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38

VOLUME 13 NUMBER 1 • JULY 2016

RESEARCH ARTICLE

SA JOURNAL OF DIABETES & VASCULAR DISEASE

detection, evaluation, and treatment of high blood cholesterol in

adults (Adult Treatment Panel III) (ATP III, 2001),

6

followed by the

ATP III as modified in 2005,

7

were used, plus the modified version

specific to the people of south Asian origin (ATP III SAS 2009).

8-10

These criteria were as follows:

• waist circumference: male > 90 cm; female > 80 cm

• triglycerides: ≥ 2.25 mmol/l

• HDL: male < 1.03 mmol/l; female < 1.28 mmol/l

• blood pressure: SBP ≥ 130 mmHg and/or DBP ≥ 85 mmHg

• fasting blood glucose: ≥ 5.56 mmol/l.

Statistical analyses

Parameters were expressed as mean and standard deviation

(SD), separately for males and females in the study population.

The prevalence (%) of the MS and its confounding factors were

calculated using standard cut-off values. All statistical analyses

were performed using SPSS (PC + version 10.0).

Results

The mean and standard deviation by gender of obesity values,

lipid profiles and blood pressure is presented in Table 1. It was

observed that males had significantly (

p

< 0.05) higher mean

total cholesterol and fasting blood glucose values (

p

< 0.05) than

females.

Table 2.

Prevalence (%) of metabolic syndrome phenotypes by

definitions

Factors

ATP III 2001 ATP III 2005 SAS 2009

WC

30.9

61.1

61.1

TG

39.7

39.7

2.3

HDL

50.9

50.9

50.9

BP

63.7

63.7

63.7

FBG

10.0

21.7

21.7

Metabolic syndrome (%)

32.3

48.3

31.4

SAS = South Asian specific.

The difference in prevalence of the MS according to the three

definitions is presented in Table 2. Using the original ATP III (2001)

definition, the overall prevalence of the MS in the study was

found to be 32.3%. However, according to the ATP III modified

criteria (2005), the prevalence was found to be 48.3% among

the participants. When the south Asian-specific cut-off values

were taken into consideration, the prevalence was found to be

31.4%.

Out of five confounding factors, the three factors playing a

crucial role were high abdominal obesity (61.1%), low HDL

cholesterol (50.9%) and high blood pressure (63.7%). It was also

observed that for all three definitions (NCEP ATP III 2001, ATP III

modified 2005, and ATP III SAS 2009), female participants had

a considerably higher prevalence of the MS compared to male

subjects (Fig. 1).

Discussion

It was observed that the prevalence of the MS was different,

depending on the three definitions used. Moreover, the prevalence

of elevated triglyceride levels (hypertriglyceridaemia), which is a

distinctive feature of people of Indian origin, varied considerably

in the study population owing to the use of the south Asian-

specific cut-off value for elevated triglycerides. The marked

difference in the overall prevalence of the MS from the ATP III

(2005) definition to the SAS (2009) definition (48.3 vs 31.4%)

was due to the use of the south Asian-specific cut-off values for

WC and triglyceride levels. Importantly, whether the modified

ATP III (2005) or the revised SAS (2009) definition is used, a large

number of individuals are likely to be misclassified due to lack of

a common minimum criterion required to better comprehend the

problem of the MS among Asian Indians.

Several other studies have shown such discrepancies, not

only in the Indian population but also in other Asian countries,

such as China and Iran. In a study from India,

10

the World Health

Organisation (WHO), ATP III and IDF criteria of the MS identified

a differential prevalence of the MS in the study population. The

WHO criteria identified a greater number of coronary artery

disease (CAD) subjects in males, but not in females.

10

Studies pertaining to Asian Indians revealed that the ATP III

criteria identified a significantly higher proportion of people with

the MS compared with the WHO criteria.

11,12

It was mentioned

that lower cut-off values of WC and BMI to define the MS

might be critical for the accurate assessment of the MS among

Fig. 1.

Prevalence of the metabolic syndrome by definitions and gender.

Table 1.

Descriptive statistics of the study population (

n

= 350)

Male (

n

= 184) Female (

n

= 166) Total (

n

= 350)

Variables Mean SD Mean SD Mean SD

Age (years)** 54.04 12.40 48.48 11.57 51.40 12.31

BMI (kg/m

2

)

22.37 4.09 23.20 4.37 22.76 4.24

WC (cm)

89.81 10.04 88.90 9.69 89.38 9.87

SBP (mmHg)

132.97 24.02 137.21 24.52 134.98 24.31

DBP (mmHg)

82.22 11.41 83.48 10.55 82.82 11.01

TC (mmol/l)*

2.23 0.31 2.24 0.26 2.27 0.29

TG (mmol/l)

1.61 0.30 1.57 0.25 1.59 0.28

HDL (mmol/l)

1.13 0.12 1.13 0.11 1.13 0.12

LDL (mmol/l)

3.39 0.70 3.25 0.59 3.32 0.65

VLDL (mmol/l)

0.32 0.006 0.31 0.005 0.31 0.005

FBG (mmol/l)** 5.17 1.30 4.92 0.93 5.05 1.15

BMI = body mass index; WC = waist circumference; WHR = waist–hip ratio;

SBP = systolic blood pressure; DBP = diastolic blood pressure; TC = total

cholesterol; TG = triglyceride; HDL = high-density lipoprotein; LDL = low-

density lipoprotein; VLDL = very low-density lipoprotein; FBG = fasting blood

glucose.

Significant gender difference at *

p

< 0.05; **

p

< 0.01.