Metabolic syndrome in urban Asian Indian adults—a population study using modified ATP III criteria

doi:10.1016/S0168-8227(03)00060-3

Diabetes Research and Clinical Practice

Volume 60, Issue 3, June 2003, Pages 199-204

https://doi.org/10.1016/S0168-8227(03)00060-3 Get rights and content

Abstract

Aims/hypothesis: To determine the prevalence of the Metabolic syndrome (MetS) using modified ATP III criteria in urban Asian Indian adults. Methods: 475 subjects (age 20–75 years) from a population data base were studied for the MetS using ATP III criteria but with a modified waist circumference (WC) appropriate for Indians. Presence of≥3 of the following; raised WC (Men≥90 cm, Women≥85 cm), triglycerides (TG) ≥1.7 mmol/l), HDL-Cholesterol (HDL-C)-<1.0 mmol/l for men, <1.3 mmol/l for women, fasting plasma glucose (FPG)≥6.1 mmol/l and blood pressure (BP)≥130/≥85 mm of Hg, or using BP medication, indicated the MetS. Insulin resistance (IR) was calculated using the Homeostasis Model Assessment (HOMA) equation. Factor analysis was used to identify clusters of correlated abnormalities. Results: MetS was present in 41.1%. WC was increased in 31.4%, TG in 45.6%, low HDL-C in 65.5%, hypertension in 55.4% and raised FPG 26.7%. MetS was present in 27.9% of subjects with FPG<6.1 mmol/l and its prevalence increased to >70% with higher FPG values. MetS was more common in women than in men (46.5 vs. 36.4%, χ²=4.6, P=0.03) and in older people. Four distinct clusters of abnormalities were identified with some gender variations. IR was more prevalent in MetS and was a component of two clusters but it was not a core component in factor analysis. Conclusions: MetS is common in Asian Indians. Its prevalence is age-related, and is more common in women. HOMA–IR or fasting plasma insulin was not a core component of the MetS.

Introduction

Clustering of cardiovascular risk factors or the Metabolic Syndrome (MetS) occurs in many ethnic groups, including Hispanics in the USA, Europoids, Asian Indians, Australian Aborigines, Polynesians and Micronesians [1], [2], [3], [4]. We have reported a high prevalence of the MetS in urban Asian Indians in the age group ≥40 years [3], [4].

Two sets of criteria have been laid down for identification of the syndrome; the WHO criteria [5] and the Adult Treatment Panel III (ATP III) of the National Cholesterol Education Programme (NCEP) in the USA [6]. The ATP III criteria is more practical and may be a better predictor of coronary heart disease (CHD) risk in the US population [7]. Unlike the WHO criteria [5], screening for microalbuminuria is not required for ATP III criteria.

The rising prevalence of diabetes, impaired glucose tolerance (IGT) and associated risk factors in urban India [8], [9], and also the young age of development of diabetes and IGT [9], indicate a need to establish the prevalence of the MetS in adults aged ≥20 years, using standard criteria. In this analysis we have used the ATP III criteria, with a modification to the value for waist circumference (WC) that is more applicable to the Asian Indian population.

Section snippets

Materials and methods

The 1995 population survey for diabetes, conducted in the city of Madras (now known as Chennai), Tamil Nadu, India was used for this analysis [8]. A cluster sampling procedure was used for the survey. The sample was representative of all socio-economic groups in the population. Among the 2183 subjects screened, every fourth subject was selected for this analysis (n=546), and 40 subjects with known diabetes were excluded (n=506). Among the 506 subjects, 475 who had all the required data for

Statistical analysis

Mean and standard deviation (S.D.) of the numerical variables are reported. Unpaired Student's ‘t’-test and χ²-test were used for group comparisons, as relevant. A P value <0.05 was considered significant.

Factor analysis with principal component analysis (PCA) was used to identify the domains that segregated. If there is a single underlying cause of the clustering of risk variables then factor analysis should identify one dominant factor. We used the PCA method of factor analysis with

Results

The study group of 475 subjects, (men:women 258:217) were aged 20–75 years. Prevalence of abnormalities based on the values detailed were: WC=31.4%, TG=45.6%, HDL-C=65.5%, hypertension=55.4%, and FPG=26.7%. MetS was present in 41.1% (n=195) of the study subjects. Among the total, only 8.6% were without any abnormality of the various components of MetS.

The MetS was seen in 27.9% of subjects with a FPG <6.1 mmol/l, in 71.8% with FPG between 6.1 and 6.9 mmol/l (IFG) and in 79.5% having FPG of ≥7.0

Discussion

The MetS is common in adult Asian Indians; 41% of subjects aged ≥20 years had features of the syndrome. Its prevalence increased with age. A higher prevalence in women might be related to their higher rates of obesity. Both general and upper body adiposity were higher in women than in men [8], [9]. The prevalence of glucose intolerance also increases more rapidly over time in women [14]. Fasting hyperinsulinaemia was present in 27% of study group. IR was common in MetS. IR was a component of

Acknowledgments

We thank the secretarial assistance of Ms. V. Bindhu in preparation of the manuscript.

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Metabolic syndrome in urban Asian Indian adults—a population study using modified ATP III criteria

Abstract

Introduction

Section snippets

Materials and methods

Statistical analysis

Results

Discussion

Acknowledgments

Diabetes Res. Clin. Pract.

Diabetes Res. Clin. Pract.

Diabetes Res. Clin. Pract.

Kelly West Lecture 1991: challenges in diabetes epidemiology-from west to the rest

Diabetes Care

Intra-urban differences in the prevalence of the metabolic syndrome in southern India—the Chennai Urban Population Study

Diabetic Med.

Clustering of cardiovascular risk factors in urban Asian Indians

Diabetes Care

Insulin resistance alone does not explain the clustering of cardiovascular risk factors in southern India

Diabetic Med.

Executive summary of the third report of the National Cholesterol Education Program (NCEP) of high blood cholesterol in adults (adult treatment panel III)

J. Am. Med. Assoc.

Prevalence of metabolic syndrome and coronary heart disease using NCEP and WHO criteria

Diabetes

Rising prevalence of NIDDM in urban population in India

Diabetologia