The Metabolic Syndrome and Incident Diabetes: Assessment of Four Suggested Definitions of the Metabolic Syndrome in a Chinese Population with High Post-prandial Glucose

Abstract

Aims: To assess the sensitivity and specificity of the four definitions of the metabolic syndrome for incident diabetes in both men and women. Methods: The screening survey for type 2 diabetes was conducted in 1994. A follow-up study on 627 high-risk non-diabetic individuals at baseline was carried out in 1999 in Beijing area. 70 men and 76 women developed diabetes during the five-year follow-up. Sensitivity and specificity of four definitions of the metabolic syndrome based on the NCEP, WHO, EGIR and AACE recommendations were compared by McNemar's test. Results: The metabolic syndrome based on all four definitions identified men at a 3.7 - 4.5-fold and women at a 1.6 - 2.8-fold risk of developing diabetes during 5-year follow-up. The AACE definition had the highest sensitivity for predicting diabetes (men: 0.61; women: 0.58) and lowest specificity (men: 0.71; women: 0.70). The WHO definition identified 53 % of male and 42 % female incident diabetes. The NCEP definition of adiposity as waist girth > 102 cm was the least sensitive, detecting only 27 % of incident diabetes in men; however, it was the most specific (0.91). The EGIR definition identified the lowest number of female cases (28 %) and fewer male cases (28 %) of incident diabetes, but was specific (women: 0.87; men: 0.91). Conclusions: Further studies on definition of the metabolic syndrome should focus on the potential ethnic differences in insulin resistance and anthropometric indicators for obesity.

Metabolic syndrome - Incident diabetes - Obesity - Hypertension - Hyperlipidaemia - Hyperinsulinism - Microalbuminuria

