Prevalence, agreement and classification of various metabolic syndrome criteria among ethnic Chinese: A report on the hospital-based health diagnosis of the adult population



      Many criteria of metabolic syndrome have been made available to practitioners in the recent past. This study has been designed to investigate the distribution, agreement and classification patterns of these criteria among the ethnic Chinese population.


      A total of 6610 (women, 42.5%) adults (mean, 52.3 years) were recruited from the hospital-based health diagnosis program during 2004. We divided criteria of metabolic syndrome into two groups: those with a major component required (WHO, EGIR, AACE, IDF) and those with equal component (ATP III, AHA, with modifications).


      The highest standardized rates were in Asian AHA criterion, up to 29.8% in men and 25.6% in women. The lowest rates were in WHO criterion, 8.8% in men and 8.0% in women. The κ values using all criteria were 0.59 in men and 0.65 in women and decreased in the major component group (0.50 in men, 0.54 in women), while increased in the equal component group (0.83 in men, 0.81 in women). Using hierarchical cluster analysis and dendrograms, two large clusters were identified in men (major components and equal components); however, mixed sub-clusters of major and equal components apparently grouped by insulin resistance and obesity criteria in women.


      There is substantial agreement and grouping of metabolic syndrome models among ethnic Chinese.


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        • Eckel R.H.
        • Grundy S.M.
        • Zimmet P.Z.
        The metabolic syndrome.
        Lancet. 2005; 365: 1415-1428
        • Ford E.S.
        • Giles W.H.
        • Dietz W.H.
        Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey.
        JAMA. 2002; 287: 356-359
        • Hu G.
        • Qiao Q.
        • Tuomilehto J.
        • et al.
        Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in non-diabetic European men and women.
        Arch Intern Med. 2004; 164: 1066-1076
        • Wallenfeldt K.
        • Hulthe J.
        • Fagerberg B.
        The metabolic syndrome in middle-aged men according to different definitions and related changes in carotid artery intima-media thickness (IMT) during 3 years of follow-up.
        J Intern Med. 2005; 258: 28-37
        • Alberti K.G.
        • Zimmet P.Z.
        Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1. diagnosis and classification of diabetes mellitus provisional report of a WHO consultation.
        Diabet Med. 1998; 15: 539-553
        • 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
        • Einhorn D.
        • Reaven G.M.
        • Cobin R.H.
        • et al.
        American College of Endocrinology position statement on the insulin resistance syndrome.
        Endocr Pract. 2003; 9: 237-252
      1. The IDF consensus group. The IDF consensus worldwide definition of the metabolic syndrome. http://www idf org/webdata/docs/MetSyndrome_FINAL pdf, 2005.

      2. 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) final report. Circulation 2002; 106:3143–421.

