII criteria. Further, this modified definition showed the maximum absolute gain in the percentage of prevalence of MS over the NCEP ATPIII definition, and it was the best predictor for MS in subjects with impaired fasting glucose, type 2 diabetes, and different age-groups. The lowest percentage of prevalence of MS was observed with the definition that excluded biochemical variables and blood pressure. The criteria for defining MS in adult Asian Indians need revision. Inclusion of modified cutoffs of waist circumference and BMI and measures of truncal subcutaneous fat in the NCEP ATPIII definition requires further validation.