Prevalence of the Metabolic Syndrome as Influenced by the Measure of Obesity Employed

The metabolic syndrome (MS) is characterized by 4 independent risk factors for cardiovascular disease: elevated triglyceride-rich lipoproteins, reduced high-density lipoproteins, elevated blood pressure, and dysglycemia. Several underlying risk factors, notably obesity, accentuate these independent risk factors. This study addressed 2 questions: Is the prevalence of MS identified equally by all measures of obesity? and Should any measure of obesity be included among diagnostic components of the MS? A cohort of 8,879 women and 23,145 men in the Cooper Center Longitudinal Study (CCLS) underwent anthropometric assessment and risk-factor measurement. Most subjects were Caucasian, and 13.1% of women and 30.5% of men had MS defined by the National Cholesterol Education Program Adult Treatment Panel (ATP) III guidelines. In ATP III, MS is diagnosed by any 3 of 5 factors (i.e., the 4 independent risk factors listed previously plus abdominal obesity, defined as increased waist girth). In the CCLS, several measures of obesity (e.g., percentage body fat, body mass index, and truncal subcutaneous fat) were found to substitute for elevated waist girth without appreciably changing MS prevalence. The impact of removing obesity from the diagnostic criteria (abridged ATP III MS, defined as 3 of 4 independent risk factors) was further examined. Abridged ATP III MS was less common than ATP III MS but recognized a subgroup of patients at higher risk for cardiovascular disease. In conclusion, abridged ATP III MS appears to be preferable to ATP III MS for the detection of candidates for intensive cardiovascular risk reduction.