Prevalence of Premorbid Metabolic Syndrome in Spanish Adult Workers Using IDF and ATPIII Diagnostic Criteria: Relationship with Cardiovascular Risk Factors

Background Metabolic Syndrome (MetS) is a complex disorder defined as a cluster of interconnected risk factors such as hypertension, dyslipidemia, obesity and high blood glucose levels. Premorbid metabolic syndrome (PMetS) is defined by excluding patients with previously diagnosed cardiovascular disease or diabetes mellitus from those suffering MetS. We aimed to determine the prevalence of PMetS in a working population, and to analyse the relationship between the diagnostic criteria of the International Diabetes Federation (IDF) and of the National Cholesterol Education Program Adult Treatment Panel III (ATPIII). The relationship between the presence of PMetS and cardiovascular risk factors was also analysed. Research Methodology/Findings A cross-sectional study was conducted in 24,529 male and 18,736 female Spanish (white western European) adult workers (20–65 years) randomly selected during their work health periodic examinations. Anthropometrics, blood pressure and serum parameters were measured. The presence of MetS and PMetS was ascertained using ATPIII and IDF criteria. Cardiovascular risk was determined using the Framingham-REGICOR equation. The results showed MetS had an adjusted global prevalence of 12.39% using ATPIII criteria and 16.46% using IDF criteria. The prevalence of PMetS was slightly lower (11.21% using ATPIII criteria and 14.72% using IDF criteria). Prevalence in males was always higher than in females. Participants with PMetS displayed higher values of BMI, waist circumference, blood pressure, glucose and triglycerides, and lower HDL-cholesterol levels. Logistic regression models reported lower PMetS risk for females, non-obese subjects, non-smokers and younger participants. Cardiovascular risk determined with Framingham-REGICOR was higher in participants with PMetS. Conclusions PMetS could be a reliable tool for the early identification of apparently healthy individuals who have a significant risk for developing cardiovascular events and type 2 diabetes.

[1]  Lawrence A Leiter,et al.  Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines , 2006, Current opinion in cardiology.

[2]  A. Karaman,et al.  Prevalence of metabolic syndrome in the Mediterranean region of Turkey: evaluation of hypertension, diabetes mellitus, obesity, and dyslipidemia. , 2009, Metabolic syndrome and related disorders.

[3]  Who Consultation on Obesity.  Obesity: preventing and managing the global epidemic. Report of a WHO consultation. , 2000, World Health Organization technical report series.

[4]  Victor M Montori,et al.  Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies. , 2007, Journal of the American College of Cardiology.

[5]  S. Ebrahim,et al.  Gender, socio-economic status and metabolic syndrome in middle-aged and old adults , 2008, BMC public health.

[6]  G. Reaven.  The metabolic syndrome: requiescat in pace. , 2005, Clinical chemistry.

[7]  Q. Qiao,et al.  Comparison of different definitions of the metabolic syndrome in relation to cardiovascular mortality in European men and women , 2006, Diabetologia.

[8]  J. Banegas,et al.  Occupation-Related Differences in the Prevalence of Metabolic Syndrome , 2008, Diabetes Care.

[9]  M. T. Martínez-Larrad,et al.  Prevalencia del síndrome metabólico (criterios del ATP-III). Estudio de base poblacional en áreas rural y urbana de la provincia de Segovia , 2005 .

[10]  P. Zimmet,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 , 1998, Diabetic medicine : a journal of the British Diabetic Association.

[11]  B. Balkau,et al.  Comment on the provisional report from the WHO consultation , 1999, Diabetic medicine : a journal of the British Diabetic Association.

[12]  A. Mykletun,et al.  Age-specific prevalence of the metabolic syndrome defined by the International Diabetes Federation and the National Cholesterol Education Program: the Norwegian HUNT 2 study , 2007, BMC public health.

[13]  A. Biggeri,et al.  Metabolic syndrome as a predictor of all-cause and cardiovascular mortality in type 2 diabetes: the Casale Monferrato Study. , 2004, Diabetes care.

[14]  N. Unwin,et al.  Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Detection, Evaluation, and Treatment of High Blood Cholesterol Education Program (NCEP) Expert Panel on Executive Summary of the Third Report of the National , 2009 .

[15]  S. Wild,et al.  Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. , 2004, Diabetes care.

[16]  J. Mckenney,et al.  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). , 2001, JAMA.

[17]  J. Victor Marcos,et al.  Metabolic syndrome: prevalence, associated factors, and C-reactive protein: the MADRIC (MADrid RIesgo Cardiovascular) Study. , 2008, Metabolism: clinical and experimental.

