Key messages
-
The global prevalence of metabolic syndrome in the military population was estimated to be 21%.
-
The overall prevalence of obesity in the military population was estimated to be 14%.
-
There was considerable variation in the overall prevalence of cardio-metabolic risk factors was considerable among military personnel.
-
The findings suggest that implementing interventions for the control of cardio-metabolic risk factors among military personnel seems necessary.
Background
Methods
Identification of relevant studies
Inclusion and exclusion criteria
Quality assessment and data extraction
Statistical analysis
Results
Study selection process
Study characteristics
Qualitative synthesis
Author, year | Country | Study type | Study year | Study population | Sampling | Sample size | Mean age/ Range | Outcome | Definition/Criteria | Prevalence%(95% CI) |
---|---|---|---|---|---|---|---|---|---|---|
Payab, 2017 [13], | Iran | C/S | 2015 | Military | Convenience | 2200 | 37.73 | Mets | ATPIII | 11.1 (9.8–12.5) |
ATPIII with waist> 90 cm | 26.6 (24.7–28.5) | |||||||||
ATPIII> 95 cm | 19.6 (17.9–21.3) | |||||||||
Sharma, 2016 [18], | India | C/S | Not provided | Military aircrew | Convenience | 210 | 20–50 | Mets | MS-4 | 33.0 (26.6–39.7) |
ATPIII | 11.9 (7.6–16.7) | |||||||||
IDF | 7.1 (4.0–11.7) | |||||||||
WHO | 3.8 (1.8–7.6) | |||||||||
Gasier, 2016 [20], | US | C | Not provided | Navy (Submariners) | Convenience | 53 | 29 | Mets | ATP-III | 30.0 (18.7–44.5) |
Baygi, 2016 [21], | Iran | C/S | 2015 | Seafarers | Convenience | 234 | 36 | Mets | IDF | 14.9 (10.8–20.3) |
Rhee, 2015 [23], | Korea | C/S | 2014 | Military aviators | Convenience | 911 | 24–49 | Mets | WHO | 9.8 (7.9–11.9) |
Herzog, 2015 [27], | US | C/S | 2012 | Military | Convenience | 79,139 | 18–65 | Mets | ATPIII | 16.7 (15.7–16.2) |
Filho, 2014 [9], | Brazil | C/S | 2012 | Military | Convenience | 452 | 45.8 | Mets | ATPIII | 38.5 (34.0–43.2) |
Scovill, 2012 [31], | US | C/S | Not provided | Mariner | Convenience | 388 | 44 | Mets | ATPIII | 39.0 (34.1–43.9) |
Hagnas, 2012 [33], | Finland | Prospectiv | Not provided | Military | Convenience | 1046 | 19.2 | Mets | IDF | 6.1 (4.8–7.8) |
Costa, 2011 [36], | Brazil | C/S | 2008 | Navy | Convenience | 1383 | 30.7 | Mets | IDF | 17.6 (15.6–19.7) |
Khazale, 2007 [43], | Jordan | C | 2006 | Air force | Convenience | 111 | 32.5 | Mets | ATPIII | 18 (11.6–26.7) |
Al-Qahtani, 2005 [47], | Saudi Arabia | C/S | 2004 | Soldiers | Convenience | 1079 | 20–60 | Mets | ATPIII | 20.8 (18.4–23.3) |
Athyros, 2005 [48], | Greece | C/S | 2003 | Military | Convenience | 300 | 37.0 | Mets | ATPIII | 9.4 (6.4–13.3) |
