Prevalence of metabolic syndrome and its influencing factors among the Chinese adults: The China Health and Nutrition Survey in 2009

doi:10.1016/j.ypmed.2013.09.023

Preventive Medicine

Volume 57, Issue 6, December 2013, Pages 867-871

https://doi.org/10.1016/j.ypmed.2013.09.023 Get rights and content

Highlights

•
MS is still highly prevalent among Chinese adults regardless the used criteria.
•
Individuals who were women, ≥ 40 years, obese, and living in urban area were more likely to have higher prevalence estimate of MS.
•
Frequency of alcohol consumption and cigarette intake were also found to be significantly associated with probability of MS.
•
National strategies should be developed to prevent, detect, treat and control MS in China.

Abstract

Objective

We aimed to estimate the up-to-date prevalence of metabolic syndrome (MS) and its influencing factors among the Chinese adults.

Methods

Data were obtained from the China Health and Nutrition Survey conducted in 2009, which was a cross-sectional and partially nationally representative study including a total of 7488 Chinese adults (age ≥ 18 years).

Results

The overall age-standardized prevalence estimates of the MS were 21.3% (95%confidence interval (CI): 20.4%–22.2%), 18.2% (95%CI: 17.3%–19.1%) and 10.5% (95%CI: 9.8%–11.2%) based on definitions of revised NCEP ATPIII, IDF and CDS criteria, respectively. Individuals who were women (compared to men: odds ratio [OR] = 1.37, 95% CI = 1.16–1.61), 40 years or older (compared to less than 40 years old: OR = 2.82, 95%CI = 2.37–3.34 for 40–59 years; OR = 4.41, 95%CI = 3.68–5.29 for 60 years or older), overweight/obese (compared to normal weight: OR = 4.32, 95%CI = 3.77–4.95 for overweight; OR = 11.24, 95%CI = 9.53–13.26 for obese), and living in urban area (compared to living in rural area: OR = 1.27, 95%CI = 1.12–1.43) were more likely to have a higher prevalence estimate of MS. In addition, frequency of alcohol consumption and cigarette intake were also found to be significantly associated with probability of MS.

Conclusions

Our results suggest an urgent need to develop national strategies for the prevention, detection, treatment and control of obesity and MS in China.

Introduction

Metabolic syndrome (MS) is becoming a major public health issue worldwide (Kassi et al., 2011). MS is characterized by a cluster of metabolic risk factors including central obesity, elevated blood pressure, dysglycemia, high triglyceride levels and low high-density lipoprotein cholesterol levels. Many evidences have suggested that MS is associated with increased risk of cardiovascular disease (CVD) (Scuteri et al., 2005), type 2 diabetes (T2D) (Wannamethee et al., 2005) and all cause-mortality (Ford, 2004). In the past few years, several expert groups have proposed several diagnostic criteria of MS including the World Health Organization criteria in 1998 (Alberti and Zimmet, 1998), the US 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) (2002), and the International Diabetes Federation (IDF) criteria in 2005 (Alberti et al., 2006), as well as the AHA/NHLBI statement in 2005 (Grundy et al., 2005) and the joint interim statement (JIS) in 2009 (Alberti et al., 2009). These criteria generally share the similar components although they vary somewhat in some specific elements. For example, the components of the revised NCEP ATPIII and IDF criteria are the same but IDF requires central obesity as one obligatory component. The CDS used body mass index (BMI) rather than waist circumference (WC) as one index to define obesity and the cut-offs for other components are different from those in the revised NCEP ATPIII and IDF criteria except for the cut-off of triglycerides.

China is currently experiencing rapid economic, social and cultural changes, including accelerated pace of nutrition transition and markable changes in people's lifestyles that may contribute to greatly increased burden of chronic diseases. MS, as a cluster of cardio-metabolic risk factors, is related to chronic diseases. Understanding the MS prevalence in the national level is important to develop the effective programs and strategies to prevent and control MS. However, little is known about the recent prevalence of MS in China.

In this study, data from the China Health and Nutrition Surveys (CHNS) in 2009 (Popkin et al., 2010), a partially nationally representative cross-sectional health and nutrition survey in China, were used to describe the recent prevalence of MS by three definitions (revised NCEP ATPIII, IDF and Chinese Diabetes Society (CDS) criteria), and to examine MS related influencing factors.

