High prevalence of the metabolic syndrome among Northern Jordanians

doi:10.1016/j.jdiacomp.2005.11.003

Journal of Diabetes and its Complications

Volume 21, Issue 4, July–August 2007, Pages 214-219

https://doi.org/10.1016/j.jdiacomp.2005.11.003 Get rights and content

Abstract

Background

The prevalence of the metabolic syndrome is rapidly increasing with a considerable ethnic variation within and across populations. This study was conducted to estimate the prevalence of the metabolic syndrome and its individual components using Adult Treatment Panel III (ATP III) criteria among Northern Jordanians.

Methods

Data were analyzed from a cross-sectional study that included a random sample of 1121 northern Jordanians aged 25 years and above. The metabolic syndrome was defined by ATP III criteria.

Results

The age-adjusted prevalence of the metabolic syndrome was 36.3% (95% CI 33.6–39.0%) (28.7% among men and 40.9% among women). The prevalence increased significantly with age in men and women. The prevalence of the metabolic syndrome was significantly higher in women than in men in age groups of 40–49 and 60 years and above. Low HDL cholesterol was the most common abnormality in men (62.7%), and abdominal obesity was the most common abnormality in women (69.1%).

Conclusions

Prevalence of the metabolic syndrome in North Jordan is considerably higher than in developed countries and other Arab populations. An integrated approach is needed for the prevention and treatment of the metabolic syndrome.

Introduction

The metabolic syndrome is essentially a group of interrelated metabolic risk factors that increase the risk of cardiovascular morbidity and mortality and total mortality (Isomaa et al., 2001, Lakka et al., 2002). These factors include obesity, abnormal glucose metabolism, high blood pressure, and dyslipidemia (DeFronzo & Ferrannini, 1991). Although the pathogenesis of the syndrome is not completely understood, it is influenced by a complex interplay between multiple genetic variations interacting with numerous environmental factors (Liese et al., 1998, Reaven, 1988). The World Health Organization (WHO) initially proposed a definition for the metabolic syndrome in 1998 (Alberti & Zimmet, 1998). More recently, the Cholesterol Education Program Adult Treatment Panel III (ATP III) provided a new working definition of the metabolic syndrome (Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, 2001).

The prevalence of the metabolic syndrome varies by definition used and population studied (Ford & Giles, 2003). The prevalence of the metabolic syndrome is rapidly increasing (Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, 2001, Ford et al., 2002) with a considerable ethnic variation within and across populations (Araneta, Wingard, & Barrett-Connor, 2002). It is present in more than 20% of the US adult population (Park et al., 2003). In the United Kingdom the metabolic syndrome has also been increasingly recognized (The UK HDL-C Consensus Group, 2004) especially in South Asians (Kain, Catto, & Grant, 2003). A considerably high prevalence of the metabolic syndrome was reported in Turkey (Ozsahin et al., 2004), Asian Indian population (Ramachandran, Snehalatha, Satyavani, Sivasankari, & Vijay, 2003), and Iran (Azizi, Salehi, Etemadi, & Zahedi-Asl, 2003).

The metabolic syndrome is common among Arab populations in Mediterranean countries (Abdul-Rahim et al., 2001, Al-Lawati et al., 2003) and among Arab Americans (Jaber, Brown, Hammad, Zhu, & Herman, 2004). In Jordan, several studies (Ajlouni et al., 1998a, Ajlouni et al., 1998b, Batieha et al., 1997, Jaddou et al., 1996) have focused on estimating the population distribution of major risk factors for cardiovascular diseases and illustrated a high prevalence of hypertension, diabetes, impaired glucose metabolism, obesity, and hyperlipidaemia. However, studies on the clustering of such risk factors in Jordanian population in the form of the metabolic syndrome are not available. Therefore, this study aimed to estimate the prevalence of the metabolic syndrome and its individual components using Adult Treatment Panel III (ATP III) criteria among Northern Jordanians.

