Waist Circumference Criteria Research Articles

The metabolic syndrome in China

The metabolic syndrome is a cluster of abnormalities including obesity, dyslipidaemia, abnormal blood glucose and raised blood pressure [1]. Reaven drew attention to this syndrome, which he called syndrome X [2]. Its importance is increasingly recognized in recent years because it predicts cardiovascular disease and the development of diabetes [3–6]. The metabolic syndrome is heterogeneous, so no definition is entirely satisfactory. The World Health Organization (WHO) proposed a definition in 1998 [7]. In 2001, 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) (NCEP-ATPIII) defined it in terms of waist circumference, blood pressure and blood biochemistry [8, 9]. In 2005, the International Diabetes Federation (IDF) made abdominal obesity a prerequisite in the definition [10]. The WHO definition is difficult to embrace because glucose tolerance tests and measurement of insulin sensitivity are seldom performed in clinical practice. In the USA, the revised NCEP and the IDF definitions are quite consistent, with 92.9% agreement [11]. In other ethnic populations, such as Asians, the new ethnic-specific waist circumference criteria may slightly increase the prevalence of the metabolic syndrome [12].

Prevalence and Risk Factors Associated With Obesity in the Elderly in Barbados

This article's objective is to examine the epidemiology of obesity in the urban elderly population of Barbados. A random sample of adults >/= 60 years underwent comprehensive interviews and measurement of their weight, height, and waist circumference (WC). Outcomes of interest were obesity (body mass index [BMI] > 30 kg/m2), high-risk WC (men >/= 102 cm; women >/= 88 cm), and high risk of disease comorbidity (from BMI and WC criteria). Total, 1,508 persons participated (80% response). Women had higher rates of obesity (31% vs. 11.9%), high-risk WC (61.9% vs. 13.9%), and disease co-morbidity risk (51.1% vs. 17.5%) compared to men. Multivariate regression confirmed female gender as an independent predictor of outcomes (p < 0.001). Other predictors were less consistent: self-reported fair/poor health status and eating two (vs. three) meals daily were associated with obesity, whereas semiprofessional occupation and unmarried status predicted high-risk WC. Obesity is highly prevalent among elderly Barbadians. Public health interventions must target this group, particularly women.

Low Ankle-Brachial Pressure Index Predicts Increased Risk of Cardiovascular Disease Independent of the Metabolic Syndrome and Conventional Cardiovascular Risk Factors in the Edinburgh Artery Study

To investigate whether a low ankle-brachial pressure index (ABI) predicts increased risk of cardiovascular disease (CVD) independent of the metabolic syndrome and conventional cardiovascular risk factors. The Edinburgh Artery Study is a population-based cohort study in which subjects were followed up until their death or for approximately 15 years. Low ABI at baseline was defined as <0.9; subjects with ABI >1.4 (n = 13) were excluded from the analyses. We used a modified version of the definition of the metabolic syndrome published in the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, replacing waist circumference criteria with BMI criteria. Data on relevant parameters were available for 1,467 men and women ages 55-74 years at baseline. Cox proportional hazards models were used to study cardiovascular morbidity and mortality before and after adjusting for potential confounding factors. We determined that 25% of the study population had the metabolic syndrome and that a low ABI was more prevalent among people with than without the metabolic syndrome (24 vs. 15%; P < 0.001). During the follow-up period, there were 226 deaths from CVD and 462 nonfatal cardiovascular events. The hazard ratio (95% CI) for low ABI after adjusting for age, sex, baseline CVD, diabetes, smoking status, LDL cholesterol, and metabolic syndrome was 1.5 (1.1-2.1) for CVD mortality and 1.5 (1.2-1.8) for all CVD outcomes. Low ABI is associated with increased risk of CVD independent of the metabolic syndrome and other major CVD risk factors.

Evaluation of the Appropriateness of the Japanese Metabolic Syndrome Diagnostic Criteria on Routine Medical Health Checkups in a Rural Area.