Bauduceau, 2005 [49], | France | C/S | 2003 | Military | Convenience | 2045 | 38.6 | Mets | ATPIII WHO | 9.0 (7.8–10.3) 14.0 (12.5–15.6) |
Author, year | Country | Study type | Study year | Study population | Sampling | Sample size | Mean age/ Range | Outcome | Definition/Criteria | Prevalence% (95% CI) |
---|---|---|---|---|---|---|---|---|---|---|
Payab, 2017 [13], | Iran | C/S | 2015 | Military | Convenience | 2200 | 37.73 | Overweight Obesity Abdominal Obesity | 25.9 ≤ BMI < 29.9 kg/m2 BMI ≥ 30 kg/m2 WC > 90 cm | 47.59 (45.4–49.7) 15.05 (13.6–16.6) 45.4 (43.3–47.5) |
Rush, 2016 [19], | US | C/S | 2001 | Military | Randomly | 77,047 | 42 | Overweight Obesity | 25 ≤ BMI < 29.9 kg/m2 BMI ≥ 30 kg/m2 | 51.0 (50.6–51.3) 23.0 (22.7–23.3) |
Gasier, 2016 [20], | US | C | Not provided | Navy (Submariners) | Convenience | 53 | 29 | BF% Overweight Obesity | BF ≥ 25% | 27.0 (15.7–40.6) |
25 ≤ BMI < 29.9 kg/m2 | 6.0 (1.5–16.6) | |||||||||
BMI ≥ 30 kg/m2 | 62.0 (47.8–74.9) | |||||||||
Baygi, 2016 [21], | Iran | C/S | 2015 | Sefarers | Convenience | 234 | 36 | Abdominal obesity Excess weight | WC > 95 cm | 38.5 (32.3–45.0) |
BMI > 25 kg/m2 | 51.1 (44.7–57.8) | |||||||||
Fajfrova,2016 [22], | Czech Republic | C/S | Armed Forces | Convenience | 69,962 | 40 | Overweight Obesity | – | 51.5 (51.0–52.0) 14.0 (13.7–14.2) | |
Rhee, 2015 [23], | Korea | C/S | 2014 | Military aviators | Convenience | 911 | 24–49 | Abdominal obesity | WC > 90 cm | 25.3 (22.5–28.2) |
Reyes-Guzman, 2015 [24], | US | C/S | 2008 | Military | Randomly | 90,905 | 25–46 | Overweight Obesity | 25 ≤ BMI < 29.9 kg/m2 | 47.8 (47.4–48.3) |
BMI ≥ 30 kg/m2 | 9.6 (9.4–9.7) | |||||||||
Lennon, 2015 [25], | US | C/S | 2012 | Sailor | Convenience | 313,513 | 17–50 | Obesity | BMI > 30 kg/m2 | 13.6 (13.4–13.7) |
Hruby, 2015 [26], | US | C/S | 2012 | Army | Convenience | 1,703,150 | 20–40 | Overweight Obesity | 25 ≤ BMI < 30 kg/m2 BMI ≥ 30 kg/m2 | 33.6 (33.5–33.6) 8.2 (8.1–8.2) |
BinHoraib, 2013 [15], | Saudi Arabia | C/S | 2009 | Military | Multi-stage stratified random | 10,229 | 34.1 | Overweight Obesity Abdominal obesity | 25 ≤ BMI < 30 kg/m2 | 40.9 (39.9–40.7) |
BMI ≥ 30 kg/m2 | 29.0 (28.1–29.9) | |||||||||
WC > 90 cm | 42.4 (41.4–43.3) | |||||||||
Binkowska-Bury, 2013 [28], | Poland | C/S | 2010 | Military | Convenience | 37,916 | 19 | Overweight Obesity | 25 ≤ BMI < 29.9 kg/m2 | 12.6 (12.2–12.9) |
BMI ≥ 30 kg/m2 | 3.0 (2.8–3.1) | |||||||||
Marion,2012 [29], | US | C/S | 2008 | Navy | Convenience | 26,341 | 26.5 | Obesity | BMI ≥ 30 kg/m2 | 15.9 (15.4–16.3) |
