NCEP Definition Research Articles

The Prevalence of the Metabolic Syndrome among the Multiethnic Population of the United Arab Emirates: A Report of a National Survey

The aim of this study was to determine the prevalence of the metabolic syndrome using the National Cholesterol Education Adult Panel III (NCEP), and to compare this with the prevalence using the International Diabetes Federation (IDF) definitions in the United Arab Emirates (UAE). Data were collected on 4097 men and women aged > or =20 from the 2000 Emirates National Diabetes study and screening for risks factors for Coronary Artery Disease (ENDCAD) Study. A stratified, multistage, random sample was selected. The age-adjusted prevalence of metabolic syndrome using the NCEP definition was 39.6%, which was similar to 40.5% using the IDF definition. In both men and women, larger waist circumference was associated with the presence of the metabolic syndrome compared to those who did not have metabolic syndrome. A low concentration of high-density lipoprotein cholesterol (HDL-C) was the commonest metabolic abnormality using the NCEP definition, whereas abdominal obesity was the commonest abnormality using the IDF definition. The presence of metabolic syndrome was significantly associated with increasing age (> or =40 years), female gender, family history of diabetes, and rural location. By either definition, the metabolic syndrome is highly prevalent in the UAE. This will have important implications for the national health-care sector in the future.

Metabolic Syndrome in Normal and Complicated Pregnancies

Abstract Objective To evaluate the prevalence of metabolic syndrome and its components in normal and complicated pregnancies. Study design Setting: university hospital, tertiary referral centre. Subjects: 90 pregnant women in four groups: 20 women with preeclampsia, 20 women with gestational hypertension, 30 women with late-onset gestational diabetes and 20 healthy pregnant women as a control group. Intervention: peripheral insulin resistance was measured by using the insulin tolerance test. Glucose, triglycerides, high-density lipoprotein cholesterol, blood pressure and body mass index were analysed. Comparisons were done by Chi-squared test, one-way analysis of variance and the Bonferroni's test. Prevalence of the metabolic syndrome was calculated by adapting both the WHO and the NCEP definitions of the metabolic syndrome to pregnancy. Results There were no cases of metabolic syndrome in the control group according to any of the adapted definitions. The prevalence of this syndrome was 3.3% and 10% in the late-onset gestational diabetes group, 35% and 20% in the gestational hypertension group and 30% and 30% in the preeclampsia group for the WHO and the NCEP definitions, respectively. Conclusions Metabolic syndrome is present in about one-third of women with pregnancy-induced hypertension but only in 10% of women with late-onset gestational diabetes.

All-Cause and Cardiovascular Mortality Using the Different Definitions of Metabolic Syndrome

The aim of the present study was to assess the risk of all-cause and cardiovascular disease (CVD) mortality in subjects identified as having metabolic syndrome (MS) using either the recent International Diabetes Federation (IDF) definition or the revised National Cholesterol Educational Program (NCEP-R) definition, but not the original NCEP (2001) definition. The study population was composed of 84,730 men and women without CVD aged > or =40 years who had a health checkup at the IPC Center. Follow-up for mortality was 4.7 +/-1.7 years. Prevalences of MS were 9.6%, 21.6%, and 16.5% according to the NCEP, IDF, and NCEP-R definitions, respectively. Compared with subjects without MS, risks of all-cause mortality associated with MS were 1.63 (95% confidence interval [CI] 1.38 to 1.93) with the NCEP, 1.25 (95% CI 1.09 to 1.45) with the IDF, and 1.32 (95% CI 1.13 to 1.53) with the NCEP-R, and risks of CVD mortality were 2.05 (95% CI 1.28 to 3.28), 1.77 (95% CI 1.18 to 2.64), and 1.64 (95% CI 1.08 to 2.50), respectively. In subjects with MS detected using the IDF and NCEP-R definitions, but not the NCEP definition, risks of all-cause mortality were 1.07 (95% CI 0.89 to 1.28) and 0.92 (95% CI 0.73 to 1.18) and 1.42 (95% CI 0.86 to 2.34) and 1.07 (95% CI 0.55 to 2.09) for CVD mortality, respectively. In conclusion, in a large French population, the recent definitions of MS almost double the prevalence compared with the original definition. Subjects identified as having MS using only the recent definitions and not the original definition did not have higher rates of all-cause and CVD mortality compared with subjects without MS during follow-up.