Objective: The diagnostic criteria for the metabolic syndrome (MetS) were published in Japan in April 2005. However, there have been no large-scale studies in rural areas to confirm these criteria. We examined the prevalence of MetS in subjects who had undergone a routine medical health checkup at our hospital, located in a rural area. This data was used to investigate the appropriateness of the diagnostic criteria for MetS.Subjects and Methods: The MetS status was examined retrospectively in 2340 subjects (1408 men, 932 women ; mean age 49.6 ± 9.7 years) who underwent a routine medical health checkup at our hospital between April 2004 and March 2005.Results: Of the 1408 men and 932 women, 209 men (14.8%) and 23 women (2.5%) were diagnosed with MetS. Forty-four men (3.1%) and 4 women (0.4%) met all three diagnostic criteria for metabolic disorders. In the female group, only 8.7% of the 932 women met the waist circumference criterion of ≥90 cm. Because this waist circumference criterion was used during the first screening but was not met by most of the women, they were eliminated from our study. Using receiver operating characteristic (ROC) analysis, the cutoff values for waist circumference were 85.0 cm (sensitivity 0.750, specificity 0.564) in men and 79.5 cm (sensitivity 0.787, specificity 0.709) in women. If the women's waist circumference criterion had been set at the value of ≥79.5 cm, this would have resulted in 48 (5.2%) women meeting the criterion.Conclusion: From the viewpoint of preventive medicine, the Japanese male MetS diagnostic criteria are fairly appropriate. However, for the women, the waist circumference criterion of ≥90 cm has been set too high and was not met by most of the female subjects. Therefore, the Japanese MetS criteria for women, particularly the cutoff value for waist circumference, requires further verification.

Effects of Two Common Polymorphisms of Peroxisome Proliferator-Activated Receptor-γ Gene on Metabolic Syndrome

Peroxisome proliferator-activated receptor (PPAR)gamma is involved mainly in adipocyte differentiation and has been suggested to play an important role in the pathogenesis of insulin resistance and atherosclerosis. We investigated the frequencies of two common polymorphisms of PPARgamma gene, exon 6 C-->T substitution and exon B Pro12Ala in healthy subjects and analyzed the correlations between the different genotypes and insulin resistance, metabolic syndrome and cardiovascular risk factors. Anthropometric measurements, fasting glucose, insulin and lipid profiles were measured in 253 Korean females. Homeostatic model assessments and quantitative insulin sensitivity check indices were calculated. Metabolic syndrome was diagnosed according to the NCEP-ATP III guidelines and the Western Pacific Region of WHO for obesity criteria for waist circumference. Polymerase chain reaction (PCR)-restriction fragment-length polymorphism and real-time PCR were performed for genotyping of the DNAs. For C161T polymorphism, allele frequencies were 0.804 and 0.196 for T allele, and 0.947 for proline and 0.053 for alanine. There was no Ala12Ala homozygote in the population. No differences were seen in the mean values of age, body mass index (BMI), blood pressure, fasting blood glucose level, fasting insulin levels, HOMA and QUICKI among different genotypes when analyzed as a whole, except that subjects with Pro12Ala had significantly higher body weight than those with Pro12Pro genotype. However, mean BMI, percent body fat and weight showed significant differences between genotypes in younger age group (< or =50 years). Although overall prevalence of metabolic syndrome had no association with the genotypes, the prevalence of decreased high-density lipoprotein cholesterol component was lower in those with the T allele than in those with the CC genotype. There was no association of the genotypes with glucose tolerance status. When the subjects were divided into four groups according to the combination of the genetic alleles of the two polymorphisms, subjects having Pro12Ala and T allele, simultaneously, showed significantly higher mean weight than those without Ala allele. Pro12Ala polymorphism seems to affect body weight, similar to the previous studies, and the effect was potentiated with the presence of T allele of C161T polymorphism. Although either polymorphism failed to show significant association with insulin resistance, the fact that the prevalence of decreased HDL-C was lower in those with the T allele of C161T polymorphism suggests that this polymorphism might have a protective effect on atherosclerotic lipid profiles, which needs further investigation.