Smith, 2012 [30], | US | Not provided | 2005 | Military | Convenience | 28,602 | 17–40 | Excess weight | BMI ≥ 25 kg/m2 | 58.9 (58.3–59.4) |
Scovill, 2012 [31], | US | C/S | Not provided | Mariner | Convenience | 388 | 44 | Obesity | BMI ≥ 30 kg/m2 | 61.0 (56.0–65.9) |
Pasiakos, 2012 [32], | US | L | Not provided | Army | Convenience | 209 | 21 | Obesity | BMI ≥ 30 kg/m2 | 14.0 (9.6–19.5) |
Sundin, 2011 [34], | UK | Not provided | 2006 | Armed Forces | Stratified Random Sampling | T:2470 M:2148 F:311 | 28.3 | Overweight T M F Obesity T M F | 25 ≤ BMI < 30 kg/m2 | 29.6 (27.7–31.4) |
BMI ≥ 30 kg/m2 | 30.5% (28.6–32.5) 27.1% (22.2–32.3) 13.5 (12.2–14.9) 13.5% (12.1–15.0) 13.5% (10.0–17.9) | |||||||||
Hansen, 2011 [35], | Denmark | Not provided | 2010 | Seafarers | Convenience | 2101 | 18–64 | Overweight | 25 ≤ BMI < 30 kg/m2 | 66.0 (36.9–67.9) |
Costa, 2011 [36], | Brazil | C/S | 2008 | Navy | Convenience | 1383 | 30.7 | Abdominal obesity | WC ≥ 90 cm | 35.0 (32.5–37.6) |
Mullie, 2010 [37], | Belgium | C/S | 2007 | Army | Random | 974 | 44.0 | Obesity | BMI ≥ 30 kg/m2 | 15.2 (13.3–17.9) |
Wenzel, 2009 [38], | Brazil | C/S | 2000 | Military Air force | Convenience | 380 | 19–49 | Overweight Obesity | 25 ≤ BMI < 30 kg/m2 | 36.0 (31.3–41.1) |
BMI ≥ 30 kg/m2 | 8.0 (5.5–11.2) | |||||||||
Saely, 2009 [39], | Switzerland | C | 2004 | Army | Convenience | 56,784 | 19.7 | Overweight Obesity | 25 ≤ BMI < 30 kg/m2 | 16.8 (16.5–17.1) |
BMI ≥ 30 kg/m2 | 4.1 (3.9–4.2) | |||||||||
Mullie, 2008 [40], | Belgium | C/S | 1992–2005 | Army | Convenience | 43,343 | 20–59 | Overweight Obesity | 25 ≤ BMI < 30 kg/m2 BMI ≥ 30 kg/m2 | 34.9 (34.4–35.3) 3.5 (3.3–3.6) |
Napradit, 2007 [42], | Thailand | C/S | 2005 | Army | Convenience | 4276 | 41.5 | Overweight Obesity | 25 ≤ BMI < 30 kg/m2 BMI ≥ 30 kg/m2 | 27.1 (25.7–28.4) 4.9 (4.3–5.6) |
Khazale, 2007 [43], | Jordan | C | 2006 | Air force | Convenience | 111 | 32.5 | Abdominal obesity | WC > 102 cm | 9.3 (4.6–16.3) |
Hoeyer, 2005 [45], | Denmark | Not provided | Not provided | Seafarers | Convenience | 1257 | 16–66 | Overweight Obesity | 25 ≤ BMI < 30 kg/m2 | 17.1 (15.1–19.2) |
BMI ≥ 30 kg/m2 | 5.8 (4.6–7.3) | |||||||||
Al-Qahtani, 2005 [46], | Saudi Arabia | C/S | 2004 | Soldiers | Convenience | 1049 | 36.1 | Overweight Obesity | 25 ≤ BMI < 30 kg/m2 | 37.5 (34.5–40.4) |
BMI ≥ 30 kg/ | 31.6 (28.7–34.4) | |||||||||
Al-Qahtani, 2005 [47], | Saudi Arabia | C/S | 2004 | Soldiers | Convenience | 1079 | 20–60 | Abdominal Obesity | WC > 102 cm | 33.1 (30.3–36.0) |
Athyros, 2005 [48], | Greece | C/S | 2003 | Military | Convenience | 300 | 37.0 | Abdominal Obesity | WC > 102 cm | 13.7 (10.1–18.2) |