Metabolic syndrome in psychiatric inpatients

Background/Aims:The metabolic syndrome is associated with an increased cardiovascular comorbidity and mortality. Many epidemiological studies prove an increased prevalence of the metabolic syndrome among psychiatric patients compared to the general population.Methods:In this on-going naturalistic observational study carried out in an inpatient treatment setting we as yet surveyed the parameters of the metabolic syndrome in 188 psychiatric patients at admission and at discharge. According to the NCEP definition at least three of the five following criteria have to be fulfilled for diagnosing the metabolic syndrome: visceral adipositas (waist circumference: male > 102 cm; female > 88 cm), diabetes mellitus (fasting glucose > 110 mg/dl), arterial hypertonia (≥130 mmHg systol., ≥ 85 mmHg diastol.), elevated triglycerides (≥ 150 mg/dl), reduced HDL cholesterol (male< 40 mg/dl; female< 50 mg/dl).Results:At discharge we found significantly more patients with visceral adipositas (p=0.0001) and elevated triglycerides (p=0.014) compared to the time of admission. A significantly higher percentage of female in comparison to male patients were diagnosed a metabolic syndrome. Higher age was associated with a higher prevalence of the metabolic syndrome (p=0.001, N=186).Conclusions:Our results demonstrate a deterioration of parameters of the metabolic syndrome in the course of an inpatient treatment. As visceral adipositas constitutes an essential risk factor for metabolic and cardiovascular diseases, an uncomplicated and easily manageable measurement of visceral body fat percentage would be desirable. In a pilot study we are evaluating the informative value of visceral body fat percentage as measured by a body composition analyzer.

Long-term outcomes in non-diabetic patients with metabolic syndrome undergoing revascularization for multi-vessel coronary artery disease

Aim The influence of metabolic syndrome (MS) on long-term mortality and morbidity in multi-vessel coronary artery disease (MV-CAD) is unclear. We studied the impact of MS on long-term outcomes in non-diabetic patients (NDM) with MV-CAD undergoing coronary revascularization in the Bypass Angioplasty Revascularization Investigation (BARI) trial and registry. Methods BARI trial and registry patients were separated into those with diabetes (DM) and those without. NDM fulfilling the NCEP definition of MS were identified. Ten year follow-up data were obtained on mortality, MI and development of diabetes. The data were analyzed using Cox proportional hazard modeling. Results In the BARI trial and registry 2962 NDM were identified. Of those, 510 patients had 3 or more components of the BARI-modified NCEP definition for MS, while 445 patients had 2 components of the definition and were classified as the “mixed group”. Compared to patients without MS, both MS group (RR = 3.2, p < 0.0001) and the mixed group (RR = 1.9, p = 0.02) had a higher incidence of DM over the 10-year follow-up. Type 2 DM was found to be highly associated with 10-year mortality (RR = 1.65, p < 0.0001). However, there was no statistically significant difference in the rate of death or MI at 5 and 10 years between NDM with or without MS. In multivariate analysis, the presence of MS was not associated with 10-year mortality in the BARI population (RR = 0.93, p = 0.62). Conclusion In this BARI follow-up study, we have affirmed the role of MS in predicting the development of diabetes in NDM at baseline. The 10-year risk of mortality and MI was not greater in NDM with MS who had MV-CAD and underwent revascularization, compared to patients without MS. Further studies to evaluate MS patients with MV-CAD undergoing coronary revascularization are warranted.

Waist circumference, metabolic syndrome and coronary artery disease in a Pakistani cohort

Background Metabolic syndrome (M-IRS) is common in Asians. This study investigated the relationship of two definitions of M-IRS to atherosclerosis in Indian Asians with suspected coronary arterial disease (CAD). Methods 400 patients with chest pain selected for the presence or absence of angiographic disease were recruited from a tertiary referral centre in Pakistan into a prospective case–control study. Patients were categorized by the National Cholesterol Education Program adult treatment panel 3 (NCEP) and International Diabetes Federation (IDF) definitions of the metabolic syndrome and the relationship of these to the presence of CAD and extent of atheroma burden was investigated. Results M-IRS was present in 53% by IDF criteria and in 44% using the Asian criteria for NCEP. The 2 populations identified were only 69% concordant. No relationship existed between the presence of NCEP M-IRS and atheroma burden. In contrast, the presence of IDF M-IRS was associated with CAD (65 vs. 34%; RR = 1.88; p < 0.001) and angiographic disease burden (28 [0–224] vs. 0 (0–198); RR = 1.83; p < 0.001).This association persisted ( β = 18.4; p < 0.001) after correction for C-reactive protein ( β = 8.67; p < 0.001), lipoprotein (a) ( β = 8.14; p = 0.002), and estimated glomerular filtration rate ( β = − 0.22; p = 0.01). Differences in presumed underlying factors were found in the 2 populations identified by the definitions though both agreed on the separate weightings given to blood pressure and HDL-C/apolipoprotein A1. Conclusions The specific Asian IDF and NCEP definitions of M-IRS show limited concordance in Pakistanis. The IDF criteria in contrast to the NCEP criteria are associated with the presence of CAD even after allowing for other risk factors identified in this population.