Population Comparison of Two Clinical Approaches to the Metabolic Syndrome

In 2005, the International Diabetes Federation (IDF) released a consensus clinical definition of the metabolic syndrome for worldwide use that included central obesity as a prerequisite (1). The IDF definition varied from the earlier Third Report of the U.S. National Cholesterol Education Program Adult Treatment Panel (ATP III) panel definition with broader criteria for waist circumference, HDL, and fasting plasma glucose (2). The impact of these changes to the prevalence of the metabolic syndrome, in particular the use of differing values for defining central obesity, has not been studied. Our aim was to compare these two definitions for the distribution and prevalence of the metabolic syndrome in a representative biomedical population study of predominantly European adults from Adelaide, South Australia (population 1.2 million) (3). Individuals aged ≥18 years from households selected at random from the electronic white pages directory were eligible. Of the eligible sample of 8,213, a total of 5,850 (71%) completed the initial interview. Of these, 4,060 (69%) attended the clinic for the biomedical examination (3). Respondents completed surveys and underwent clinic assessment, including measurement of blood pressure height, weight, waist, and fasting glucose and lipid levels (3). The study was approved by the institutional ethics committees of the North West Adelaide Health Service, …

New “Pre-diabetes” Category and the Metabolic Syndrome in Japanese

Recently, impaired fasting glucose (IFG) was redefined as fasting plasma glucose of 100-125 mg/dl, and individuals with IFG and/or impaired glucose tolerance (IGT) were referred to as having "pre-diabetes". However, there is a lack of data using the new definition of IFG and "pre-diabetes". The aim of this study was to examine associations of the metabolic syndrome components with the new "pre-diabetes" category in relatively lean Japanese. Six hundred and sixty-one Japanese study participants underwent a 75 g oral glucose tolerance test. They were classified into three groups-normal (n=225), pre-diabetes (n=308), and diabetes (n=128). The metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III, as modified for waist circumference criteria by the Regional Office for the Western Pacific Region of WHO. Prevalence of the metabolic syndrome in each group was 10.7%, 27.9%, and 53.9%, respectively. Of the metabolic syndrome components, the OR for prevalent pre-diabetes was 2.00 (95% CI, 1.73-2.31, p<0.001) for fasting glucose, 1.93 (95% CI, 1.54-2.42, p<0.001) for waist circumference, and 1.36 (95% CI, 1.10-1.68, p=0.005) for triglycerides. Similar associations were found in prevalent diabetes. Insulin resistance assessed using Stumvoll's index was significantly associated with both pre-diabetes and diabetes. Pre-diabetes and the metabolic syndrome frequently coexist in relatively lean Japanese. This association seems to link with abdominal adiposity and insulin resistance.

Body mass index and waist circumference correlate to the same degree with insulin-mediated glucose uptake

To compare the relationship between insulin-mediated glucose uptake (IMGU) and excess adiposity as determined by measurement of either body mass index (BMI) or waist circumference (WC), IMGU was quantified by determining the steady-state plasma glucose (SSPG) concentration with the insulin suppression test and the relationship between the SSPG concentration and BMI or WC evaluated in a study of 208 healthy individuals (128 women/80 men). The results indicated that BMI and WC were correlated ( P < .001) to a similar degree in both men ( r = 0.90) and women ( r = 0.86). Steady-state plasma glucose and both indices of excess adiposity were also significantly correlated ( P < .001) to an essentially identical extent in men ( r values of 0.71 vs 0.70) and women ( r values of 0.54 vs 0.53). When the population was divided into tertiles on the basis of SSPG concentrations, 96% of those in the most insulin-resistant tertile were identified as being overweight/obese by BMI criteria and 84% as abdominally obese by WC criteria. However, a substantial number of those in the most insulin-sensitive tertile also demonstrated excess adiposity as defined by either BMI (45%) or WC (33%). To summarize, (1) BMI and WC correlate closely within an individual and equally well with IMGU, and (2) BMI is as effective as WC in identifying insulin-resistant individuals.

