Prevalence of metabolic syndrome among younger population by modified NCEP ATP III and IDF criteria

 

B Poonguzhali^1*, N Dheebalakshmi²

 

 

Abstract               Background: Prevalence of metabolic syndrome in various countries in South Asia is increasing, due to rapid nutritional and lifestyle transition in urbanized areas. Different guidelines issued by NCEP-ATP III and IDF have been proposed to identify metabolic syndrome in clinical practice. For effective prevention of CVD and Type 2 diabetes mellitus, components of the MS and obesity recognized early in the lifetime is important. Aim: To assess the prevalence of metabolic syndrome among younger population by modified NCEP-ATP III and IDF criteria. Material and Methods: 136 individuals, aged 24-39 years, were recruited to the study. Anthropometric and blood pressure measurements and laboratory investigations were carried out following standard protocols. Metabolic syndrome was diagnosed according to the NCEP-ATP III and IDF criteria. Results: The prevalence of metabolic syndrome in younger population by Modified NCEP ATP III criteria was 47.1% and IDF criteria was 44.9%. Maximum number of individuals 103 (75.7%) had affected by obesity (increased waist circumference) followed by 64 (47.1%) had abnormal triglyceride levels. Conclusion: Early identification of metabolic abnormalities and appropriate intervention may be of primary importance in this population. Health education and awareness among the younger age group is required to prevent major non- communicable health disorders.

Key Words: Younger population, metabolic syndrome, prevalence, Modified NCEP ATP III criteria, IDF Criteria.

 

 

 

INTRODUCTION

A combination of decreasing demands and increased intake of food and physical inactivity has led to increasing prevalence of obesity, hyper glycaemia/diabetes, hypertension and dyslipidemia. A combination of all the above features is called metabolic syndrome (MetS).¹ Prevalence of metabolic syndrome in various countries in South Asia is increasing, due to rapid nutritional and lifestyle transition in urbanized areas.² Metabolic syndrome is attracting more commercial interest, due to components of the MetS enhances the chance for cardiovascular disease and also the total morbidity and mortality in our population.³ Different guidelines issued by World Health Organization (WHO), National Cholesterol Education Program – Adult Treatment Panel III (NCEP-ATP III) and International Diabetes Federation (IDF) have been proposed to identify metabolic syndrome in clinical practice.⁴ Asian Indians considered to be a “high risk population” for both metabolic syndrome and CVD.⁵ In India, prevalence of metabolic syndrome is varying between 10% to 50% depending on age and sex.⁶ Persons affected with metabolic syndrome have a 30-40% chance of developing diabetes and CVD within 20 years, it depends on number of individual components present.³ Primordial prevention is the best one to protect the adult CVD epidemic.⁷ For effective prevention of CVD and Type 2 diabetes mellitus, components of the MetS and obesity recognized early in the lifetime is important.⁷ Thus, the present study was conducted to assess the prevalence of metabolic syndrome among younger population by modified NCEP-ATP III and IDF criteria.

 

MATERIAL AND METHODS

Study Population: Patients and bystanders who attended the medicine OPD of our college for routine medical check-up formed the subjects for the present cross-sectional study. The total of 136 subjects that came to the hospital during a study period was enrolled into the study. Ethical approval was obtained from Institutional Ethical Committee.

Inclusion Criteria

• Patients and bystanders attending medicine outpatient department
• Age between 24-39 years.
• Both sexes

Exclusion Criteria

• Subjects with congenital diseases
• Severely ill patients.
• Pregnant women
• Not willing to participate.

Definition: Metabolic syndrome was diagnosed according to the modified NCEP-ATP III and IDF criteria. The modified NCEP criteria⁸ require at least three of the following components: (1) abdominal obesity (waist circumference ≥90 cm for Asian men or ≥80 cm for Asian women), (2) triglycerides ≥150 mg/dL, (3) HDL cholesterol ≤40 mg/dL for men or 50 mg/dL for women, (4) systolic/diastolic blood pressure ≥130/85 mmHg or receiving drug treatment, and (5) fasting plasma glucose ≥100 mg/dL. For NCEP criteria abdominal obesity is a component of the syndrome but not a prerequisite for diagnosis. The IDF criteria of MetS⁹ uses central obesity (waist circumference ≥90 cm for South Asian men or ≥80 cm for South Asian women) as a mandatory criterion and the presence of at least two of the other four criteria which are identical to those provided by NCEP ATP III.