Section snippets

Study population and data collection

This survey was conducted in the town of Sarih in the north of Jordan to estimate the prevalence of diabetes mellitus, hypertension, hyperlipidaemia, obesity, and metabolic syndrome, and to determine their risk indicators. This town with about 3328 households and 19,227 residents (Department of Statistics 2002—Jordan) was selected because of the presence of a health center in which to perform the study and because of its proximity to the study team. A systematic sample of 550 households (every

Participant's characteristics

A total of 1121 participants (394 men and 727 women) aged 25 years and above had complete information for all components of the metabolic syndrome. The demographic, anthropometric, and metabolic characteristics of participants are depicted in Table 1, Table 2. Age of the subjects ranged from 25 to 85 years with a mean of 46.2±13.2 (±S.D.). About 52% of the subjects had less than high school education. Eighty-five percent (85.3%) were married and 7.7% were single. The average levels of waist and

Discussion

This study reported an estimate of the prevalence of the metabolic syndrome among Northern Jordanians aged 25 years and above. Using the ATP III diagnostic criteria, we found that the age-standardized prevalence of the metabolic syndrome was 36.3% (28.7% among men and 40.9% among women). This estimate was considerably higher than that reported in the US population (24%, ATP III criteria) (Park et al., 2003) and Arab populations including Arab Americans (23%, ATP III criteria and 28%, WHO

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A meta-analysis was conducted on a total of 61 eligible studies with a total of 120071 individuals which were selected and critically appraised through a systematic approach within each country.
The pooled estimates of MS varied in different areas with a range of 23.6% in Kuwait to 40.1% in U.A Emirates. Overall, nearly one-third of population (around 80,000,000) suffering from MS in the Middle-East. Moreover, the west countries in this area have relatively higher prevalence than those located in the east. The highest Population Attributable Risk (PAR) of the diseases due to MS was related to the mortality because of cardiovascular disease (29.6 per cent) compared to the lowest one was obtained for coronary heart disease (17.2 per cent). The study also verified PAR for stroke, myocardial infraction, and all-cause mortality overall and by country.
Present findings strongly support the fact that high prevalence of MS have notifiable portion in developing cardiovascular disease, stroke, myocardial infarction and mortality. Therefore, it should be regarded as a major health concern in the region.
Metabolic syndrome and its risk factors among middle aged population of Iran, a population based study
2016, Diabetes and Metabolic Syndrome: Clinical Research and Reviews
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Based on the results, the prevalence of MS in the 64–40 years Iranian peoples was 12.14%. Other studies conducted in Iran and other parts of the world reported a higher prevalence for MS. The prevalence of this disorder among adults was 38.5% in the United States [9], 27.8% in Spain [32], 21.1% in France [10], 25.9% in Norway [33], 54.8% in Mexico [11], 35.73% in Morocco [2], 30% in Tanzania [34], 25% in Korea [35], 21.3–39% in China [12,13], 40–50% in India [36], 21% in Saudi Arabia [14], 36.3% in Jordan [37], 33.5% in Turkey [15], and 21.9–32% in different regions of Iran [16–23]. Possible reasons for this difference and lower prevalence of MS, are racial and regional differences, age differences between studies, and the use of different definitions for MS. It should be noted that in this study, there was no access to IFG or IGT and those with non-fasting blood glucose greater than or equal to 140, or those who use anti diabetic medication were considered as individuals with insulin resistance.
To determine the prevalence of metabolic syndrome (MS) and its risk factors in a middle-aged population in Iran.
The sample was 5190 individuals aged 40–64 years participated in the first phase of the Shahroud eye cohort study. Prevalence of MS was determined in terms of the age and sex. Other variables were evaluated by using simple and multiple logistic regression methods.
The prevalence of MS was 10.88% in men, 13.03% in women and 12.14% in total. The prevalence proportion increased with increasing age. In multivariate logistic regression model, age (odds ratio (OR) = 1.06), education (OR = 0.98) and smoking (OR = 0.50), had significant effects on MS. In this model, gender, marital status and economic status had no significant effect on MS. Higher prevalence of obesity and overweight in non-smokers (79.9%) compare to smokers (47.4%, P < 0.001), indicated that the association of smoking and MS is confounded.
Despite the low prevalence of MS in this study, older age was associated with increased risk of developing MS and higher education was associated with decreased this risk, therefore health education, changing the lifestyle, and taking greater attention in elderly is needed in order to prevent the MS and its complications.
Age and gender differences in the clustering of metabolic syndrome combinations: A prospective cohort research from the Kerman Coronary Artery Disease Risk Study (KERCADRS)
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In another population in Northern Jordan, the prevalence of the metabolic syndrome [46] was reported to be 36.3%, with a significantly higher prevalence in women than in men. The most common abnormality was low HDL cholesterol in men (62.7%) and increased waist circumference in women (69.1%) [47]. The prevalence of the metabolic syndrome [46] was reported to be 21.0% in one city in Oman, with low HDL cholesterol (75.4%) and increased waist circumference as the two most common components [22].
The features of metabolic syndrome (MetS) and its components are now different in Iran compared to western countries.
The aim of this study was to provide estimates of the prevalence of the different MetS combinations in younger and older men and women in Iran.
A detailed interview regarding social demographics risk profile, and components of MetS was administered according to the Kerman Coronary Artery Disease Risk Study (KERCADRS) as population-based, epidemiological research among a cohort of 6000 individuals that residence in Kerman city.
The overall prevalence of MetS was 25.2% in men and 42.5% in women considering the International Diabetes Federation (IDF) criteria and 31.0% in men and 38.0% in women when the National Cholesterol Education Program (NCEP) definition was applied. MetS was significantly more prevalent in females, using both definitions. The prevalence of MetS increased with age in both gender when both syndrome criteria were considered. The prevalence of different combinations of the syndrome by both definitions peaked in the age range 51–60 years among both men and women. The appearance of each component was observed earlier in women than men.
The prevalence of the MetS in the State of Kerman, a great province in the south-east of Iran is estimated as 35.0%, higher than in most developed countries and some other Middle-East regions, with generally higher prevalence rates for women. The prevalence of MetS increases with age in both genders with earlier appearance in men.
Genetic association with low concentrations of high density lipoprotein-cholesterol in a pediatric population of the Middle East and North Africa: The CASPIAN-III study
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Depressed high-density lipoprotein cholesterol (HDL-C) is prevalent the Middle East and North Africa. Some studies have documented associations between HDL-C and several single nucleotide polymorphisms (SNPs) in candidate gene polymorphisms.
We investigated the associations between SNP genotypes and HDL-C levels in Iranian students, aged 10–18 years. Genotyping was performed in 750 randomly selected participants among those with low HDL-C levels (below 5th percentile), intermediate HDL-C levels (5–95th) and high HDL-C levels (above the 95th percentile). Minor allele frequencies (MAFs) of the SNPs of interest were compared between the three HDL-C groups.
The vast majority of pairwise comparisons of MAFs between HDL-C groups were significant. Pairwise comparisons between low and high HDL-C groups showed significant between-group differences in MAFs for all SNPs, except for APOC3 rs5128. Pairwise comparisons between low and intermediate HDL-C groups showed significant between-group differences in MAFs for all SNPs, except for APOC3 rs5128 and APOA1 rs2893157. Pairwise comparisons between intermediate and high HDL-C groups showed significant between-group differences in MAFs for all SNPs, except for ABCA1 APOC3 rs5128 and APOA1 rs2893157. After adjustment for confounding factors, including age, sex, body mass index, low physical activity, consumption of saturated fats, and socioeconomic status, ABCA1 r1587K and CETP A373P significantly increased the risk of depressed HDL-C, and CETP Taq1 had a protective role.
This study replicated several associations between HDL-C levels and candidate gene SNPs from genome-wide associations with HDL-C in Iranians from the pediatric age group.
Association of breakfast intake with cardiometabolic risk factors
2013, Jornal de Pediatria
Citation Excerpt :
As indicated in the current study, the risk of elevated TG, LDL-C and low HDL-C was significantly increased in subjects who skipped breakfast. Population-based studies in the Middle East have shown a markedly high prevalence of dyslipidemia in this region.28 This can be explained by an ethnic predisposition to MetS in Iran and its neighbouring countries.29
this study aimed to evaluate the association of breakfast intake with cardiometabolic risk factors in a nationally-representative sample of Iranian pediatrics.
the study participants considered of 5,625 school students aged 10-18 years, studied in the third survey of the national school-based surveillance system (CASPIAN-III). They were classified into three groups based on the number of days they ate breakfast: “regular breakfast eater” (6-7days/week), “often breakfast eater” (3-5days/week), and “seldom breakfast eater” (0-2 days/week). Metabolic syndrome (MetS) was defined based on the Adult Treatment Panel III (ATP III) criteria modified for the pediatric age group. Moreover, high total cholesterol, high low-density lipoprotein cholesterol (LDL-C) and generalized obesity were included as other cardiometabolic risk factors. Multiple logistic regression analyses were used to evaluate the association between the breakfast intake category and cardiometabolic risk factors.
the number of subjects classified as “regular”, “often” and “seldom” breakfast eaters were 2,653(47.3%), 1,327(23.7%) and 1,624(29.0%), respectively. The average of triglycerides (TG), LDL-C, systolic blood pressure (SBP) and body mass index (BMI) were higher in the “seldom breakfast eater” group (P for trend<0.001), whereas the mean of high-density lipoprotein cholesterol (HDL-C) was lower in this group than their other counterparts. Seldom breakfast eaters had an increased risk of obesity, elevated TG and LDL-C, as well as low HDL-C compared to “regular breakfast eaters”. The risk of MetS was significantly increased in subjects who seldom ate breakfast (OR 1.96, 95% CI 1.18-3.27).
skipping breakfast is associated with increased risk of MetS and other cardiometabooic factors in children and adolescents. Promoting the benefit of eating breakfast could be a simple and important implication to prevent these risk factors.
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Os participantes do estudo, composto de 5.625 alunos em idade escolar de 10-18 anos, participaram da terceira pesquisa do sistema nacional de vigilância nas escolas (CASPIAN-III). Eles foram classificados em três grupos, com base na quantidade de dias em que consumiam café da manhã: “indivíduos que consomem café da manhã regularmente” (6-7 dias/semana), “indivíduos que consomem café da manhã normalmente” (3-5 dias/semana) e “indivíduos que consomem café da manhã raramente” (0-2 dias/semana). A síndrome metabólica (SM) foi definida com base nos critérios do III Painel de Tratamento de Adultos (ATP III), adaptados para a faixa etária pediátrica. Ademais, o colesterol total elevado, a lipoproteína de baixa densidade-colesterol elevada (LDL-C) e a obesidade generalizada foram incluídos como outros fatores de risco cardiometabólico. As análises de regressão logística múltipla foram utilizadas para avaliar a associação entre a categoria consumo de café da manhã e fatores de risco cardiometabólico.
A quantidade de pessoas classificadas como indivíduos que consomem café da manhã “regularmente”, “normalmente” e “raramente” foram 2.653 (47,3%), 1.327 (23,7%) e 1.624 (29%), respectivamente. As médias de triglicerídeos (TG), LDL-C, pressão arterial sistólica (PAS) e índice de massa corporal (IMC) foram mais elevadas no grupo de “indivíduos que consomem café da manhã raramente” (P para tendência < 0,001), ao passo que a lipoproteína de alta densidade-colesterol (HDL-C) foi menor nesse grupo que nos outros. Os indivíduos que consomem café da manhã raramente apresentaram um aumento no risco de obesidade, TG e LDL-C elevados, bem como baixo HDL-C em comparação a “indivíduos que consomem café da manhã regularmente”. O risco de SM foi significativamente maior nos indivíduos que consomem café da manhã raramente (RC 1,96, 95% IC 1,18-3,27).
Pular o café da manhã está relacionado a aumento no risco de SM e outros fatores cardiometabólicos em crianças e adolescentes. Promover o benefício do consumo do café da manhã pode ser uma implicação simples e importante para evitar esses fatores de risco.
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Original articleHigh prevalence of the metabolic syndrome among Northern Jordanians

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Study population and data collection

Participant's characteristics

Discussion

Diabetes Research and Clinical Practice

Diabetes Research and Clinical Practice

The metabolic syndrome in the West Bank population: An urban–rural comparison

Diabetes Care

Diabetes and impaired glucose tolerance in Jordan: Prevalence and associated risk factors

Journal of Internal Medicine

Obesity in Jordan

International Journal of Obesity and Related Metabolic Disorders

Definition, diagnosis and classification of diabetes mellitus and its complications: Part 1. Diagnosis and classification of diabetes mellitus, provisional report of a WHO consultation

Diabetic Medicine

Prevalence of the metabolic syndrome among Omani adults

Diabetes Care

Type 2 diabetes and metabolic syndrome in Filipina-American women: A high-risk nonobese population

Diabetes Care

Hyperlipidemia in Jordan: A community-based survey

Saudi Medical Journal

Intra-abdominal fat is a major determinant of the National Cholesterol Education Program Adult Treatment Panel III criteria for the metabolic syndrome

Diabetes

Metabolic syndrome: Time for action

American Family Physician

Insulin resistance: A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease

Diabetes Care

Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)

Journal of the American Medical Association

A comparison of the prevalence of the metabolic syndrome using two proposed definitions

Diabetes Care

Original article
High prevalence of the metabolic syndrome among Northern Jordanians