Metabolic syndrome in normal and complicated pregnancies

Objective To evaluate the prevalence of metabolic syndrome and its components in normal and complicated pregnancies. Study design Setting: university hospital, tertiary referral centre. Subjects: 90 pregnant women in four groups: 20 women with preeclampsia, 20 women with gestational hypertension, 30 women with late-onset gestational diabetes and 20 healthy pregnant women as a control group. Intervention: peripheral insulin resistance was measured by using the insulin tolerance test. Glucose, triglycerides, high-density lipoprotein cholesterol, blood pressure and body mass index were analysed. Comparisons were done by Chi-squared test, one-way analysis of variance and the Bonferroni's test. Prevalence of the metabolic syndrome was calculated by adapting both the WHO and the NCEP definitions of the metabolic syndrome to pregnancy. Results There were no cases of metabolic syndrome in the control group according to any of the adapted definitions. The prevalence of this syndrome was 3.3% and 10% in the late-onset gestational diabetes group, 35% and 20% in the gestational hypertension group and 30% and 30% in the preeclampsia group for the WHO and the NCEP definitions, respectively. Conclusions Metabolic syndrome is present in about one-third of women with pregnancy-induced hypertension but only in 10% of women with late-onset gestational diabetes.

Defining the metabolic syndrome: Resolving unresolved issues?

Background Several definitions exist for the metabolic syndrome. In concert with the blood pressure and glucose criteria of the NCEP definition, it has now been suggested that the use of fibrates and nicotinic acid be incorporated into the dyslipidemia criteria. While statins are the drugs most widely prescribed for lowering LDL-cholesterol, they also affect triglyceride and HDL-cholesterol levels. The aims of the present study were (1) to investigate how adding lipid-lowering therapy to the NCEP definition might influence the prevalence of the metabolic syndrome and (2) to compare the characteristics of patients identified according to the newly proposed IDF definition with those identified according to the NCEP definition. Methods We conducted a cross-sectional study on 2373 patients with clinically manifest vascular disease. In order to allow for the influence of lipid-lowering therapy on the identification of patients with the metabolic syndrome, the NCEP definition was modified in two ways. In NCEP-rev1, the use of lipid-lowering agents fulfilled the hypertriglyceridemia criterion; in NCEP-rev2, triglycerides and HDL-cholesterol plasma concentrations were recalculated for lipid-lowering agents. Results The prevalence of the metabolic syndrome was 41% according to the NCEP definition, 50% according to the NCEP-rev1, 44% according to the NCEP-rev2, and 52% according to the IDF definition. Patients identified only with the NCEP definition had lower HDL-cholesterol, higher triglycerides, and higher fasting glucoses levels than patients only diagnosed with the IDF definition. Conclusion Adding the use of lipid-lowering drugs to the NCEP definition may lead to the identification of an additional group of patients at an elevated risk for cardiovascular diseases and diabetes. The NCEP definition of the metabolic syndrome identifies patients with a worse cardiovascular risk profile than patients qualifying for the metabolic syndrome with the IDF definition in a cohort of patients with clinical manifestations of vascular disease.