Metabolic syndrome: Demographic features, etiology, and clinical management

The metabolic syndrome, also known as the dysmetabolic syndrome, syndrome X, or the insulin resistance syndrome, refers to the clustering of cardiovascular disease risk factors that are present in many individuals who are at increased risk for cardiovascular events and/or type 2 diabetes. The criteria for metabolic syndrome include a combination of categorical and borderline risk factors that can be readily measured in clinical practice. Although the Adult Treatment Panel III of the National Cholesterol Education Program set the criteria to identify cardiovascular risk, the syndrome had already been well recognized in the endocrine community as identifying people at risk for diabetes. Recently, the International Diabetes Federation proposed a worldwide definition with ethnic-specific criteria for waist circumference. Therapies targeted to specific components of the metabolic syndrome, such as improving glycemic control, managing dyslipidemia, and reducing the prothrombotic state, should help to minimize cardiovascular risk, particularly if initiated early.

Prevalence of the metabolic syndrome in patients with schizophrenia: Baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III

One important risk factor for cardiovascular disease is the metabolic syndrome (MS), yet limited data exist on its prevalence in US patients with schizophrenia. Methods Using baseline data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Schizophrenia Trial, assessment of MS prevalence was performed based on National Cholesterol Education Program (NCEP) criteria, and also using a fasting glucose threshold of 100 mg/dl (AHA). Subjects with sufficient anthropometric data, data on use of antihypertensives, hypoglycemic medications or insulin, and fasting glucose and lipid values > 8 h from last meal were included in the analysis. Comparative analyses were performed using a randomly selected sample from NHANES III matched 1 : 1 on the basis of age, gender and race/ethnicity. Results Of 1460 CATIE baseline subjects, 689 met analysis criteria. MS prevalence was 40.9% and 42.7%, respectively using the NCEP and AHA derived criteria. In females it was 51.6% and 54.2% using the NCEP and AHA criteria, compared to 36.0% ( p = .0002) and 36.6% ( p = .0003), respectively for males. 73.4% of all females (including nonfasting subjects) met the waist circumference criterion compared to 36.6% of males. In a logistic regression model with age, race and ethnicity as covariates, CATIE males were 138% more likely to have MS than the NHANES matched sample, and CATIE females 251% more likely than their NHANES counterparts. Even when controlling for differences in body mass index, CATIE males were still 85% more likely to have MS than the NHANES male sample, and CATIE females 137% more likely to have MS than females in NHANES. Conclusions The metabolic syndrome is highly prevalent in US schizophrenia patients and represents an enormous source of cardiovascular risk, especially for women. Clinical attention must be given to monitoring for this syndrome, and minimizing metabolic risks associated with antipsychotic treatment.

Relative risks of the metabolic syndrome according to the degree of insulin resistance in apparently healthy Korean adults