[18]  P. Clark,et al.  Metabolic Syndrome in African Americans: Views on Making Lifestyle Changes , 2010, Journal of transcultural nursing : official journal of the Transcultural Nursing Society.

[19]  Anne W. Taylor,et al.  Area-level socioeconomic characteristics and incidence of metabolic syndrome: a prospective cohort study , 2013, BMC Public Health.

[20]  H. Minuk,et al.  Metabolic syndrome. , 2005, Journal of insurance medicine.

[21]  Euni Lee,et al.  Association between Lifestyle Factors and Metabolic Syndrome among African Americans in the United States , 2013, Journal of nutrition and metabolism.

[22]  Leila C. Kahwati,et al.  The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity: a systematic review. , 2009, American journal of preventive medicine.

[23]  E. A. M. Gale,et al.  The metabolic syndrome: useful concept or clinical tool? Report of a WHO Expert Consultation , 2010, Diabetologia.

[24]  J. Marrugat,et al.  Estimación del riesgo coronario en España mediante la ecuación de Framingham calibrada , 2003 .

[25]  A. González-Quintela,et al.  [Prevalence of cardiovascular risk factors in the Spanish working population]. , 2006, Revista espanola de cardiologia.

[26]  L. Heinen,et al.  Addressing obesity in the workplace: the role of employers. , 2009, The Milbank quarterly.

[27]  Neil J Stone,et al.  Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines , 2004, Circulation.

[28]  A. Astrup,et al.  Obesity : Preventing and managing the global epidemic , 2000 .

[29]  A. J. van der Beek,et al.  Lifestyle-focused interventions at the workplace to reduce the risk of cardiovascular disease--a systematic review. , 2010, Scandinavian journal of work, environment & health.

[30]  K. Khunti,et al.  Is having a family history of type 2 diabetes or cardiovascular disease a predictive factor for metabolic syndrome? , 2009, Primary care diabetes.

[31]  Elizabeth Goodman,et al.  Prevalence of the Metabolic Syndrome Among U.S. Workers , 2010, Diabetes Care.

[32]  V. Mohan,et al.  Intimal media thickness, glucose intolerance and metabolic syndrome in Asian Indians—the Chennai Urban Rural Epidemiology Study (CURES −22) , 2006, Diabetic medicine : a journal of the British Diabetic Association.

[33]  Jennifer Childress,et al.  Results of the 2004 National Worksite Health Promotion Survey. , 2008, American journal of public health.

[34]  A. Alkerwi,et al.  Prevalence of the metabolic syndrome in Luxembourg according to the Joint Interim Statement definition estimated from the ORISCAV-LUX study , 2011, BMC public health.

[35]  Robert Henning,et al.  A Conceptual Framework for Integrating Workplace Health Promotion and Occupational Ergonomics Programs , 2009, Public health reports.

[36]  M. A. Sánchez-Chaparro,et al.  Prevalencia de factores de riesgo vascular en la población laboral española , 2006 .

[37]  R. Krauss,et al.  Diagnosis and management of the metabolic syndrome , 2005 .

[38]  S. Grundy,et al.  Harmonizing the metabolic syndrome: 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 As , 2009, Circulation.

[39]  F. J. Félix-Redondo,et al.  [Prevalence of metabolic syndrome estimated with the new World Health Organization recommendations. The HERMEX study]. , 2011, Gaceta sanitaria.

[40]  J. Mckenney,et al.  Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II) , 1993, JAMA.

[41]  J. Shaw,et al.  The metabolic syndrome: prevalence in worldwide populations. , 2004, Endocrinology and metabolism clinics of North America.

[42]  Pedro Tauler,et al.  Body Adiposity Index and Cardiovascular Health Risk Factors in Caucasians: A Comparison with the Body Mass Index and Others , 2013, PloS one.

[43]  H. Okumura,et al.  Effect of a worksite-based intervention program on metabolic parameters in middle-aged male white-collar workers: a randomized controlled trial. , 2010, Preventive medicine.

[44]  Y. Ko,et al.  Prevalence and risk factors of metabolic syndrome in the Korean population--Korean National Health Insurance Corporation Survey 2008. , 2013, Journal of advanced nursing.

[45]  Ilse de Bourdeaudhuij,et al.  Effectiveness of workplace interventions in Europe promoting healthy eating: a systematic review. , 2012, European journal of public health.

