Comparison of Prevalence of the Metabolic Syndrome by Using Different Defining Criteria

This cross sectional study was done to see the prevalence of the metabolic syndrome and its components among patients attending in the medicine out patient department of BSMMU by using different defining criteria. The metabolic syndrome according to the modified NCEP ATP III criteria was 27.2% (female 32.41% > male 21.7%). However, according to original NCEP ATP III criteria, proportion of the metabolic syndrome was 22.5% (female 30.6% > male 13.7%). But the metabolic syndrome defined by the modified WHO criteria was 9.0% (male 10.6% > female 7.5%). Comparative analysis of the metabolic syndrome indicated that the proportion of the metabolic syndrome differs in different criteria. In modified WHO criteria the metabolic syndrome was less then NCEP ATP III (modified and original) criteria and there was male preponderance. The proportion of the metabolic syndrome defined by modified and original ATP III criteria is more or less similar. TAJ 2010; 23(1): 10-14 1 Assistant Professor, Department of Medicine, Rajshahi Medical College, Rajshahi. 2 Assistant Professor, Department of Hepatology, Rajshahi Medical College, Rajshahi. 3 Assistant Professor, Department of Gasteroenterology, Rajshahi Medical College, Rajshahi. 4 Associate Professor, Department of Medicine, Pabna Medical College, Pabna. 5 Professor, Department of Medicine, Dhaka Medical College. 6 Professor, Department of Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka. Introduction Metabolic syndrome is a global health problem of great magnitude and a major public health concern in developed and developing countries. People with the metabolic syndrome are at increased risk of diabetes mellitus and coronary artery disease relative to people without the syndrome. A number of expert groups have developed clinical criteria for the metabolic syndrome. The most widely accepted of these have been produced by World Health Organization (WHO), the European Group for the study of Insulin Resistance (EGIR), NCEP ATP III and International Diabetes Federation (IDF). All groups agree on the core components of the metabolic syndrome: obesity, insulin resistance, dyslipidaemia and hypertension. However, they apply the criteria differently to identify such a cluster. Comparison of definitions of the metabolic syndrome: ATP III, 2001 clinical identification of the metabolic syndrome (ATP III 2001) Three or more of the following five risk factors Risk factors Defining level Central obesity • Men • Women Waist circumference * > 102 cm (> 40 inch) > 88 cm (> 35 inch) Triglycerides ≥ 150 mg/dl (1.7 mmol/L) HDL cholesterol • Men • Women < 40 mg/dl (1.03 mmol/L) < 50 mg/dl (1.29 mmol/L) Blood pressure ≥ 130/≥ 85 mm of Hg Fasting glucose ≥ 110 mg/dl (≥ 6.1 mmol/L) * Modified NCEP ATP III criteria in the Asia Pacific region includes waist circumference for men is > 90 cm and for women is > 80 cm. WHO clinical criteria for the metabolic syndrome, 1999 Diabetes or impaired fasting glycaemia or impaired glucose tolerance or insulin tolerance plus 2 or more of the following risk factors : Risk factor Defining level Central obesity • Men • Women BMI : > 30kg/m2 and/or waist to hip ratio > 0.9 > 0.85 Dyslipidaemia • Triglycerides or • HDL-cholesterol Men Women ≥ 1.7 mmol/L (≥ 150 mg/dl) < 0.9 mmol/L (35 mg/dl) < 1.0 mmol/L (39 mg/dl) Blood pressure ≥ 140/≥ 90 mm of Hg Microalbuminuria • Urinary albumin excretion rate • Albumin creatinine ratio ≥ 20μ gm/min ≥ 30 mg/g Modified WHO criteria Fasting plasma glucose ≥6.1 mmol/L plus two or more of the followings (1) central obesity BMI : ≥ 25kg/m and/or waist to hip ratio > 0.9 in men,> 0.85 in women (2) Triglycerides ≥ 1.7 mmol/L (≥ 150 mg/dl) (3) HDL-cholesterol < 0.9 mmol/L (35 mg/dl) in men, < 1.0 mmol/L (39 mg/dl) in women (4) Blood pressure ≥ 140/≥ 90 mm of Hg. Results This cross sectional study was done from September 2005 to May 2007. The main objective of the study was to see the prevalence of the metabolic syndrome and its components among patients attending the medicine out patient department of BSMMU by using original and modified ATP III and modified WHO criteria and to evaluate the more applicable and practical defining criteria in epidemiological and clinical practice. All the patients attending in the MOPD of BSMMU were interviewed in alternate day and a total of 334 patients of both sexes who were ≥ 20 years of age were included in the study by systemic sampling with an interval of 1:5. Table 1. Age and gender distribution of the studied patients (n 334) Age in years Gender Total (n=334) p value Male (n=161) Female (n=173) No. % No. % No. % <30 37 23.0 49 28.3 86 25.7 30-39 39 24.2 44 25.4 83 24.9 40-49 38 23.6 38 22.0 76 22.8 50-59 31 19.3 30 17.3 61 18.3 ≥60 16 9.9 12 6.9 28 8.4 Mean ± SD 41.7±12.1 38.6±12.2 40.1±12.2 0.020 p value reached from unpaired student’s t test Table 2. Number of components of metabolic syndrome in modified and original ATP III criteria Age Number of components Modified ATP III Original ATP III 3 4 5 3 4 5 All 44 35 12 35 33 7 <30 3 4 0 2 4 0 30-39 9 6 0 5 6 0 40-49 11 9 2 9 7 1 50-59 16 10 6 16 11 3 ≥60 5 6 4 3 5 3 Male 20 9 6 12 7 3 <30 1 0 0 1 0 0 30-39 3 0 0 0 0 0 40-49 7 3 0 4 1 0 50-59 5 4 4 5 4 2 ≥60 4 2 2 2 2 1 Female 24 26 6 23 26 4 <30 2 4 0 1 4 0 30-39 6 6 0 5 6 0 40-49 4 6 2 5 6 1 50-59 11 6 2 11 7 1 ≥60 1 4 2 1 3 2