（ 様 式 ３ ）

論文

要

旨

Development of Predictive Equation and Score for 5-Year
Metabolic Syndrome Incidence in Japanese Adults
日本人成人における５年後のメタボリックシンドローム発症の予測式およびスコアの作成

Anwar Ahmed Salim【Introduction】
Metabolic syndrome (MetS) develops from underlying risk factors mainly abdominal obesity and insulin
resistance. The global prevalence of MetS is around 20-25% and that of Japan is 19.3%. MetS is contributing to
the increased risk of developing atherosclerotic cardiovascular diseases and increased cardiovascular disease(CVD) morbidity and mortality. Predicting MetS is important for identifying high-risk individuals and providing
preventive interventions. However, MetS prevalence and CVD risk associated with MetS depend on ethnicvariation and the MetS definition used. The Japanese criteria for MetS differ from other available guidelines
such as the World Health Organization, International Diabetes Federation, National Cholesterol Education
Program Adult Treatment Panel-III, and American Heart Association/National Heart, Lung, and Blood Institute,by including waist circumference (WC) as an essential component, with unique WC cut-off points. The optimal
WC obtained from computed tomography scans indicates a visceral fat area of 100 cm2 at the navel level isequivalent to a WC of > 85 cm for men and > 90 cm for women in Japan. Furthermore, risk prediction models
are becoming more prevalent in healthcare practice due to their increasing importance in early disease detection,intervention, and decision-making. Although previous reports develop MetS prognostic models for different
populations the majority lacked validation, were cross-sectional studies, had a smaller sample size, did not
involve lifestyle factors, and none used Japanese criteria for MetS. Therefore, the current study aimed todetermine independent predictors of MetS, develop and validate an equation, and develop a simple prognostic
model for 5-year MetS risk in adult Japanese population using Japanese MetS criteria.
【Methods】
We analyzed the health check-up data of 198,292 individuals from Kagoshima Kouseirin Hospital from October
2008 to March 2019. We included participants aged 30-69 years, with 5-year follow-up data, and excluded allparticipants with MetS at baseline. We remained with 54, 198 participants (mean [±SD] age, 54.5 ± 10.1 years;men, 46%) who were randomly assigned in a ratio of 2:1 to derivation cohort, used to develop a risk score forMetS and validation cohort, used to evaluate the validity of the score. Multivariate logistic regression analysis
was performed in derivation cohort and scores were assigned to factors corresponding to beta coefficients. We
evaluated predictive ability of the scores using the area under the curve (AUC), then applied them to validation
cohort to assess reproducibility. The outcome was MetS incidence after 5-years of follow-up.

【Results】
After 5-year follow-up a total of 2,326 (6.4%) and 1,216 (6.7%) participants in derivation and validation cohorts
developed MetS, respectively. The primary model ranged from 0–27 points and had an AUC of 0.81
(sensitivity: 0.81, specificity: 0.81, cut-off score: 14), and consisted of age, sex, blood pressure (BP), body massindex (BMI), serum lipids, glucose measurements, tobacco smoking, and alcohol consumption. The simplified
model (excluding blood tests) ranged from 0–17 points with an AUC of 0.78 (sensitivity: 0.83, specificity: 0.77,
cut-off score: 15) and included: age, men, systolic BP, diastolic BP, BMI, tobacco smoking, and alcohol
consumption. We classified individuals with a score of <15 and ≥15 points as low- and high-risk MetS,respectively. Furthermore, the equation model generated an AUC of 0.85 (sensitivity: 0.86, specificity: 0.55).
Analysis of the validation and derivation cohorts yielded similar results.
【Discussion and Conclusion】
The present study created and validated an equation and a simple prognostic model for the 5-year riskof MetS in the general Japanese population. From the primary model that included blood sampling variables, wefound 11 independent predictors of MetS, consisting of age, sex, SBP, DBP, BMI, TG, LDL-C, HDL-C, FPG,
tobacco smoking, and alcohol consumption. The primary model was useful (AUC, 0.81) for predicting MetS.
Similarly, the simplified model with excluded blood variables showed acceptable discrimination (AUC, 0.78) inpredicting MetS. The continuous equation model had excellent predictive ability (AUC, 0.85) for MetS. In
addition, the incidence of MetS gradually and simultaneously increased as the score increased in both derivationand validation cohorts. We recommend the application of simplified prediction score in clinical settings because
it is easier to use with similar predictive ability as the primary model and has only seven variables that do not
require the results of blood sampling. The equation model can be used for the near future generation of MetS
screening software applications. To our knowledge, this is the first study to create an equation and a simplified
prognostic score based on the Japanese MetS definition criteria to predict the 5-year risk of MetS.

PLoS One;18(4):e0284139. doi: 10.1371/journal.pone.0284139. PMID: 37027431; PMCID: PMC10081753.