All-Cause Mortality Associated With Specific Combinations of the Metabolic Syndrome According to Recent Definitions

The aim was to evaluate the impact of specific component combinations of the metabolic syndrome on all-cause mortality risk in a large French cohort. The population was composed of 39,998 men (aged 52.6 +/- 8.3 years) and 20,756 women (aged 54.7 +/- 9.2 years) who were examined at the Investigations Préventives et Cliniques Center from 1999 to 2002. Mean follow-up was 3.57 +/- 1.12 years. Metabolic syndrome was defined according to three definitions: the National Cholesterol Educational Program (NCEP 2001), the revised NCEP (NCEP-R; American Heart Association/National Heart, Lung, and Blood Institute 2005), and the International Diabetes Federation (IDF 2005). Subjects with metabolic syndrome were compared with subjects without metabolic syndrome and with subjects with no metabolic syndrome components using Cox regression models. The prevalence of metabolic syndrome increased from 10.3% (NCEP) to 17.7% (NCEP-R) and 23.4% (IDF). After adjustment for age, sex, classical risk factors, and socioprofessional categories, and compared with subjects without metabolic syndrome, the risk of all-cause mortality was 1.79 (95% CI 1.35-2.38), 1.46 (1.14-1.88), and 1.32 (1.04-1.67) with the NCEP, NCEP-R, and IDF definitions, respectively. Among the combinations significantly associated with all-cause mortality, the following three-component combinations and the four-component combination were more highly significant than other combinations (P < 0.05): elevated waist circumference plus elevated glucose, plus either elevated blood pressure or elevated triglycerides, and the combination of all four of these. In a large middle-aged French population, four specific components of metabolic syndrome are associated with a much higher mortality risk. These results may have a significant impact on detecting high-risk subjects suffering from metabolic disorders and underline the fact that metabolic syndrome is a nonhomogeneous syndrome.

Metabolic syndrome and arterial stiffness: The Health 2000 Survey

Metabolic syndrome and its components have been associated with arterial stiffness and cardiovascular disease. The objective of this study was to examine the independent influences of metabolic syndrome, its components, and other cardiovascular risk factors on arterial stiffness as well as to compare 2 definitions for metabolic syndrome (National Cholesterol Education Program [NCEP] and International Diabetes Federation [IDF]) in their ability to identify subjects with arterial stiffness. The study population consisted of 401 Finnish men and women aged 45 years and older who participated in a substudy of the Finnish population–based Health 2000 Survey. Pulse wave velocity (PWV) measured by whole-body impedance cardiography was used as a marker of elevated arterial stiffness. In multivariate models, systolic blood pressure, age, waist circumference, and fasting blood glucose ( P ≤ .001 for all) were independent determinants for PWV. In the models including metabolic syndrome instead of its components, the NCEP and IDF definitions were similarly associated with PWV ( P ≤ .01 for both), the other independent determinants being age, sex ( P < .001 for both) and plasma C-reactive protein concentration ( P = .016 and P = .005 in models containing the NCEP and IDF definitions, respectively). Systolic blood pressure, age, waist circumference, and fasting blood glucose level were independently associated with increased arterial stiffness. Metabolic syndrome determined increased arterial stiffness independently of other known cardiovascular risk factors. The NCEP and IDF definitions did not differ in their ability to identify subjects with increased arterial stiffness.

Simple Demographic Model to Predict Multiple Cardiometabolic Risk Factors in Two Well-Known Observational Cohorts

Objective Determining the prevalence of multiple cardiometabolic risk (CMR) factors requires clinical and laboratory data not readily available to most health-care plans. We evaluated the ability of a simple model derived from the National Health and Nutrition Examination Survey (NHANES) using commonly available demographic information to predict prevalence of multiple CMR factors. Methods We defined CMR factors according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) and International Diabetes Federation (IDF) guidelines for metabolic syndrome classification in both the Atherosclerosis Risk in Communities (ARIC) and the Framingham Offspring Study (FOS) cohorts. Using NHANES data, a simple demographic model consisting of sex, race and ethnicity, smoking status, and the natural logarithm of age, generated the coefficients used to predict the prevalence of multiple CMR factors in ARIC and FOS. Predicted prevalences were compared with the observed prevalences in both cohorts. Results The ARIC and FOS cohorts consisted of 11,596 and 3532 subjects with a mean age of 62.6 and 58.8 years, respectively. The observed proportion of participants with metabolic syndrome in ARIC was 52.1% and 58.8% according to the NCEP and IDF definitions, respectively. In FOS the observed prevalence was 41.4% and 45.8% using the NCEP and IDF definitions. Predicted prevalences of metabolic syndrome for the NCEP and IDF definitions, respectively, were 51.3% and 53.5% in ARIC, and 48.2% and 51.4% in FOS. Differences between the observed and predicted prevalences for three of four additional risk factor sets, including abdominal obesity (AO) alone, AO plus diabetes, and AO plus diabetes plus dyslipidemia, were small (between 1 to 7 percentage points) in both cohorts. The model poorly predicted the prevalence of AO plus dyslipidemia. Conclusion A simple demographic model adequately predicted the prevalence of CMR factors. The model should help health-care plans lacking clinical and laboratory data to estimate prevalence of CMR factors in their populations. Future studies need to evaluate the influence of race, sex, and ethnicity on prevalence of these risk factors in various settings.