Bauduceau, 2005 [49], | France | C/S | 2003 | Military | Convenience | 2045 | 38.6 | Abdominal obesity | WC > 102 cm | 17.0 (15.4–18.7) |
Mazokopakis, 2004 [50], | Greece | C/S | 1998 | Warship personnel | Convenience | 274 | 24.4 | Overweight Obesity | 25 ≤ BMI < 29.9 kg/m2 | 26.5 (21.2–31.9) |
BMI ≥ 30 kg/m2 | 4.7 (2.6–8.1) | |||||||||
Lindquist, 2001 [51], | US | C/S | 1995–1998 | Military | Convenience | 33,457 | 20–35 | Overweight | BMI ≥ 25 kg/m2 | 52.0 (51.4–52.5) |
Author, year | Country | Study type | Study year | Study population | Sampling | Sample size | Mean age/ Range | Outcome | Definition/Criteria | Prevalence% (95% CI) |
---|---|---|---|---|---|---|---|---|---|---|
Payab, 2017 [13], | Iran | C/S | 2015 | Military | Convenience | 2200 | 37.73 | HTN | SBP ≥130 mmHg or DBP ≥85 mmHg | 2.6 (1.98–3.37) |
Gasier, 2016 [20], | US | C | Not provided | Obese Navy (Submariners) | Convenience | 53 | 29 | Insulin resistant | HOMA> 2.73 | 30.0 (18.7–44.5) |
Baygi, 2016 [21], | Iran | C/S | 2015 | Sefarers | Convenience | 234 | 36 | High TG | TG ≥150 mg/dl | 25.2 (20.3–31.8) 26.5 (21.1–32.7) 26.5 (21.1–32.7) 28.2 (22.6–34.5) 19.2 (14.5–25.0) 23.1 (17.9–29.11) |
Low HDL | HDL < 40 mg/dl | |||||||||
High LDL | LDL.130 mg/dl | |||||||||
High TC | TC ≥ 200 mg/dl | |||||||||
HTN | SBP ≥130 mmHg or DBP ≥85 mmHg | |||||||||
High FBS | FBS > 100 mg/dl | |||||||||
Rhee, 2015 [23], | Korea | C/S | 2014 | Military aviators | Convenience | 911 | 24–49 | High BP Impaired glucose High TG Low HDL | SBP ≥130 mmHg or DBP ≥85 mmHg FBS ≥ 100 mg/dl TG ≥150 mg/dl HDL < 40 mg/dl | 31.7 (28.7–34.9) 19.0 (16.5–21.7) 16.6 (14.2–19.1) 7.9 (6.3–9.9) |
Filho, 2014 [9], | Brazil | C/S | 2012 | Military | Convenience | 452 | 45.8 | HTN | SBP ≥130 mmHg or | 55.8 (51.0–60.4) 50.9 (46.2–55.6) 30.5 (26.4–35.0) 30.5 (26.4–35.0) |
High TG | DBP ≥85 mmHgTG | |||||||||
Low HDL | ≥150 mg/dl | |||||||||
High FBS | HDL < 40 mg/dl FBS > 100 mg/dl | |||||||||
Scovill, 2012 [31], | US | C/S | Not provided | Mariner | Convenience | 388 | 44 | HTN | SBP ≥130 mmHg or | 42.0 (37.1–47.1) 42.0 (37.1–47.1) 47.0 (41.8–52.0) 22.0 (17.9–26.4) |
High TG | DBP ≥85 mmHg | |||||||||
Low HDL | TG ≥150 mg/dl | |||||||||
High FBS | HDL < 40 mg/dl LDL > 130 mg/dlFBS ≥ 100 mg/dl | |||||||||
Pasiakos, 2012 [32], | US | L | Not provided | Army | Convenience | 209 | 21 | High TC High TG Low HDL High LDL High FBS | TC ≥ 200 mg/dl TG ≥150 mg/dl HDL < 40 mg/dl LDL > 130 mg/dl FBS > 100 mg/dl | 8.0 (4.9–12.9) 5.0 (2.4–8.9) 33.0 (26.8–39.9) 39.0 (32.2–45.7) 8.0 (4.9–12.9) |
Costa, 2011 [36], | Brazil | C/S | 2008 | Navy | Convenience | 1383 | 30.7 | Low HDL HTN High TG High FBS | HDL < 40 mg/dl SBP ≥130 mmHg or DBP ≥85 mmHg TG ≥150 mg/dl FBS ≥ 100 mg/dl | 43.0 (40.4–45.7) 26.3 (24.0–28.7) 19.3 (17.3–21.5) 6.6 (5.4–8.0) |
