The new definition of metabolic syndrome by the international diabetes federation is less likely to identify metabolically abnormal but non-obese individuals than the definition by the revised national cholesterol education program: The Korea NHANES Study

Abstract

Objective: The new definitions for metabolic syndrome (MS) proposed by the IDF and revised NCEP have caused some confusion because patients have emerged that have satisfied the revised NCEP but not the IDF criteria. We performed this study to compare the prevalence of these criteria and to investigate the characteristics of discrepant cases. Research design and methods: A total of 7962 individuals aged X 20 years (3597 men; 4365 women) who participated in the 1998 Korean NHANES were included. We assessed the agreement between the revised NCEP and IDF criteria and investigated the characteristics of cases satisfying the revised NCEP criteria but not the IDF criteria. Results: The prevalence of MS by the revised NCEP (25.7% of men and 31.9% of women) was higher than that according to the IDF (14.2% of men and 26.6% of women). The IDF criteria failed to identify 44.9% of men and 16.6% of women identified as having MS according to the revised NCEP criteria. The discrepant group showed more adverse metabolic profiles and unfavorable lifestyles despite lower waist circumference as compared with those having MS by both the IDF and revised NCEP criteria. The prevalence of discrepant cases was higher among the elderly. Conclusions: The IDF criteria were inferior to the revised NCEP criteria in identifying the metabolically abnormal but nonobese groups known to be predisposed to type 2 diabetes and cardiovascular disease. Further research regarding the appropriateness of central obesity as an obligatory criterion proposed by the IDF seems to be warranted.

No existing definition of metabolic syndrome meets criteria as a syndrome

“…The IDF criteria did not identify 44.9% of men or 16.6% of women identified with the revised NCEP definition of metabolic syndrome in their data. 1 In our data, the IDF criteria also did not identify 40% of the men and 11% of the women identified with the revised NCEP definition of metabolic syndrome. 2 As for definitions of MS, Reaven 3 commented that the approach of WHO was the most rational effort, and the recent version of IDF was the most dangerous because approximately two-thirds of those in insulin-resistant tertile were either normal weight or overweight, and only about one-third of most insulinresistant persons were actually obese, and he subscribed a joint statement from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) 4 that the providers should avoid labeling patients with the term metabolic syndrome.…”

“…Yoon et al 1 reported that the revised National Cholesterol Education Program (NCEP) criteria seemed to be more appropriate for diagnosing metabolic syndrome (MS) given that the International Diabetes Federation (IDF) criteria could not identify high-risk patients who lacked central obesity but who nevertheless showed a clustering of metabolic risk factors. The IDF criteria did not identify 44.9% of men or 16.6% of women identified with the revised NCEP definition of metabolic syndrome in their data.…”

Prevalence and Determinants of Metabolic Syndrome According to Three Definitions in Middle-Aged Chinese Men

“…15 Reports on the prevalence of metabolic syndrome from other populations are sometimes in agreement with our results and sometimes not. Although the prevalence of metabolic syndrome in a Korean population was similar to ours (metabolic syndrome prevalence for men was 14.2% according to the IDF criteria and 25.7% according to ATP III-modified criteria), 16 in Taiwan the prevalence of metabolic syndrome defined by ATP III-modified criteria was much higher (35.32% for men aged 40-64 years and 43.23% for men aged 65 years and over). In Asian Indians metabolic syndrome prevalence was reported to be 23.2%, 25.8%, and 18.3% according to WHO, IDF, and ATP III criteria, respectively.…”

The impact of the metabolic syndrome and its components on the incidence of ischemic heart disease and stroke: the Japan public health center-based study

“…An earlier study among the Korean population showed that the IDF criteria failed to detect 44.9% of men and 16.6% of women with the metabolic syndrome identified by the revised NCEP/ATP criteria, because of the mis-identification of non-obese high-risk persons. 31 In our Japanese population, non-overweight persons with X2 risk factors constituted a large proportion of the population (24% in men and 19% in women). The PAFs for ischemic cardiovascular disease among non-overweight people with X2 risk factors were 20% in men and 14% in women, similar to or larger than those among overweight people with X2 risk factors.…”