A new simple criterion for diagnosing metabolic syndrome was proposed in the third report of the NCEP (National Cholesterol Education Program). In the present study, we analysed the association between metabolic syndrome and insulin resistance to investigate the effects of the latter on the prevalence of metabolic syndrome based on the new criteria recommended in the ATP (Adult Treatment Panel) III report. A total of 7057 participants (4472 men and 2585 women), who underwent medical screening at the Sungkyunkwan University Kangbuk Samsung Hospital, were investigated. Fasting insulin levels were measured and components of the metabolic syndrome as defined by the ATP III report were determined. We also applied the criteria for abdominal obesity as defined by APC-WC (Asia-Pacific criteria for waist circumference). The prevalence of metabolic syndrome as defined by ATP III was 5.3% (5.0% in men and 5.8% in women) and 8.9% (8.1% in men and 10.3% in women) by APC-WC. The odds ratio for the metabolic syndrome was significantly higher in subjects with higher insulin resistance than in those with lower insulin resistance. The mean levels of HOMA (homoeostatic model assessment) and fasting insulin were significantly higher in those with more of the components of the metabolic syndrome. A high HOMA (> or =2.56) and fasting insulin concentration (> or =9.98 microIU/ml; where IU is international unit) were found to be independent risk factors of the metabolic syndrome by multiple regression analysis after adjusting for age, sex and body mass index (P<0.001). These results show that the metabolic syndrome is significantly correlated with the insulin resistance index, and that appropriate values of HOMA and fasting insulin concentration may serve as a helpful guide for the management of metabolic syndrome.

Prevalence and factor analysis of metabolic syndrome in an urban Korean population.

The aim of this study was to explore the prevalence and pattern of the metabolic syndrome and its association with hyperinsulinemia in an urban Korean population of 269 men and 505 women. The National Cholesterol Education Program Adult Treatment Panel (ATP) III guidelines were used to calculate the sex-specific prevalence of the metabolic syndrome. After excluding individuals taking medication for hypertension, diabetes, or dyslipidemia, we used factor analysis to examine the pattern of the metabolic syndrome in 206 men and 449 women. The prevalence of metabolic syndrome was 16.0% in men and 10.7% in women aged 30-80 years. However, ATP III criteria for central obesity are not optimal for an Asian-Pacific population; when waist circumference is reduced from 102 to 90 cm in men and 88 to 80 cm in women, the prevalence of the metabolic syndrome increased to 29.0 and 16.8%, respectively. Sex-specific factor analysis showed four factors in men (obesity, glucose intolerance, hypertension, and dyslipidemia) and three in women (obesity-hypertension, glucose intolerance, and obesity-dyslipidemia). Insulin resistance estimated from fasting insulin levels clustered with three of the four factors in men and two of the three factors in women. By ATP III or Asian-Pacific waist circumference criteria, the prevalence of the metabolic syndrome increased with increasing tertiles of insulin resistance, which was estimated by a homeostasis model assessment. The metabolic syndrome is common in an urban Korean population when using Asian-Pacific waist criteria. The prevalence of the metabolic syndrome increased with increasing tertiles of insulin resistance.

Metabolic syndrome and new category ‘pre-hypertension’ in a Japanese population

SUMMARYObjective: To examine whether insulin resistance and metabolic syndrome are associated with pre-hypertension, a new stage developed by the Joint National Committee on Prevention, Detection, Education and Treatment of High Blood Pressure (JNC-7).Patients and methods: Subjects included 506 Japanese taking no anti-hypertensive medication. Subjects were divided into three groups according to blood pressure status using the JNC-7 criteria. Normotension (NTN) was defined as a Systolic Blood Pressure (SBP) < 120 mmHg and a Diastolic Blood Pressure (DBP) < 80 mmHg, pre-hypertension (PHT) as a SBP 120–139 mmHg or a DBP 80–89 mmHg and hypertension (HTN) as a SBP ≥ 140 mmHg or a DBP ≥ 90 mmHg. The metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III as modified for waist circumference criteria by the Regional Office for the Western Pacific Region of WHO. Insulin sensitivity was assessed by plasma glucose and insulin concentrations obtained at fasting or during a 75 g oral glucose tolerance test.Results: There were no differences with respect to age, gender or glucose intolerance status among the three groups. The mean values of body mass index were similar between NTN and PHT, but were significantly higher in HTN than in other groups. The prevalence of the metabolic syndrome was 9.9% in NTN, 19.2% in PHT and 35.5% in HTN, respectively. The prevalence increased linearly with worsening of blood pressure status ( p < 0.0001). An increase in the number of metabolic syndrome components (MS score) was also associated with a progress in blood pressure status. Even in the non-obese persons, the prevalence of the metabolic syndrome and the MS score increased linearly with worsening in blood pressure status. The homeostasis model assessment of insulin resistance (HOMA-R) was significantly higher in PHT and HTN than in NTN and increased significantly with worsening in blood pressure status. Furthermore, the quantitative insulin sensitivity check index (QUICKI) and the insulin sensitivity index proposed by Stumvoll et al. decreased significantly with worsening in blood pressure status.Conclusions: The metabolic syndrome is prevalent even in the pre-hypertensive stage in a Japanese population and insulin resistance contributes to the underlying mechanisms of these abnormalities.