Mullie, 2010 [37], | Belgium | C/S | 2007 | Army | Random | 974 | 44.0 | High TC | TC ≥ 190 mg/dl | 65.0 (61.7–67.9) |
Wenzel, 2009 [38], | Brazil | C/S | 2000 | Military Air force | Convenience | 380 | 19–49 | HTN | SBP ≥140 mmHg or DBP ≥90 mmHg | 22.0 (18.1–26.7) |
Saely, 2009 [39], | Switzerland | C | 2004 | Army | Convenience | 56,784 | 19.7 | Pre-HTN HTN High TC | 120 ≤ SBP < 139 mmHg SBP ≥140 mmHg or DBP ≥90 mmHg TC ≥ 190 mg/dl | 61.4 (61.0–61.8) 26.8 (26.4–27.2) 7.8 (7.6–8.0) |
Smoley, 2008 [41], | US | C/S | 2004 | Service members | Convenience | 15,391 | 27.8 | Pre HTN HTN | 120 ≤ SBP < 139 mmHg or 80 ≤ DBP < 89 mmHg SBP ≥140 mmHg or DBP ≥90 mmHg | 63.0 (62.2–63.7) 11.0 (105–11.5) |
Napradit, 2007 [42], | Thailand | C/S | 2005 | Army | Convenience | 4276 | 41.5 | HTN | SBP ≥140 mmHg or DBP ≥90 mmHg | 34.5 (33.1–35.9) |
Khazale, 2007 [43], | Jordan | C | 2006 | Air force | Convenience | 111 | 32.5 | High SBP High DBP High TC Low HDL High FBS | SBP > 130 mmHg DBP > 85 mmHg TC ≥ 150 mg/dl HDL < 40 mg/dl FBS > 100 mg/dl | 9.6 (4.6–16.3) 23.1 (13.8–29.6) 52.2 (42.6–61.7) 38.7 (29.7–48.5) 9.6 (4.6–16.3) |
Vaicaitiene, 2006 [44], | Lithuania | C/S | Not provided | Military | Random | 200 | 25–54 | High TC | TC ≥ 240 mg/dl | 43.4 (36.5–50.6) |
Al-Qahtani, 2005 [47], | Saudi Arabia | C/S | 2004 | Soldiers | Convenience | 1079 | 20–60 | High TG High BP | TG ≥150 mg/dl SBP > 130 mmHg DBP > 85 mmHg | 32.2 (29.4–35.5) 29.5 (26.8–32.3) |
Athyros, 2005 [48], | Greece | C/S | 2003 | Military | Convenience | 300 | 37.0 | High FBS High TG Low HDL Impaired Glucose | FBS > 100 mg/dl TG ≥150 mg/dl HDL < 40 mg/dl FBS > 100 mg/dl | 4.0 (2.2–7.1) 25.0 (20.3–30.4) 9.4 (6.4–13.3) 3.0 (1.5–5.8) 1.0 (0.3–3.1) |
Bauduceau, 2005 [49], | France | C/S | 2003 | Military | Convenience | 2045 | 38.6 | HTN High TG Low HDL High FBS | SBP > 130 mmHg or DBP > 85 mmHg TG ≥150 mg/dl HDL < 40 mg/dl FBS > 100 mg/dl | 51.0 (48.7–53.1) 17.0 (15.4–18.7) 9.6 (8.4–10.9) 5.0 (4.1–6.0) |
Meta-analysis
Variables | No. of studies | Sample Size | Prevalence (CI 95%) | Model | I2(%) | *P-value |
---|---|---|---|---|---|---|
MetS | 10 | 4,912,369 | 21 (17–25) | Random | 97 | < 0.001 |
Overweight | 19 | 2,867,867 | 35 (31–39) | Random | 99 | < 0.001 |
Obesity | 22 | 3,211,654 | 14 (13–16) | Random | 99 | < 0.001 |
Abdominal obesity | 8 | 17,581 | 29 (20–39) | Random | 99 | < 0.001 |
HTN | 13 | 816,414 | 26 (19–34) | Random | 99 | < 0.001 |
High TG | 9 | 7001 | 24 (16–31) | Random | 98 | < 0.001 |
