An Evaluation of Candidate Definitions of the Metabolic Syndrome in Adult Asian Indians

Abstract

OBJECTIVES -We aimed to evaluate eight candidate definitions of the metabolic syndrome (MS) against the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) definition as the reference for optimally defining MS in adult Asian Indians. RESEARCH DESIGN AND METHODS -We used clinical and biochemical data from our previous cross-sectional epidemiological studies. Candidate definitions of MS were proposed by modifying the NCEP ATPIII definition. These modifications included the following: waist circumference cutoffs as Ͼ90 cm in men and Ͼ80 cm in women, BMI cutoff as Ͼ23 kg/m 2 , and a measure of truncal subcutaneous fat (subscapular skinfold thickness [SST] Ͼ18 mm).RESULTS -The highest prevalence (29.9%) of MS was observed by the inclusion of modified cutoffs of waist circumference and BMI and SST in place of the existing cutoffs of waist circumference in the NCEP ATPIII criteria. Further, this modified definition showed the maximum absolute gain in the percentage of prevalence of MS over the NCEP ATPIII definition, and it was the best predictor for MS in subjects with impaired fasting glucose, type 2 diabetes, and different age-groups. The lowest percentage of prevalence of MS was observed with the definition that excluded biochemical variables and blood pressure. R esistance to insulin-mediated glucose uptake is important for the development of the metabolic syndrome (MS) and subsequently type 2 diabetes. Clustering of clinical and metabolic risk factors, known as "metabolic syndrome," is defined by criteria laid down by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) (1). High predisposition to the development of type 2 diabetes in certain ethnic groups, such as Asian Indians, necessitates early identification of MS for the purpose of prevention (2). CONCLUSIONS -The criteria for defining MS in adult AsianDoubts have been expressed as to whether the NCEP ATPIII definition is appropriate for identifying MS in Asians. Anthropometric parameters of Asians are different than those for white Caucasians and blacks. For example, Asian Indians have smaller body size, excess body fat, and truncal and abdominal adiposity but lower average waist circumference than white Caucasians (2). The cutoffs of waist circumference to define abdominal obesity by the NCEP ATPIII definition underestimate abdominal obesity in adult Asians (3).Further, application of NCEP ATPIII criteria requires the analysis of fasting blood samples for blood glucose, serum triglycerides, and HDL cholesterol levels. The results of these metabolic variables are usually not available on the first clinic visit; and more importantly, the cost of these tests may be prohibitive for economically challenged individuals. Innovative definitions of MS comprised of easy-to-measure relevant anthropometric measures thus need to be evaluated in individuals residing in developing countries.In the present study, we devised eight candidate definitions of MS by including modified waist circumference and modified BMI...

The prevalence of metabolic syndrome among low-income South Asian Americans

“…Moreover, most existing studies of SA have focused on Indians (8,14,17,18,(30)(31)(32) , neglecting other groups of SA. The present work represents one of only a few studies to examine MetS prevalence (and the prevalence of abnormal indicators) in the USA in a large sample of SA Americans of different ethnicities and use the newer suggested cut-offs.…”

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