Prevalence of metabolic syndrome among adult Filipinos

Rationale: Metabolic syndrome is a common condition worldwide. Until recently, there is no universal definition for metabolic syndrome. Its prevalence in the Philippines has never been studied before. Objectives: To determine the prevalence of metabolic syndrome among adult Filipino population. Sample Population: 4541 individuals aged ≥20 years. Methods: Nationwide survey using two-stage stratified sampling design was done in 1998. Measurement of risk factors was done by blood pressure and waist circumference determination; and laboratory testing for lipid profile and fasting blood sugar using Cholestech LDX machine. Metabolic syndrome was defined based on NCEP and International Atherosclerosis Society (IAS) criteria. For IAS criteria, the waist circumference was based on Asia Pacific criterion (>90 and 80 cm, for male and female, respectively). Results: Based on NCEP criteria, the prevalence of metabolic syndrome is 14.2% (95% CI: 13.2–15.2). Using the IAS criteria, the prevalence is 19.3% (95% CI: 18.1–20.4). Stratifying the prevalence based on age revealed a prevalence of 6.6%, 17.7%, and 18.3% for ages 20–39, 40–59, 60 years and older, respectively, by NCEP criteria. IAS criteria showed a prevalence of 10.0%, 23.6%, and 24.1% for ages 20–39, 40–59, 60 years and older, respectively. Conclusion: Metabolic syndrome is common among Filipino adult population. There is an increasing prevalence with age. Using NCEP criteria instead of the IAS with waist circumference criterion adjusted for Asia Pacific population may underestimate the prevalence of metabolic syndrome.

Can we apply the National Cholesterol Education Program Adult Treatment Panel definition of the metabolic syndrome to Asians?

Limited information is available about the metabolic syndrome in Asians. Furthermore, the definition of central obesity using waist circumference may not be appropriate for Asians. The objectives of this study were to determine the optimal waist circumference for diagnosing central obesity in Asians and to estimate the prevalence of the metabolic syndrome in an Asian population. We used data from the 1998 Singapore National Health Survey, a cross-sectional survey involving 4,723 men and women of Chinese, Malay, and Asian-Indian ethnicity aged 18-69 years. Receiver operating characteristic analysis suggested that waist circumference >80 cm in women and >90 cm in men was a more appropriate definition of central obesity in this population. The prevalence of the metabolic syndrome was then determined using the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria with and without the modified waist circumference criteria. In Asians, decreasing waist circumference increased the crude prevalence of the metabolic syndrome from 12.2 to 17.9%. Using the modified Asian criteria, the prevalence of the metabolic syndrome increased from 2.9% in those aged 18-30 years to 31.0% in those aged 60-69 years. It was more common in men (prevalence 20.9% in men versus 15.5% in women; P < 0.001) and Asian Indians (prevalence 28.8% in Asian-Indians, 24.2% in Malays, and 14.8% in Chinese; P < 0.001). NCEP ATP III criteria, applied to an Asian population, will underestimate the population at risk. With a lower waist circumference cutoff, the prevalence of the metabolic syndrome is comparable to that in Western populations. Ethnic differences are likely to exist between populations across Asia.