Comparison of the Different Diagnostic Criteria for the Metabolic Syndrome among University Staff in Shenyang
|School||Shenyang Institute of Physical|
|Course||Human Movement Science|
|Keywords||Metabolic Syndrome Obesity Diagnostic Criteria Prevalence Body Mass Index Waist Circumference Waist-to-stature Ratio Receiver Operator Characteristic Curve Analysis|
Objective: Four diagnostic criteria of metabolic syndrome (MS) such as the Chinese Diabetes Society for the Diagnostic Criteria of Metabolic Syndrome (CDS criteria), the revised version of the National Cholesterol Education Program’s Adult Treatment Panel III (ATP III criteria), the International Diabetes Federation (IDF criteria), and the Japanese Committee for the Diagnostic Criteria of Metabolic Syndrome (JC criteria) were used in this study. The purposes of the study were to compare the prevalence of the MS by applying the four different MS diagnostic criteria, and to examine their inter-rater agreements in order for exploring problems of the CDS creteria. Meanwhile, the abilities of various obesity indexes in identifying MS were evaluated, and optimal cutoff values for each obesity index were calculated.Methods: By using cross-sectional study method, anthropometric measurements (height, waist circumference, hip circumferenc and weight), physiological parameters (systolic blood pressure, and diastolic blood pressure), and blood sample tests (fasting plasma glucose, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol) were taken among 1907 staff in a university in Shenyang. Crude prevalences of MS were calculated using the four diagnostic criteria, and were standardized based on age distrbution of the year 2000 China population. The receiver operating characteristic curve analysis were performed to find the best obesity index among body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-stature ratio (WSR) in diagnosis of MS. The optimal cutoff values were determined by the maximal Youden’s indexes.Results: (1)Based on the CDS criteria, ATP III criteria, IDF criteria and JC criteria, the crude prevalence of MS were 22.2% (men: 26.1%, women: 13.6%), 35.5%( men: 38.1%, women: 29.8%), 32.3% (men: 34.4%, women: 27.8%), and 27.8% (men: 36.1%, women: 8.3%), respectively. The standardized prevalence were 16.6% (men: 21.7%, women: 8.3%), 26.8% ( men: 32.4%, women:19.1%), 23.8% ( men: 28.4%, women: 17.5%), and 21.4% (men: 31.0%, women: 5.3%), respectively. The crude and age-standardized prevalence diagnosed by the CDS were significantly lower than the other criteria’s (χ2=76.31,χ2=44.54,χ2=13.55; all P<0.001) .(2) Regardless of the different diagnostic creteria used, the prevalence in men was significantly higher than in women, and increased with age in both genders. Among individual MS component, abnormal rates of obesity, blood pressure, and triglycerides were significantly higher than the other components. Abnormal rates of boold pressure, fasting plasma glucose, and triglycerides in men were significantly higher than those in women. (all P<0.001).(3) Subjects with individual abnormal component of obesity, triglycerides, fasting plasma glucose, and systolic blood pressure showed 8.0 times higher risks of suffering from MS compared to the subjects with the corresponding normal component. Increased of triglycerides were associated with increased risks of the MS. By using the CDS criteria, ATP III criteria, IDF criteria, and JC criteria odds ratios were 21.27 (95%CI: 15.14–29.86), 18.38 (95%CI: 13.79–24.50), 10.13 (95%CI: 7.74–13.25), and 18.90 (95%CI: 13.86–25.77), respectively. The risks of subjects with obesity were 18.62 and 18.54 times higher than those with the normal body weight according to the CDS criteria and ATP III criteria respectively. (all P<0.001)(4) Agreements between the CDS criteria and theATP III criteria, IDF criteria and JC criteria were moderate with kappa values of 0.635 (95%CI: 0.598–0.672), and 0.615 (95%CI: 0.576–0.654), and 0.701 ((95%CI: 0.664–0.738), respectively. Agreement between the ATP III criteria and IDF criteria was perfect with kappa value of 0.929 (95%CI: 0.911–0.947).(5) Agreement between BMI and waist circumference was moderate with kappa value of 0.575 (95%CI: 0.540–0.610); agreement of BMI and waist circumference was low with kappa value of 0.509 (95%CI: 0.448～0.570). Risks in subjects with normal BMI and abnormal waist circumference were 2.53 time higher than those with the two components in normal ranges (95%CI: 1.59–3.86) after adjustment for age and gender.(6) WSR had the largest area under the ROC curve and showed significantly better ability than BMI to identify MS (all P<0.05). The optimal WSR cutoff values were 53 for men and 51 for women. Risks of clustering MS risk factors were significantly higher in subjects with WSR above the cutoff values than those in normal ranges (P<0.05). Reducing the WSR to the normal ranges could prevent 41.3–44.6% clustering of MS risk factors.(7) When replacement of BMI with WSR in the CDS criteria, crude prevalnece of MS was 25.7% (men: 29.0%, women: 18.5%) .Conclusions: (1) The MS is highly prevent in the university staff. The prevalence of MS in men is higher than in women, and increase with incresing age in both genders.(2) The prevalence of MS diagnosed by the CDS criteria, ATP III criteria, IDF criteria and JC criteria are different. The prevalence of MS diagnosed by the CDS is the lowest than the other criteria’s.(3) The agreements among CDS criteria, ATP III criteria, IDF criteria and JC criteria are moderate, and the agreement between ATP III criteria and IDF criteria is perfect. (4) The agreement between ATP III and IDF criteria is perfect. The agreement between BMI and waist circumference is moderate, but the agreement in women is low.(5) WSR is the simplest and best effective index of obesity to identify MS. We suggest that WSR may be contributed to the defination of international diagnostic criteria for MS in the future.