Variants of the Transcription Factor 7-Like 2 Gene (TCF7L2) are Strongly Associated with Type 2 Diabetes but not with the Metabolic Syndrome in the MONICA/KORA Surveys

Recently, significant associations between common variants of the transcription factor 7-like 2 gene ( TCF7L2) and type 2 diabetes have been reported. This study was designed to replicate the reported associations of the two highly correlated (r (2)=0.86) TCF7L2 single nucleotide polymorphisms rs12255372 and rs7903146 with type 2 diabetes in a case-control study of 2369 MONICA/KORA participants (678 cases/1691 controls from Augsburg, Germany). To further investigate the pathogenic mechanism underlying these associations, we extended our analyses to the metabolic syndrome (IDF, NCEP definitions) and its components in a population-based study comprising 1404 male and female KORA participants aged 55-74 years. Results of our analyses strongly confirmed the minor T alleles as risk variants for type 2 diabetes (rs7903146: OR (TvsC) [95% CI]=1.36 [1.18;1.58], p=0.00003, and rs12255372: OR (TvsG) [95% CI]=1.31 [1.13;1.51], p=0.0003). Moreover, the T allele at rs7903146 was inversely associated with log-transformed, HOMA-%B (beta=-0.07, p=0.005) as a measure of basal insulin secretion, and log-transformed fasting insulin (beta=-0.06, p=0.02). No association was found with insulin resistance (HOMA-IR) and the metabolic syndrome. These findings support replication evidence that TCF7L2 variants increase type 2 diabetes risk. TCF7L2 may primarily affect pancreatic beta cell function.

Association of C-Reactive Protein, Interleukin-1 Receptor Antagonist and Adiponectin with the Metabolic Syndrome

This Finnish population-based study, mean age 46 years, evaluates the association of high-sensitivity C-reactive protein (hs-CRP), interleukin-1 receptor antagonist (IL-1Ra), and adiponectin with the NCEP and IDF definitions of metabolic syndrome (MetS). Adiponectin levels were higher, hs-CRP and IL-1Ra levels lower in subjects without MetS compared to subjects with MetS. If MetS was present according to both IDF and NCEP criteria, BMI, waist, triglycerides, hs-CRP, and IL-1Ra were significantly higher compared to subjects who had MetS according to either only IDF or only NCEP criteria. The hs-CRP, IL-1Ra, and adiponectin linearly correlated with the number of the components of MetS according to both definitions. Decreased levels of adiponectin and increased levels of hs-CRP and IL-1Ra are tightly associated with the components of MetS. Individuals who had MetS according to both criteria had the most adverse changes in cardiovascular risk factors.

Metabolic syndrome and coronary heart disease risk in a population-based study of middle-aged men from France and Northern Ireland: A nested case-control study from the PRIME cohort

Metabolic Syndrome (MetS) was found associated with an increased CHD risk in several studies but data about this relationship in Southern Europe are lacking. We studied the association of MetS according to three different indexes (the National Cholesterol Education Program's definition (NCEP), a modified World Health Organization's definition (WHO) and the recent International Diabetes Federation's definition (IDF)) with CHD risk in a case-control study nested within the PRIME cohort, composed of subjects from France (Southern Europe) and Belfast (Northern Europe). The PRIME prospective study is composed of 10 592 men, aged 50-59 at baseline and followed for 5 years. Subjects included in this nested case-control study were 296 cases of incident CHD and 540 controls, who remained free of CHD during the 5 years of follow-up of the PRIME cohort and matched for age, recruitment centre and recruitment date. All subjects had questionnaires and a medical examination at baseline, and a blood sample was taken. Using the IDF's, the WHO's and the NCEP's definitions respectively, the frequency of MetS was 38.9%, 35.5% and 29.7% in cases and 32.4%, 28.7% and 22.6% in controls. After adjustment for physical activity, smoking and drinking habits, MetS was associated with CHD risk whichever the definition used (ORIDF=1.41 [1.02-1.95], P<0.04, ORWHO=1.40 [1.01-1.94], P<0.05 and ORNCEP=1.46[1.04-2.04], P<0.04). These results were homogeneous in France (low risk of CHD) and Belfast (high risk of CHD). Our results add further evidence that MetS is predictive of CHD risk in middle-aged men from Northern and Southern Europe, and highlight differences between the three definitions studied.