        • Grundy S.M.
        • Cleeman J.I.
        • Daniels S.R.
        • et al.
        Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement.
        Circulation. 2005; 112: 2735-2752
        • Ford E.S.
        • Mokdad A.H.
        • Giles W.H.
        Trends in waist circumference among U.S. adults.
        Obes Res. 2003; 11: 1223-1231
        • Reaven G.M.
        The metabolic syndrome: requiescat in pace.
        Clin Chem. 2005; 51: 931-938
        • Grundy S.M.
        Point: the metabolic syndrome still lives.
        Clin Chem. 2005; 51: 1352-1354
        • Ko G.T.
        • Cockram C.S.
        • Chow C.C.
        • et al.
        High prevalence of metabolic syndrome in Hong Kong Chinese-comparison of three diagnostic criteria.
        Diabet Res Clin Pract. 2005; 69: 160-168
        • Tan C.E.
        • Ma S.
        • Wai D.
        • et al.
        Can we apply the National Cholesterol Education Program Adult Treatment Panel definition of the metabolic syndrome to Asians?.
        Diabet Care. 2004; 27: 1182-1186
        • Austin M.A.
        • Edwards K.L.
        • McNeely M.J.
        • et al.
        Heritability of multivariate factors of the metabolic syndrome in non-diabetic Japanese mericans.
        Diabetes. 2004; 53: 1166-1169
        • Girman C.J.
        • Dekker J.M.
        • Rhodes T.
        • et al.
        An exploratory analysis of criteria for the metabolic syndrome and its prediction of long-term cardiovascular outcomes: the Hoorn study.
        Am J Epidemiol. 2005; 162: 438-447
        • Chien K.L.
        • Yang C.Y.
        • Lee Y.T.
        Major gene effects in systolic and diastolic blood pressure in the families receiving health examination in Taiwan.
        J Hypertens. 2003; 21: 1-7
        • Chien K.L.
        • Hsu H.C.
        • Chao C.L.
        • et al.
        Interaction of obesity, metabolic syndrome and Framingham risk on steatohepatitis among healthy Taiwanese: population-based nested case-control study.
        Cardiovasc Diabetol. 2006; 5: 12
        • Chien K.L.
        • Hsu H.C.
        • Su T.C.
        • Lee Y.T.
        Consistency in genetic inheritance mode and heritability patterns of triglyceride vs. high density lipoprotein cholesterol ratio in two Taiwanese family samples.
        BMC J Genet. 2003; 4: 7-16
        • Chien K.L.
        • Hsu H.C.
        • Chen M.F.
        • Lee Y.T.
        Association of C-reactive protein, smoking and metabolic syndrome among the health check-up population.
        Acta Cardiol Sin. 2005; 21: 98-104
        • Chen T.H.
        • Chiu Y.H.
        • Luh D.L.
        • et al.
        Community-based multiple screening model: design, implementation, and analysis of 42,387 participants.
        Cancer. 2004; 100: 1734-1743
        • Landis J.R.
        • Koch G.G.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Fleiss J.L.
        • Levin B.
        • Paik M.C.
        Statistical methods for rates and proportions.
        3rd ed. John Wileys & Sons, Inc., Hoboken, NJ2003
        • Akbay A.
        • Elhan A.
        • Ozcan C.
        • Demirtas S.
        Hierarchical cluster analysis as an approach for systematic grouping of diet constituents on basis of fatty acid, energy and cholesterol content: application on consumable lamb products.
        Med Hypoth. 2000; 55: 147-154
        • Bittner M.
        • Meltzer P.
        • Chen Y.
        • et al.
        Molecular classification of cutaneous malignant melanoma by gene expression profiling.
        Nature. 2000; 406: 536-540
        • Kahn R.
        • Buse J.
        • Ferrannini E.
        • Stern M.
        The metabolic syndrome—time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes.
        Diabet Care. 2005; 28: 2289-2304
        • He Y.
        • Jiang B.
        • Wang J.
        • et al.
        Prevalence of the metabolic syndrome and its relation to cardiovascular disease in an elderly Chinese population.
        J Am Coll Cardiol. 2006; 47: 1588-1594
        • Gu D.
        • Reynolds K.
        • Wu X.
        • et al.
        Prevalence of the metabolic syndrome and overweight among adults in China.
        Lancet. 2005; 365: 1398-1405
        • Wang J.J.
        • Hu G.
        • Miettinen M.E.
        • Tuomilehto J.
        The metabolic syndrome and incident diabetes: assessment of four suggested definitions of the metabolic syndrome in a Chinese population with high post-prandial glucose.
        Horm Metab Res. 2004; 36: 708-715
      3. Wang JJ, Li HB, Kinnunen L, et al. How well does the metabolic syndrome defined by five definitions predict incident diabetes and incident coronary heart disease in a Chinese population? Atherosclerosis, published online 26 May 2006.

      4. Chien KL, Hsu HC, Sung FC, et al. Metabolic syndrome as a risk factor for coronary heart disease and stroke: an 11-year prospective cohort in Taiwan community, Atherosclerosis, published online 18 September 2006.

        • Anuurad E.
        • Shiwaku K.
        • Nogi A.
        • et al.
        The new BMI criteria for Asians by the regional office for the western pacific region of WHO are suitable for screening of overweight to prevent metabolic syndrome in elder Japanese workers.
        J Occup Health. 2003; 45: 335-343
        • Miyaki K.
        • Hara A.
        • Naito M.
        • et al.
        Two new criteria of the metabolic syndrome: prevalence and the association with brachial-ankle pulse wave velocity in Japanese male workers.
        J Occup Health. 2006; 48: 134-140
        • Mora S.
        • Lee I.M.
        • Buring J.E.
        • Ridker P.M.
        Association of physical activity and body mass index with novel and traditional cardiovascular biomarkers in women.
        JAMA. 2006; 295: 1412-1419
        • Dallongeville J.
        • Cottel D.
        • Arveiler D.
        • et al.
        The association of metabolic disorders with the metabolic syndrome is different in men and women.
        Ann Nutr Metab. 2004; 48: 43-50
        • Hara K.
        • Matsushita Y.
        • Horikoshi M.
        • et al.
        A proposal for the cutoff point of waist circumference for the diagnosis of metabolic syndrome in the Japanese population.
        Diabet Care. 2006; 29: 1123-1124
        • Pan W.H.
        • Flegal K.M.
        • Chang H.Y.
        • et al.
        Body mass index and obesity-related metabolic disorders in Taiwanese and US whites and blacks: implications for definitions of overweight and obesity for Asians.
        Am J Clin Nutr. 2004; 79: 31-39
        • Chen H.J.
        • Bai C.H.
        • Yeh W.T.
        • et al.
        Influence of metabolic syndrome and general obesity on the risk of ischemic stroke.
        Stroke. 2006; 37: 1060-1064