# Metabolic Syndrome and Its Components among Taxi Drivers in the City of Tshwane, South Africa
## 4 Discussion
In the present study, the prevalence of MetS among taxi drivers was significantly high among those who had \(\geq\)10 years driving experience. The driving duration has been reported as one of the risk factors that relates to MetS [38]. Furthermore, the prevalence of MetS varies by age, settings, and race, and South Africa has recorded a range of 5-62% [18; 19; 20; 21; 22; 23; 24]. Consistent with studies in other developing countries, Africa and SSA, unequal variation in MetS rates (4-63.7%) has been observed [39; 57; 58; 59; 60]. Challenges concerning the comparison of the presence of MetS across studies exist due to the various definitions of MetS [61]. The literature further documents the influence of culture differences, occupation, and lifestyle factors [28; 37; 62; 63]. A combination of these factors may explain the similarities or differences in the prevalence of MetS reported in this study in comparison to other studies. To complicate the matter further, diagnosis of MetS based only on the presence of three out of the five risk factors differs by definition [18]. According to [PERSON] et al. [62], the different criteria for MetS have not been adapted for either the South African or African populations. The majority of the drivers in this study had individual components of the MetS, which are obesity (36%), hypertension (36%), and diabetes (46%). The coexistence of these components contribute to the prevalence of MetS [63]. Similar to previous studies [17; 20; 56], the prevalence of MetS in the current study may be driven by the presence of obesity, hypertension, and diabetes. The presence of MetS and its components are attributed to urbanization and epidemiological transition in South Africa [17]. Taxi drivers with MetS had a high prevalence of obesity in this study. Obesity is alarming in South Africa with variations in several factors such as age and gender [64; 65; 66]. A high prevalence of hypertension was significantly observed among older taxi drivers compared to younger drivers. Disparities in the presence of hypertension by gender, age, and setting in South Africa have been reported [67; 68; 69]. In addition, hypertension is ascribed to sedentary lifestyle, nutrition, and stress, which might be the case in the current study, in agreement with other researchers [56]. A high proportion of physical inactivity confirms sedentary lifestyle in the current study, which is common among commercial drivers [70]. On the other hand, this study reported higher glucose levels (46%) among taxi drivers than among different population groups (13.8-26.3%) [19; 20]. Recent reports by the International Diabetes Federation has reported 1.8 million South Africans with diabetes, and further estimated an additional undiagnosed population of 69% [31]. Elevated glucose level in the current study could be related to a high prevalence of obesity, which is a risk factor for diabetes [27], as well as physical inactivity and excessive alcohol consumption, which has been previously reported [39; 71]. Failure to control diabetes might lead to health complications, which include MetS [39]. According to the literature, the prevalence of diabetes is affected by factors such as age, dietary habits, gender, daily work hours, geographical location, obesity rates, economic transition, and the different criteria used for diagnosing diabetes [19; 38]. In addition to physical inactivity reported in this study, smoking and alcohol use were high among taxi drivers. Smoking has been reported as one of the major lifestyle factors leading to cardiovascular diseases, subsequent to hypertension [72], and predisposes to several health issues such as MetS [73]. Furthermore, the literature documents that most drivers consume alcohol as a way of relaxation after a strenuous day as well as to boost appetite and as part of social events [74]. Excessive consumption of alcohol has been associated with hypertension and increases calorie intake [73].