Criterios de clasificación y significación clínica del síndrome metabólico

The metabolic syndrome (MS) is a multifactorial entity (genetic and behavioral). Its incidence and prevalence have risen dramatically, especially in Western countries, where lifestyle is changing (high caloric intake of mostly saturated fat, heavy alcohol consumption, smoking and little physical activity). It results from the striking increase prevalence of obesity and is an increasingly recognized factor for cardiovascular risk. The MS is defined in various ways. The most recent NCEP and IDF definitions are simple and easy to use in clinical practice. Nevertheless, a unique worldwide definition is still needed, as these definitions show significant differences in some ethnic groups.

Prevalence of the metabolic syndrome in populations of Asian origin: Comparison of the IDF definition with the NCEP definition

Aims To estimate the prevalence of the metabolic syndrome using the IDF versus NCEP definition. Population 14 222 non-diabetic and 1516 diabetic subjects, aged 25–74 years. Results The age-standardized prevalence of the IDF metabolic syndrome in non-diabetic men (women) was 12.0% (15.0%), 13.8% (2.5%), 12.8% (17.0%), and 13.2% (20.3%), respectively, in Chinese, Japanese, Mauritian Indians, and native Indians. The prevalence ratio of IDF to NCEP was 1.5 (1.5), 2.7 (0.4), 1.2 (1.2), and 1.0 (1.3) in Chinese, Japanese, Mauritian, and Native Indian men (women), respectively. When the same obesity criteria for Japanese as for others were used the ratio for Japanese was 1.5 in both genders. Of all subjects fulfilling either of the two definitions, only 28% of men and 47% of women met the both. The prevalence of central obesity was 52 times greater using the IDF definition than using the NCEP definition in Japanese men but it was 0.8 times lower in Japanese women. Conclusions The IDF definition brought a higher prevalence of the metabolic syndrome than the NCEP in all except for Japanese women but many lean subjects with hypertension and/or dyslipidemia were undetected by this definition. The IDF criterion for central obesity for Japanese needs to be reconsidered.

The implications of anthropometric, inflammatory and glycaemic control indices in the epidemiology of the metabolic syndrome given by different definitions: a classification analysis

Individuals with the metabolic syndrome (MS) are at high risk for coronary heart disease. In this study, we evaluated the levels of inflammatory, lipidaemic and glycaemic control markers in subjects with and without MS, as given by different definitions. During 2001-2002, we randomly enrolled 1,514 men (18-87 years old) and 1,528 women (18-89 years old), without any clinical evidence of cardiovascular disease, from the Attica area, Greece. Among several variables, we also measured inflammatory markers, total antioxidant capacity, glucose and insulin levels and various lipids. MS was defined according to either the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III criteria or the International Diabetes Federation (IDF) Epidemiology Task Force group. In all the analyses, subjects with diabetes were excluded. The prevalence of the MS was 17.9% according to the NCEP definition and 48.9% according to the IDF definition (p < 0.001). The prevalence of MS was higher in men compared with women according to both definitions (p for gender differences <0.001). Moreover, 3.9% of the total study sample fulfilled only the NCEP criteria, but not the IDF, while 38.6% fulfilled only the IDF criteria. Subjects who were defined as having MS using the IDF criteria were younger, had higher body mass index, C-reactive protein, fibrinogen, tumour necrosis factor-alpha levels, total antioxidant capacity and lower glucose and insulin levels. Prevalence of the MS is very high among Greek adults when the IDF definition is used, while it is still considerable when we adopt the NCEP criteria. It is evident that subjects who fulfilled the IDF criteria showed increased levels of inflammatory markers compared with those who fulfilled the NCEP ATP III criteria.