[46]  Fernando Costa,et al.  Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. , 2006, Current opinion in cardiology.

[47]  Toshiro Tango,et al.  Effects of lifestyle modification on metabolic syndrome: a systematic review and meta-analysis , 2012, BMC Medicine.

[48]  R. Weinstock,et al.  Diabetes prevention and control in the workplace: a pilot project for county employees. , 2011, Journal of public health management and practice : JPHMP.

[49]  C. Lamendola,et al.  Relationship to insulin resistance of the adult treatment panel III diagnostic criteria for identification of the metabolic syndrome. , 2004, Diabetes.

[50]  W. Mechelen,et al.  Meta-analysis of workplace physical activity and dietary behavior interventions on weight outcomes , 2010 .

[51]  P. Macfarlane,et al.  Can metabolic syndrome usefully predict cardiovascular disease and diabetes? Outcome data from two prospective studies , 2008, The Lancet.

[52]  Andreas Holtermann,et al.  Occupational physical activity, metabolic syndrome and risk of death from all causes and cardiovascular disease in the HUNT 2 cohort study , 2012, Occupational and Environmental Medicine.

[53]  Ali H Mokdad,et al.  Increasing prevalence of the metabolic syndrome among u.s. Adults. , 2004, Diabetes care.

[54]  M. Marfell-Jones,et al.  International standards for anthropometric assessment. , 2012 .

[55]  L J Gray,et al.  Effectiveness of interventions for reducing diabetes and cardiovascular disease risk in people with metabolic syndrome: systematic review and mixed treatment comparison meta‐analysis , 2012, Diabetes, obesity & metabolism.

[56]  Maria Inês Schmidt,et al.  The metabolic syndrome and 11-year risk of incident cardiovascular disease in the atherosclerosis risk in communities study. , 2005, Diabetes care.

[57]  R. Elosua,et al.  Metabolic syndrome in Spain: prevalence and coronary risk associated with harmonized definition and WHO proposal. DARIOS study. , 2012, Revista espanola de cardiologia.

[58]  M. Martínez-Larrad,et al.  [Prevalence of the metabolic syndrome (ATP-III criteria). Population-based study of rural and urban areas in the Spanish province of Segovia]. , 2005, Medicina clinica.

[59]  Y. Friedlander,et al.  Is prediction of cardiovascular disease and all-cause mortality genuinely driven by the metabolic syndrome, and independently from its component variables? The Dubbo study. , 2011, Heart, lung & circulation.

[60]  R. Elosua,et al.  Metabolic Syndrome in Spain: Prevalence and Coronary Risk Associated With Harmonized Definition and WHO Proposal. DARIOS Study , 2012 .

[61]  R. D'Agostino,et al.  [Coronary risk estimation in Spain using a calibrated Framingham function]. , 2003, Revista espanola de cardiologia.

[62]  A. Domingo-Salvany,et al.  [Proposal for a social class measure. Working Group of the Spanish Society of Epidemiology and the Spanish Society of Family and Community Medicine]. , 2000, Atencion primaria.

[63]  S. Sawada,et al.  Waist circumference and metabolic syndrome: the risk for silent coronary artery disease in males. , 2012, Metabolic syndrome and related disorders.

[64]  Lawrence Joseph,et al.  The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis. , 2010, Journal of the American College of Cardiology.

[65]  Jeffrey R. Harris,et al.  Workers’ Health Risk Behaviors by State, Demographic Characteristics, and Health Insurance Status , 2010, Preventing chronic disease.

[66]  D. Fernández-Bergés,et al.  Cardiovascular Risk Factors in Spain in the First Decade of the 21 st Century , a Pooled Analysis With Individual Data From 11 Population-Based Studies : the DARIOS Study , 2011 .

[67]  Gregory Kaltsas,et al.  Metabolic syndrome: definitions and controversies , 2011, BMC medicine.

[68]  E. Alegrı́a,et al.  [Prevalence of metabolic syndrome in the Spanish working population: MESYAS registry]. , 2005, Revista espanola de cardiologia.

[69]  E. Alegrı́a,et al.  Prevalencia del síndrome metabólico en población laboral española: registro MESYAS , 2005 .

[70]  K. Khunti,et al.  Screening for the metabolic syndrome using simple anthropometric measurements in south Asian and white Europeans: a population-based screening study. The Leicester Ethnic Atherosclerosis and Diabetes Risk (LEADER) Study. , 2010, Primary care diabetes.

[71]  Fernando Costa,et al.  Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. , 2005, Circulation.