Method of collection of data: Informed consent was taken from the all subjects. A pre-structured and pretested proforma was used to collect the data. Baseline data including age, gender, religion, detailed medical history, clinical examinations and relevant investigations were included as part of the methodology. The following parameters were collected: age, gender, religion, waist circumference, blood pressure and fasting clinical chemistry parameters. Waist circumference was measured using a non-stretchable fibre measuring tape. The subjects were asked to stand erect in a relaxed position with both feet together on a flat surface. Waist circumference was taken at the midpoint between the lower margin of the last palpable rib and the top of the iliac crest. Blood pressure was recorded in the sitting position in the right arm to the nearest 2 mmHg using the mercury sphygmomanometer (Diamond Deluxe BP apparatus, Pune, India). Two readings were taken 5 min apart and the mean of the two was taken as blood pressure. Blood samples were collected from each participant after a 9-hour overnight fasting and employing standard infection prevention procedures. The collected blood samples were used to determine the concentrations of HDL-cholesterol, triglyceride, and fasting glucose.

Statistical Analysis: Data collected were entered in excel. Analysis was done by SPSS version 18. Simple proportion, Percentage, Mean, Standard deviation, and Pearson correlation co-efficient were calculated. Appropriate test of significance like chi-square test and “t” test were done. Values of p < 0.05 were considered statistically significant.

RESULTS

Out of the 136 included individuals, majority 65 (47.8%) were among the age group of 35-39 years. The youngest age of the individual participated in this study was 24 years and the oldest was 39 years with the mean age of 32.6±5.04 years. Maximum number of persons 78 (57.4%) were males, followed by females 58 (42.6%). According to religion wise, 82 (60.3%) persons coming under Hindu, followed by 42 (30.9%) persons of Christians, and 12 (8.8%) persons of Muslims.

 

Table 1: General Characteristics of the Study Population

According to the parameters of metabolic syndrome, minimum waist circumference was 78 cm and maximum was 104 cm with the mean of 91.92±5.46. Minimum systolic BP was 100 mmHg and maximum was 160 mmHg with the mean of 131.56±11.77, followed by diastolic BP, minimum was 70 mmHg and maximum was 100 mmHg with the mean of 84.07±7.11. About fasting blood sugar, minimum was 82 mg/dl and maximum was 170 mg/dl with the mean of 106.82±13.32. In lipids, minimum triglyceride was 112 mg/dl and maximum was 204 mg/dl with the mean of 155.71±22.18, followed by High density lipoprotein cholesterol, minimum was 25 and maximum was 54 with the mean of 40.50±6.88.

 

Table 2: Prevalence of Abnormal Parameters

In our study population, maximum number of persons 103 (75.7%) have affected by obesity (Increased waist circumference) followed by 64 (47.1%) have abnormal triglyceride levels. Among the abnormal triglyceride levels, 62 (45.6%) have high triglyceride levels and 21 (15.4%) have history of lipid lowering drug treatment. Next maximum 61 (44.9%) persons affected by hypertension and then 50 (36.8%) affected by diabetes and abnormal high density lipoprotein cholesterol levels. Among hypertensive patients 52 (38.2%) having abnormal diastolic blood pressure and 51 (37.5%) have abnormal systolic blood pressure levels. Among diabetic patients 47 (34.6%) having abnormal fasting blood sugar levels and 38 (27.9%) have history of anti-diabetic treatment. Among abnormal high density lipoprotein cholesterol 41 (30.1%) having low high density cholesterol levels and 21 (15.4%) have history of lipid lowering drug treatment.

 

Table 3: Prevalence of Metabolic Syndrome

In our study population, prevalence of metabolic syndrome was 47.1% (64 persons) according to the Modified NCEP ATP III Criteria and according to the IDF Criteria, prevalence was 44.9% (61 persons). It was a little lower than the NCEP-ATP III Criteria prevalence.

DISCUSSION

Metabolic syndrome prevalence is increasing in the childhood and adolescent population. Applying the criteria of metabolic syndrome serves as a simple and inexpensive tool for identifying patients at high risk for diabetes mellitus and cardiovascular disease particularly those who do not fall into traditional risk categories. Though various diagnostic criteria for MetS have been published, since Asian Indians have a tendency to develop metabolic abnormalities at a lower body mass index and waist circumference than other groups, conventional criteria may under estimate the prevalence of MetS. This was also confirmed in our study; if abdominal obesity was considered an essential criterion (as recommended by the IDF guidelines) the prevalence of MetS was underestimated (came down to 44.9% from 47.1%). Such a discrepancy has also been noted in previous studies and underscores the importance of using the modified South Asian guidelines to diagnose MetS in the ethnic Indian population, (using obesity as an optional, and not an essential criterion, and the South Asian-specific waist circumference). Shahbazian et al¹⁰ reported the prevalence of MetS based on ATP III criteria was 22.8% in an urban population in south west of Iran. Jun Hyun et al¹¹ reported the prevalence of metabolic syndrome based on ATP III criteria was 38.8% in rural population of Korea. The ICMR task force collaborative study reported the prevalence of metabolic syndrome to be 30% in urban areas of Delhi and 11% in rural Haryana using ATP-III criteria. Mishra et al² reported 30% prevalence among the urban slum population in Delhi. Ramchandran et al¹² reported a prevalence of 41% in urban area of Chennai using modified ATP-III criteria among adults aged 20 to 75 yr. They also reported that prevalence was higher in women than men (46.5 vs. 36.4%) and in older people. Sarkar et al¹³ reported 40-50% prevalence in Bhutia tribe, with no rural-urban difference. Among the Toto tribe, the rural community prevalence was low 4-9%. Ramachandran et al¹² reported prevalence of 46.5% while using a modified waist circumference for Indian women ≥ 85 cm (modified NCEP ATP-III criteria for Asian Indian). Vinodh et al¹⁴ reported 29.6% of metabolic syndrome by modified ATP-III criteria among urban adults of Kurnool, Karnataka. Thakur et al¹⁵ reported 68.6% of metabolic syndrome by modified ATP-III criteria (63.6% by IDF criteria) among adults in the northern hilly state of Himachal Pradesh. In our study, it was 47.1 % by modified NCEP ATP-III criteria and 44.9 % by IDF criteria. The differences may be attributed to the difference in study areas, and the different definitions of metabolic syndrome used. Thus, our study reports higher prevalence of metabolic syndrome. It is reported that prevalence of metabolic syndrome may vary with ethnic background. Thus, higher prevalence observed in our study suggests that Indian Asians may be more prone to metabolic syndrome compared to other parts of the world. However, certain reports from different parts of India has observed that even within the same ethnic population group significant differences in the prevalence metabolic syndrome may prevail. Thus, it appears that apart from ethnicity several other characteristic features of given population may collectively contribute to the higher prevalence of MetS. Many factors including: age, weight, menopause in women, race, smoking, alcohol consumption, low income economies, high carbohydrate intake, consumption of soft drink, low physical activity, poor cardiovascular fitness, Genetic factors and antipsychotic drugs may play a role in MetS.

 

CONCLUSION

In our study, prevalence of metabolic syndrome in younger population (24-39 years) by Modified NCEP ATP III Criteria was 47.1%. Prevalence of metabolic syndrome in younger population (24-39 years) by IDF Criteria was 44.9%. The significant increase in the prevalence of metabolic syndrome is the major risk factor for mainly coronary heart disease and diabetes mellitus. Health education and awareness among individuals about nutrition, physical exercise and maintenance of waist circumference from the younger age group is required to prevent major non- communicable health disorders in the era of increasing life expectancy.

 

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