Section snippets

Study design and subjects

The CHNS is a large-scale, partially nationally representative, and successive cross-sectional survey that was designed to explore how the health and nutritional status of the Chinese population has been affected by its social and economic changes. A multistage, random cluster process was used to draw study sample from nine provinces (Liaoning, Heilongjiang, Jiangsu, Shandong, Henan, Hubei, Hunan, Guangxi and Guizhou). The recruitment strategies of the participants have been described elsewhere

Characteristics of the study population

Table 2 shows the characteristics of the total study population (n = 7488) by sex. There was no significant difference in mean age and BMI, and distribution of general obesity, and low HDL-C using CDS criteria between two sex groups (All p > 0.05). However, significant difference was found for mean WC, SBP, DBP, TG, HDL-C and fasting plasma glucose, and distribution of central obesity, high BP, high TG and low HDL-C using NCEP ATPIII criteria (All p < 0.001, which were still statistically significant

Discussion

The present study provided the updated information on the prevalence of MS and its related influencing factors among Chinese adults based on the most recent, partially nationally representative data from the CHNS. The age-standardized prevalence of MS was very high, with 21.3%, 18.2% and 10.5% based on definitions of revised NCEP ATPIII, IDF and CDS criteria, respectively. High BP was the most frequent component in men and high WC was the most frequent component in women. MS was associated with

Contributions

Study concept and design: BX. Acquisition of data: DH and YH. Analysis and interpretation of data: BX and DZ. Drafting of the manuscript: BX. Critical revision of the manuscript for important intellectual content: BX, DH, YH, and DZ.

Acknowledgment

This study was supported by the NIH (R01-HD30880, DK056350 and R01-HD38700). We thank the National Institute of Nutrition and Food Safety, China Center for Disease Control and Prevention, Carolina Population Center, the University of North Carolina at Chapel Hill and the Fogarty International Center for the financial support for CHNS data collection and analysis files in 2009.

References (26)

D. Gu et al.
Prevalence of the metabolic syndrome and overweight among adults in China
Lancet
(2005)
B. Xi et al.
Trends in prevalence, awareness, treatment, and control of hypertension among Chinese adults 1991–2009
Int. J. Cardiol.
(2012)
W. Yang et al.
A comparison of two proposed definitions for metabolic syndrome in the Chinese adult population
Am. J. Med. Sci.
(2007)
K.G. Alberti et al.
Definition, diagnosis and classification of diabetes mellitus and its complications, part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation
Diabet. Med.
(1998)
K.G. Alberti et al.
Metabolic syndrome: a new world-wide definition. A consensus statement from the International Diabetes Federation
Diabet. Med.
(2006)
K.G. Alberti et al.
A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity
Circulation
(2009)
H. Cai et al.
Prevalence and determinants of metabolic syndrome among women in Chinese rural areas
PLoS One
(2012)
A.V. Chobanian et al.
The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report
JAMA
(2003)
P. Deurenberg et al.
Asians are different from Caucasians and from each other in their body mass index/body fat per cent relationship
Obes. Rev.
(2002)
W.H.O. Expert Consultation
Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies
Lancet
(2004)

E. Ford

The metabolic syndrome and mortality from cardiovascular disease and all-causes: findings from the National Health and Nutrition Examination Survey II mortality study

Atherosclerosis

(2004)

M.S. Freiberg et al.

Alcohol consumption and the prevalence of the metabolic syndrome in the US: a cross-sectional analysis of data from the Third National Health and Nutrition Examination Survey

Diabetes Care

(2004)

Further study of risk factors for stroke and coronary heart disease group

The prevalence of metabolic syndrome in a 11-provinces cohort in China

Chin. Pre. Med. J.

(2002)

Cited by (213)