Influence of Metabolic Syndrome and General Obesity on the Risk of Ischemic Stroke

In 2005, the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) guideline lowered the fasting glucose cut point used to define metabolic syndrome (MS). This study investigated the influence of MS on ischemic stroke (IS) risk using both the original and revised definitions. In addition, because abdominal obesity is the measure of obesity used in the guideline to define MS, we also investigated whether general obesity (GOB) should be considered in the definition of MS. Baseline data from 3453 adults (> or =20 years of age) in the Cardiovascular Diseases Risk Factor Two-Township Study were linked to insurance claim and death certificate records. The 2001 and 2005 NCEP-ATP III definitions were used with Asian and Taiwanese specific cut-off values for waist circumference and body mass index. Hazard ratios of MS and GOB on IS were calculated using Cox models, and the Kaplan-Meier method was used to derive free-of-IS survival curves. During 10.4 years of follow-up, 132 persons developed IS. Hazard ratios of subjects with 1 to 2 and > or =3 MS component disorders were 2.69 and 4.30, respectively, under the 2001 definition, and 3.16 and 5.15, respectively, under the 2005 definition (all P values <0.05). MS subjects with GOB had reduced survival at a borderline significance level. Adding GOB in the MS definition did not significantly alter the number of subjects with MS nor the ability to predict stroke risk. Replacing abdominal obesity with GOB in MS definition reduced the number slightly and increased the hazard ratio. MS predicted IS and the 2005 NCEP definition showed a stronger dose-response relationship with IS. Adding GOB to the existing MS definition had limited benefit.

Metabolic syndrome is associated with markers of subclinical atherosclerosis in a French population-based sample

Metabolic syndrome (MetS) is associated with increased risk of cardiovascular disease (CVD). The relation of MetS with early stages of atherosclerosis, more important from a prevention perspective, has not been evaluated extensively. We examined the association of MetS, using WHO and NCEP definitions, with number of carotid and femoral plaques; carotid intima-media thickness (IMT); pulse wave velocity (PWV) in a random population-based sample of 1153 French adults (35–65 year). Impact of inflammatory factors (C-reactive protein and soluble intercellular adhesion molecule-1) on these parameters was also evaluated. Prevalence of MetS was 14.5 (CI: 12.3–16.0) and 17.5 (CI: 15.1–20.2)%, using NCEP and WHO definitions, respectively. MetS significantly predicted number of plaques, IMT, and PWV after adjustment for traditional risk factors ( P < 0.05). Inflammatory factors predicted peripheral plaques only. The risk of subclinical atherosclerosis was considerably increased with MetS ( P < 0.05); odds ratios ranged 1.80–2.15 with NCEP definition, and 1.48–1.97 with WHO definition. Individuals meeting both NCEP and WHO definitions had slightly greater risk of increased plaques, IMT, and PWV. MetS was strongly associated with subclinical atherosclerosis and aortic stiffness, and can be used as a surrogate marker for high CVD risk, deserving aggressive treatment.

Heterogeneous phenotypes of insulin resistance and its implications for defining metabolic syndrome in Asian Indian adolescents

Objective To assess the phenotypic correlations of insulin resistance with obesity and its relationship with the metabolic syndrome in Asian Indian adolescents. Design and subjects We analyzed clinical, anthropometric (body mass index [BMI], waist circumference [WC]) and laboratory (fasting blood glucose [FBG], lipids and fasting serum insulin) data from 793 subjects (401 males and 392 females) aged 14–19 years randomly selected from Epidemiological Study of Adolescents and Young (ESAY) adults ( n = 1447). The percentile cut-offs for 14–19 years age from ESAY cohort were used for defining abnormal values of variables. We devised three sets of definitions of metabolic syndrome by including BMI and fasting insulin levels with other defining variables. Results Nearly 28.9% of adolescents had fasting hyperinsulinemia despite normal values of BMI, WC, FBG, lipids, and blood pressure. Remarkably, NCEP criteria with appropriate percentile cut-off points for Asian Indian adolescents identified metabolic syndrome in only six (0.8%) subjects. Inclusion of both BMI and WC in the definition resulted in increase in the prevalence of metabolic syndrome to 4.3%. With inclusion of hyperinsulinemia, the prevalence of metabolic syndrome increased to 4.2% (from 0.8%) in the modified NCEP definition, 5.2% (from 0.9%) when BMI was substituted for WC, and 10.2 (from 4.3%) when both BMI and WC were included. Conclusions Our data show marked heterogeneity of phenotypes of insulin resistance and poor value of NCEP definition to identify metabolic syndrome. We propose that BMI and fasting insulin should be evaluated in candidate definitions of metabolic syndrome in Asian Indian adolescents.