Low HDL | 9 | 6033 | 28 (17–38) | Random | 99 | < 0.001 |
High LDL | 29 | 157,730 | 32 (27–36) | Random | 99 | < 0.001 |
High TC | 6 | 58,512 | 34 (10–57) | Random | 99 | < 0.001 |
High FBS | 6 | 4436 | 9 (5–12) | Random | 92 | < 0.001 |
Quality assessment
Study | Total score | Item 1 | Item 2 | Item 3 | Item 4 | Item 5 | Item 6 | Item 7 | Item 8 | Item 9 | Item 10 |
---|---|---|---|---|---|---|---|---|---|---|---|
Payab, 2017 | 7 | N | Y | Y | Y | N | Y | Y | N | Y | Y |
Sharma, 2016 | 5 | N | – | Y | Y | N | Y | N | N | Y | Y |
Rush, 2016 | 6 | N | Y | Y | Y | N | Y | N | N | Y | Y |
Gasier, 2016 | 3 | N | N | N | N | N | Y | UC | N | Y | Y |
Baygi, 2016 | 7 | N | Y | Y | Y | NA | Y | Y | N | Y | Y |
Fajfrova,2016 | 4 | N | Y | Y | Y | NA | N | Y | N | N | N |
Rhee, 2015 | 8 | N | Y | Y | Y | NA | Y | Y | Y | Y | Y |
Reyes-Guzman, 2015 | 7 | N | Y | Y | Y | N | Y | N | Y | Y | Y |
Lennon, 2015 | 6 | N | Y | Y | Y | NA | Y | N | N | Y | Y |
Hruby, 2015 | 7 | N | Y | Y | Y | NA | Y | UC | Y | Y | Y |
Herzog, 2015 | 7 | N | Y | Y | Y | NA | Y | UC | Y | Y | Y |
Filho, 2014 | 5 | N | N | Y | Y | N | Y | UC | N | Y | Y |
BinHoraib, 2013 | 8 | N | Y | Y | Y | N | Y | Y | Y | Y | Y |
Binkowska-Bury, 2013 | 4 | N | Y | Y | N | NA | Y | UC | Y | N | N |
Marion,2012 | 7 | N | Y | Y | Y | NA | Y | UC | Y | Y | Y |
Smith, 2012 | 7 | N | Y | Y | Y | NA | Y | UC | Y | Y | Y |
Scovill, 2012 | 3 | N | Y | Y | N | N | Y | UC | N | N | N |
Pasiakos, 2012 | 5 | N | N | Y | Y | N | Y | UC | Y | N | Y |
Hagnas, 2012 | 3 | N | Y | Y | N | N | N | Y | N | N | N |
Sundin, 2011 | 7 | N | Y | Y | Y | N | Y | N | Y | Y | Y |
Hansen, 2011 | 7 | N | Y | Y | Y | NA | Y | Y | N | Y | Y |
Costa, 2011 | 6 | N | N | Y | Y | N | Y | N | Y | Y | Y |
Mullie, 2010 | 6 | N | N | Y | Y | Y | Y | UC | N | Y | Y |
Wenzel, 2009 | 7 | N | N | Y | Y | N | Y | Y | Y | Y | Y |
Saely, 2009 | 5 | N | Y | Y | N | NA | Y | UC | N | Y | Y |
Mullie, 2008 | 7 | N | Y | Y | Y | N | Y | N | Y | Y | Y |
Smoley, 2008 | 8 | N | Y | Y | Y | NA | Y | Y | Y | Y | Y |
Napradit, 2007 | 7 | N | Y | Y | Y | N | Y | N | Y | Y | Y |
Khazale, 2007 | 5 | N | Y | N | Y | N | Y | N | N | Y | Y |
Vaicaitiene, 2006 | 7 | N | Y | Y | Y | N | Y | Y | N | Y | Y |
Hoeyer, 2005 | 5 | N | N | Y | Y | N | Y | N | N | Y | Y |
Al-Qahtani, 2005 | 6 | N | N | Y | N | Y | Y | N | Y | Y | Y |
Al-Qahtani, 2005 | 6 | N | N | Y | N | Y | Y | N | Y | Y | Y |
Athyros, 2005 | 6 | N | Y | Y | Y | N | Y | N | N | Y | Y |
Bauduceau, 2005 | 5 | N | Y | Y | Y | N | Y | Y | N | N | N |
Mazokopakis, 2004 | 3 | N | N | Y | Y | N | Y | N | N | N | N |
Lindquist, 2001 | 6 | N | Y | Y | Y | Y | Y | N | Y | N | N |