Prevalence and secular trends in premetabolic syndrome in the United States: Findings from 1999-2020 nationally representative data of adults
2024, Annals of Epidemiology
Although Premetabolic syndrome (PeMetSyn) is a precursor for metabolic syndrome (MetSyn), its prevalence and trends are unknown. This study examined the prevalence and trends in PreMetSyn and its association with sociodemographic risk factors in American adults.
The 1999–2000 to 2017–2020 United States National Health and Nutritional Health Surveys (NHANES) data were used. PreMetSyn was defined as co-occurrence two cardiometabolic risk factors consisting of abdominal obesity, elevated triglycerides, reduced HDL-C, elevated blood pressure, and fasting plasma glucose. We calculated sex-specific overall prevalence of PreMetSyn and by race/ethnicity, age, education, poverty, and body mass index (BMI) categories. Sex-specific logistic regression models were used to test the association between sociodemographic risk factors and PreMetSyn.
From 1999 − 2000 to 2017–2020, the age-adjusted overall prevalence of PreMetSyn increased by 155.4% (from 9.2% to 23.5%) in men and by 131.3% (from 11.2% to 25.9%) in women. Increases in prevalence of PreMetSyn were observed by race/ethnicity, age, education, poverty and BMI levels in men and women from 1999–2000 to 2017–2020. Survey cycle, race/ethnicity, age, education, poverty-income ratio, and BMI were independently associated with greater odds of PreMetSyn in males and females. During this period, the co-occurrence of abdominal obesity and elevated blood pressure was the most common comorbidity and increased from 20.6% to 30.8% in men and from 27.8% to 36.1% in women.
This nationally representative study indicates a rapid increase from 1999–2000 to 2017–2020 in the proportion of American adults who meet the criteria for PreMetSyn. Early identification of subjects with PreMetSyn in the U.S. is a public health priority for initiating effective strategies to prevent the development of MetSyn and its associated chronic diseases.
Effects of short-term exposure to gaseous pollutants on metabolic health indicators of patients with metabolic syndrome in Northwest China
2023, Ecotoxicology and Environmental Safety
Currently few studies have explored the relationship between exposure to gaseous pollutants and metabolic health indicators in patients, especially in patients with metabolic syndrome (Mets). This study collected 15,520 patients with Mets in a prospective cohort of nearly 50,000 people with 7 years of follow-up from 2011 to 2017, and matched air pollutants and meteorological data during the same period. The mixed effects model was used to analyze the relationship between different short exposure windows (1-week, 1-month, 2-month, and 3-month) of gaseous pollutants (SO₂, NO_2, and O₃) and the metabolic health indicators of patients after controlled the confounding factors. Stratified analysis was performed by demographic characteristics and behavioral factors. The effects of gaseous pollutants on patients with different Met components were also analyzed. The results showed that the short-term exposure to SO₂, NO_2, and O₃ had a certain effect on the metabolic health indicators of patients with Mets in different exposure windows, and with the extension of the exposure window period, the effects increased. The stratified analysis showed that gender, age, and life behaviors might modify these detrimental effects. In addition, the effects of gaseous pollutants on metabolic health indicators in G4 and G7 were more obvious than other Met components, and the effects of gaseous pollutants on the level of LDL-C were found to be statistically significant in most components. Therefore, patients with Mets should pay more attention to the influence of gaseous pollutants to take appropriate protection to reduce potential health risk.
Maternal micronutrient disturbance as risks of offspring metabolic syndrome
2023, Journal of Trace Elements in Medicine and Biology
Metabolic syndrome (MetS) is defined as a constellation of individual metabolic disturbances, including central obesity, hypertension, dyslipidemia, and insulin resistance. The established pathogenesis of MetS varies extensively with gender, age, ethnic background, and nutritional status. In terms of nutritional status, micronutrients are more likely to be discounted as essential components of required nutrition than macronutrients due to the small amount required. Numerous observational studies have shown that pregnant women frequently experience malnutrition, especially in developing and low-income countries, resulting in chronic MetS in the offspring due to the urgent and increasing demands for micronutrients during gestation and lactation. Over the past few decades, scientific developments have revolutionized our understanding of the association between balanced maternal micronutrients and MetS in the offspring. Examples of successful individual, dual, or multiple maternal micronutrient interventions on the offspring include iron for hypertension, selenium for type 2 diabetes, and a combination of folate and vitamin D for adiposity. In this review, we aim to elucidate the effects of maternal micronutrient intake on offspring metabolic homeostasis and discuss potential perspectives and challenges in the field of maternal micronutrient interventions.
Predictive modeling the probability of suffering from metabolic syndrome using machine learning: A population-based study
2022, Heliyon
Citation Excerpt :
Nevertheless, our study shows that premenopausal women also have higher risk of suffering from MetS than men, which suggests that hormonal changes in the menopause may not be the only key risk factor in the sex-specific differences in the prevalence of MetS. Differences in regional and ethnic variations, socio-economic, cultural behaviors, education levels, dietary habits disparities and physical activity levels are likely to influence this gender differences in MetS prevalence [4, 62, 63, 67]. It is reported in NHANES that a greater relative increase in the prevalence of MetS have was observed in women compared to men (22.8 vs. 11.2%) in the USA [67].
