Elsevier

Metabolism

Volume 58, Issue 6, June 2009, Pages 746-752
Metabolism

Impact of different metabolic syndrome classifications on the metabolic syndrome prevalence in a young Middle Eastern population

https://doi.org/10.1016/j.metabol.2008.11.014Get rights and content

Abstract

The metabolic syndrome (MetS) prevalence in a young Middle Eastern population has never been studied. We studied this prevalence in a randomly selected population of Lebanese students using different MetS classifications. Three hundred eighty-one subjects aged 18 to 30 years were included in the study. Anthropometric and biological parameters (waist circumference [WC], systolic and diastolic blood pressures, fasting plasma glucose, triglycerides, total cholesterol, high-density lipoprotein cholesterol, and homeostasis model assessment [HOMA] index to assess insulin resistance) were measured. Receiver operating characteristic (ROC) curves were generated to determine population-specific cutoff values for MetS parameters and HOMA index. The MetS prevalence was calculated using the National Cholesterol Education Program's Adult Treatment Panel III (ATP-III), the actualized ATP-III, and our cutoffs, either with or without HOMA index as an extra risk factor. The MetS prevalence using the ATP-III and the actualized ATP-III was, respectively, 5.25% and 5.28%. It increased to 9.19% when using our cutoff values and to 12.64% when HOMA index was added. This increase was significant only in men. The identified cutoff values are, for WC, 91 cm in women and 99.5 cm in men and, for HOMA index, 2.32. Among the MetS components, WC was the best MetS predictor, whereas fasting plasma glucose was the poorest. Our study shows that the MetS prevalence in Lebanon is comparable with other countries. In addition, we identified in our population new cutoff points for MetS parameters and HOMA index that allow the detection of a higher number of subjects with the MetS, mainly in the male population.

Introduction

The metabolic syndrome (MetS) was first described by Reaven [1] in 1988 as a cluster of risk factors for diabetes and cardiovascular disease such as obesity, dyslipidemia, hypertension, and impaired fasting plasma glucose (FPG). Subsequently, several definitions for this entity have been proposed [2], [3], [4]. The 2 mainly retained definitions are those of the World Health Organization [2] and the National Cholesterol Education Program's (NCEP's) Adult Treatment Panel III (ATP-III) [4]. The ATP-III is more commonly used because its criteria are easily measurable because they do not include insulin resistance, which is a nonreproducible measurement [5].

Worldwide, the prevalence of the MetS significantly increases with age [6], [7], [8] and can vary in the same population depending on the used definition [9], [10]. This prevalence is also ethnic dependent [10], [11], [12], being much more prevalent in Hispanics compared with African Americans and Europeans [10]. In the Arab world, using the ATP-III panel criteria, the MetS prevalence was 24.3% in a population older than 40 years [13]. The prevalence of the MetS in populations younger than 30 years has been the subject of several publications [6], [7], [8], [14], [15], [16], [17]. Worldwide, this prevalence changes according to the study population and ranges from 2.9% [6] to 11.0% [7]. To our knowledge, no previous study looked at this prevalence in a Middle Eastern young population.

On the other hand, insulin resistance, which is not included in the ATP-III definition and which is commonly measured by the homeostatic model assessment (HOMA) index, predicts cardiovascular disease independently of the MetS [18].

The objective of this study is to assess the prevalence of the MetS according to the original and actualized ATP-III (ATP-IIIa) panel risk factors [4] in a representative sample of Lebanese students who are 18 to 30 years old. In addition, our study will define new cutoff values for the MetS parameters in our population and will look at the relation between MetS and HOMA index.

Section snippets

Participants

Participants were students recruited from the Saint Joseph University Medical Sciences Campus located in Beirut. This private university, the second biggest one in Lebanon, admits students from all parts of the country that has an overall population of 4 million inhabitants. To obtain a sample representative of the young Lebanese population based on probability, approximately 400 subjects were needed, taking into account an error of 2%. Students were recruited randomly using a computerized

Results

Three hundred eighty-one subjects were included in this cross-sectional study (201 men and 180 women). The population age ranges between 18 and 30 years, with a mean of 23.9. Baseline characteristics of the population (clinical and biological parameters) are shown in Table 1.

Discussion

Our results show that the prevalence of the MetS in a sample of the young Lebanese population is 5.25% using the ATP-III panel criteria. This prevalence is comparable with other published prevalences worldwide in the 18- to 30-year age range and using, similarly to our study, the ATP-III criteria. In the United States, in a 20- to 29-year-old population, this prevalence was 6.7% [14]. In European populations [7], [15], [16], [17], the prevalence ranges from 3% to 11%; it is the lowest in Italy

Acknowledgments

This work was fully supported by grants from the Conseil de la Recherche at Saint-Joseph University, Beirut, Lebanon, under the reference FM 122.

We are grateful to the members of the “Centre Universitaire de Santé Familiale et Communautaire” at Saint-Joseph University for their assistance.

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  • Cited by (0)

    This work was done at Saint-Joseph University, Beirut, Lebanon.

    1

    Rima Chedid and Marie-Hélène Gannagé-Yared are first coauthors in this article.

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