References

• 1 Reaven G M. Banting lecture 1988: Role of insulin resistance in human disease.  Diabetes. 1988;  37 1595-1607
• 2 Bjorntorp P. Abdominal obesity and the metabolic syndrome.  Ann Med. 1992;  24 465-468
• 3 Kohrt W M, Kirwan J P, Staten M A, Bourey R E, King D S, Holloszy J O. Insulin resistance in aging is related to abdominal obesity.  Diabetes. 1993;  42 273-281
• 4 Zavaroni I, Mazza S, Fantuzzi M, Dall'Aglio E, Bonora E, Delsignore R, Passeri M, Reaven G M. Changes in insulin and lipid metabolism in males with asymptomatic hyperuricaemia.  J Intern Med. 1993;  234 25-30
• 5 Zavaroni I, Mazza S, Fantuzzi M, Dall'Aglio E, Bonora E, Delsignore R, Passeri M, Reaven G M. Insulin resistance, hypertension and microalbuminuria in patients with type 2 (non-insulin-dependent) diabetes mellitus.  Diabetologia. 1993;  36 642-647
• 6 Lindahl B, Asplund K, Eliasson M, Evrin P-E. Insulin resistance syndrome and fibrinolytic activity: the northern Sweden MONICA study.  Int J Epidemiol. 1996;  25 291-299
• 7 Kaplan N M. The deadly quartet. Upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension.  Arch Intern Med. 1989;  149 1514-1520
• 8 DeFronzo R A, Ferrannini E. Insulin resistance: A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease.  Diabetes Care. 1991;  14 173-194
• 9 Tiengo A, Del Prato S. Plurimetabolic syndrome: association of diabetes, dyslipidemia, and arterial hypertension.  Cardiologia. 1995;  40 237-243
• 10 World Health Organization .Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Report of a WHO Consultation. Part 1: Diagnosis and Classification of Diabetes and Mellitus. Geneva; World Health Organization 1999 (publ. no.WHO/NCD/NCS/99.2): Web site: http://whqlibdoc.who.int/hq/1999/who_ncd_ncs_99.2.pdf
• 11 Freeman M S, Mansfield M W, Barrett J H, Grant P J. Heritability of features of the insulin resistance syndrome in a community-based study of healthy families.  Diabet Med. 2002;  19 994-999
• 12 Parker L, Lamont D W, Unwin N, Pearce M S, Bennett S M, Dickinson H O, White M, Mathers J C, Alberti K G, Craft A W. A lifecourse study of risk for hyperinsulinaemia, dyslipidaemia and obesity (the central metabolic syndrome) at age 49 - 51 years.  Diabet Med. 2003;  20 406-415
• 13 Stern M P. Diabetes and cardiovascular disease. The ”common soil“ hypothesis.  Diabetes. 1995;  44 369-374
• 14 Bonora E, Kiechl S, Willeit J, Oberhollenzer F, Egger G, Targher G, Alberiche M, Bonadonna R C, Muggeo M. Prevalence of insulin resistance in metabolic disorders: the Bruneck Study.  Diabetes. 1998;  47 1643-1649
• 15 Rantala A O, Kauma H, Lilja M, Savolainen M J, Reunanen A, Kesaniemi Y A. Prevalence of the metabolic syndrome in drug-treated hypertensive patients and control subjects.  J Intern Med. 1999;  245 163-174
• 16 Balkau B, Charles M A. Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR).  Diabet Med. 1999;  16 442-443
• 17 Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults . 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).  JAMA. 2001;  285 2486-2497
• 18 Bloomgarden Z T. American Association of Clinical Endocrinologists (AACE) Consensus Conference on the Insulin Resistance.  Diabetes Care. 2003;  26 933-939
• 19 Molarius A, Seidell J C. Selection of anthropometric indicators for classification of abdominal fatness - a critical review.  Int J Obes Relat Metab Disord. 1998;  22 719-727
• 20 Laaksonen D E, Lakka H M, Niskanen L K, Kaplan G A, Salonen J T, Lakka T A. Metabolic syndrome and development of diabetes mellitus: application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study.  Am J Epidemiol. 2002;  156 1070-1077
• 21 Lakka H M, Laaksonen D E, Lakka T A, Niskanen L K, Kumpusalo E, Tuomilehto J, Salonen J T. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men.  JAMA. 2002;  288 2709-2716
• 22 Hanson R L, Imperatore G, Bennett P H, Knowler W C. Components of the ”metabolic syndrome“ and incidence of type 2 diabetes.  Diabetes. 2002;  51 3120-3127
• 23 Hu G, Qiao Q, Tuomilehto J, Balkau B, Borch-Johnsen K, Pyörälä K for the DECODE Study Group. Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women.  Arch of Intern Med. 2004;  164 1066-1076
• 24 Diabetes Research Group . Diabetes mellitus survey of 300 000 in fourteen provinces and cities of China.  Chin Med J. 1981;  20 678-684
• 25 Pan X R, Yang W Y, Li G W, Liu J. Prevalence of diabetes and its risk factors in China, 1994. National Diabetes Prevention and Control Cooperative Group.  Diabetes Care. 1997;  20 1664-1669
• 26 Pan X R, Hu Y H, Li G W, Liu P A, Bennett P H, Howard B. Impaired glucose tolerance and its relationship to ECG-indicated coronary heart disease and risk factors among Chinese. Da Qing IGT and diabetes study.  Diabetes Care. 1993;  16 150-156
• 27 Yuan S Y, Zhu L X, Hu H Y, Pan S F, Yuan M X, Guo F X, Zhen Q L, Zhan H W, Lu Z X, Fu H J, Li S Q, Chen J W, Liu Y T, Zhang F, Wang F R, Zhang M X, Chu P Z, Fen J P. A screening survey of diabetes mellitus in a population of 20 682 and of OGTT in a population of 1566 in Beijing district.  Chin J Endocrinol Metab. 1997;  13 69-72
• 28 Carnethon M R, Palaniappan L P, Burchfiel C M, Brancati F L, Fortmann S P. Serum insulin, obesity, and the incidence of type 2 diabetes in black and white adults: the atherosclerosis risk in communities study: 1987 - 1998.  Diabetes Care. 2002;  25 1358-1364
• 29 Steering Commitee of the Western Pacific Region of the World Health Organization, the International Association for the Study of Obesity, and the International Obesity Task Force .The Asia-Pacific perspective: redefining obesity and its treatment. Melbourne, Australia; Health Communications Australia Pty Limited 2000: World Wide Web: http://www.diabetes.com.au/research/report_obesity.htm
• 30 Han T S, van Leer E M, Seidell J C, Lean M E. Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample.  BMJ. 1995;  311 1401-1405
• 31 Ko G T, Chan J C, Woo J, Lau E, Yeung V T, Chow C C, Wai H P, Li J K, So W Y, Cockram C S. Simple anthropometric indexes and cardiovascular risk factors in Chinese.  Int J Obes. 1997;  21 995-1001
• 32 Yoshiike N, Matsumura Y, Zaman M M, Yamaguchi M. Descriptive epidemiology of body mass index in Japanese adults in a representative sample from the National Nutrition Survey 1990 - 1994.  Int J Obes. 1998;  22 684-687
• 33 Matsumoto K, Miyake S, Yano M, Ueki Y, Yamaguchi Y, Akazawa S, Tominaga Y. Glucose tolerance, insulin secretion, and insulin sensitivity in nonobese and obese Japanese subjects.  Diabetes Care. 1997;  20 1562-1568
• 34 The ECODE-DECODA Study Group on behalf of the European Diabetes Epidemiology Group, and the International Diabetes Epidemiology Group . Age, body mass index and Type 2 diabetes - associations modified by ethnicity.  Diabetologia. 2003;  46 1063-1070
• 35 Shaw J E, Zimmet P Z, de Courten M, Dowse G K, Chitson P, Gareeboo H, Hemraj F, Fareed D, Tuomilehto J, Alberti K G. Impaired fasting glucose or impaired glucose tolerance. What best predicts future diabetes in Mauritius?.  Diabetes Care. 1999;  22 399-402
• 36 The DECODE Study Group, the European Diabetes Epidemiology Group . Glucose tolerance and cardiovascular mortality: comparison of fasting and 2-hour diagnostic criteria.  Arch Intern Med. 2001;  161 397-405
• 37 Wang J J, Yuan S Y, Zhu L X, Fu H J, Li H B, Hu G, Tuomilehto J. Effects of impaired fasting glucose and impaired glucose tolerance on predicting incidence type 2 diabetes in a Chinese Population with high post-prandial glucose.  Diabetes Res Clin Pract. 2004;  in press