There is an increasing trend of Metabolic syndrome (MetS) prevalence, which has been considered as an important contributor for cardiovascular disease (CVD), cancers and diabetes. However, there is often a long asymptomatic phase of MetS, resulting in not diagnosed and intervened so timely as needed. It would be very helpful to explore tools to predict the probability of suffering from MetS in daily life or routinely clinical practice.
To develop models that predict individuals’ probability of suffering from MetS timely with high efficacy in general population.
The present study enrolled 8964 individuals aged 40–75 years without severe diseases, which was a part of the REACTION study from October 2011 to February 2012. We developed three prediction models for different scenarios in hospital (Model 1, 2) or at home (Model 3) based on LightGBM (LGBM) technique and corresponding logistic regression (LR) models were also constructed for comparison. Model 1 included variables of laboratory tests, lifestyles and anthropometric measurements while model 2 was built with components of MetS excluded based on model 1, and model 3 was constructed with blood biochemical indexes removed based on model 2. Additionally, we also investigated the strength of association between the predictive factors and MetS, as well as that between the predictors and each component of MetS.
In this study, 2714 (30.3%) participants suffer from MetS accordingly. The performances of the LGBM models in predicting the probability of suffering from MetS produced good results and were presented as follows: model 1 had an area under the curve (AUC) value of 0.993 while model 2 indicated an AUC value of 0.885. Model 3 had an AUC value of 0.859, which is close to that of model 2. The AUC values of LR model 1 and 2 for the scenario in hospital and model 3 at home were 0.938, 0.839 and 0.820 respectively, which seemed lower than that of their corresponding machine learning models, respectively. In both LGBM and logistic models, gender, height and resting pulse rate (RPR) were predictors for MetS. Women had higher risk of MetS than men (OR 8.84, CI: 6.70–11.66), and each 1-cm increase in height indicated 3.8% higher risk of suffering from MetS in people over 58 years, whereas each 1- Beat Per Minute (bpm) increase in RPR showed 1.0% higher risk in individuals younger than 62 years.
The present study showed that the prediction models developed by machine learning demonstrated effective in evaluating the probability of suffering from MetS, and presented prominent predicting efficacies and accuracies. Additionally, we found that women showed a higher risk of MetS than men, and height in individuals over 58 years was important factor in predicting the probability of suffering from MetS while RPR was of vital importance in people aged 40–62 years.
Relations of residents’ knowledge, satisfaction, perceived importance and participation in emergency management: A case study in modern and old urban communities of Ningbo, China
2022, International Journal of Disaster Risk Reduction
The community is the first scene of emergency events, and community residents are the primary responders. Participation of residents is highly important to the emergency management of urban communities, and it can be influenced by residents' attitudes towards both emergency management and the community. In this paper, the emergency management of urban communities is studied by statistical analysis within typical modern and old urban communities in Ningbo, China. Questionnaires were issued to collect residents' demographic characteristics, familiarity with emergency knowledge, perceived importance of emergency management, satisfaction with community management, and participation in emergency activities held by the community. Both descriptive and inferential statistics were used to analyze the data and explore the relations among variables. Finally, a series of path clusters involving 11 paths were proposed to explain the relations of residents’ demographics, knowledge, perceived importance, satisfaction, and their participation in emergency management in urban communities. Based on the primary data analysis and path clusters, some policy implications are provided to promote the emergency management participation of residents in urban communities.
The Association between Uric Acid and Metabolic Syndrome in a Middle-Aged and Elderly Taiwanese Population: A Community-Based Cross-Sectional Study
2024, Healthcare (Switzerland)

View all citing articles on Scopus

View full text

Prevalence of metabolic syndrome and its influencing factors among the Chinese adults: The China Health and Nutrition Survey in 2009

Highlights

Abstract

Objective

Methods

Results

Conclusions

Introduction

Section snippets

Study design and subjects

Characteristics of the study population

Discussion

Contributions

Acknowledgment

Lancet

Int. J. Cardiol.

Am. J. Med. Sci.

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

Diabet. Med.

Metabolic syndrome: a new world-wide definition. A consensus statement from the International Diabetes Federation

Diabet. Med.

A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity

Circulation

Prevalence and determinants of metabolic syndrome among women in Chinese rural areas

PLoS One

The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report

JAMA

Asians are different from Caucasians and from each other in their body mass index/body fat per cent relationship

Obes. Rev.

Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies