Geographic Variations of the International Diabetes Federation and the National Cholesterol Education Program–Adult Treatment Panel III Definitions of the Metabolic Syndrome in Nondiabetic Subjects

Abstract

OBJECTIVE -We have carried out international comparisons of the metabolic syndrome using the International Diabetes Federation (IDF) and National Cholesterol Education ProgramAdult Treatment Panel III (ATP III) definitions. This analysis could help to discern the applicability of these definitions across populations.RESEARCH DESIGN AND METHODS -Nondiabetic subjects aged 35-64 years were eligible for analysis in population-based studies from San Antonio (Mexican Americans and non-Hispanic whites, n ϭ 2,473), Mexico City (n ϭ 1,990), Spain (n ϭ 2,540), and Peru (n ϭ 346). Statistics examined the agreement between metabolic syndrome definitions.RESULTS -Because of the lower cutoff points for elevated waist circumference, the IDF definition of the metabolic syndrome generated greater prevalence estimates than the ATP III definition. Prevalence difference between definitions was more significant in Mexican-origin and Peruvian men than in Europid men from San Antonio and Spain because the IDF definition required ethnic group-specific cutoff points for elevated waist circumference. ATP III and IDF definitions disagreed in the classification of 13-29% of men and 3-7% of women. In men, agreement between these definitions was 0.54 in Peru, 0.43 in Mexico City, 0.62 in San Antonio Mexican Americans, 0.69 in San Antonio non-Hispanic whites, and 0.64 in Spain. In women, agreement between definitions was 0.87, 0.89, 0.86, 0.87, and 0.93, respectively. CONCLUSIONS -The IDF definition of the metabolic syndrome generates greater prevalence estimates than the ATP III definition. Agreement between ATP III and IDF definitions was lower for men than for women in all populations and was relatively poor in men from Mexico City. Diabetes Care 29:685-691, 2006C ardiovascular diseases accounted for 29.3% (16.7 of 57 million) of the world's deaths in 2002, and more than one-third of these deaths occured in middle-aged adults (1). Many cardiovascular risk factors are related to the adoption of a sedentary lifestyle (2). The metabolic syndrome is characterized by a clustering of central obesity, insulin resistance, glucose intolerance, hypertension, atherogenic dyslipidemia, hypercoagulability, and proinflammatory state (2). The etiology of the metabolic syndrome is unknown, but predisposing factors include aging, obesity, sedentary lifestyle, and genetics. This syndrome predicts cardiovascular disease and type 2 diabetes (3). However, concept and definition of the metabolic syndrome are subject to debate (4,5), including the applicability of a single definition to people of different ethnic origin (6).The analysis of geographic variations of the metabolic syndrome could generate new insights since similar analyses on cardiovascular risk factors have improved our knowledge of cardiovascular disease (7). Studies on geographic variations of the metabolic syndrome are few (8 -10). They are often difficult because of differences in aims, survey protocols, assessment period, and definition of the metabolic syndrome.We examined two definitions of...

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