Comparison of the Prevalence of the Metabolic Syndrome by WHO, AHA/NHLBI, and IDF Definitions in a German Population with Type 2 Diabetes: The Diabetes in Germany (DIG) Study

Abstract

This study investigated the prevalence of the metabolic syndrome (MetS) in a German population with type 2 diabetes (T2DM) using the three definitions for MetS according to WHO 1999, AHA/NHLBI 2005, and IDF 2005 criteria. Four-thousand and twenty participants as a cross section of daily practice of diabetes care in Germany (238 unselected sites) were included in the Diabetes in Germany (DIG) study. Inclusion criteria: T2DM and age between 35-80 years. Exclusion criteria: major cardiovascular event <3 months before entry, NYHA-IV, macroproteinuria, and cancer <5 years before entry. The components of MetS were measured following a standard protocol for anthropometric and laboratory control. The average diabetes duration was 8.4 years and HbA_1C 7.0%. The prevalence of MetS by WHO criteria was 26.1%, by AHA/NHLBI 79.3%, and by IDF 82.6%. The degree of agreement (kappa statistic) was kappa=0.69 between AHA/NHLBI and IDF definitions, but only 0.12 for WHO vs. IDF, and 0.17 for WHO vs. AHA/NHLBI. The frequency of central obesity by WHO was 50.9%, by AHA/NHLBI 72.9%, and by IDF 92.0% and for hypertension 29.3%, 92.6%, and 92.6%, respectively. However, the frequencies of lipid components by the three definitions were in the same range (57.8%, 59.5%, 59.5%). In this representative German sample of patients with type 2 diabetes, the prevalence of MetS was very highly independent of using the IDF or AHA/NHLBI definition. Females were significantly more affected than males. The distinctly lower prevalence delineated from WHO criteria is due to low frequency of central obesity and hypertension as consequence of higher cutoff limits for these components used in the WHO definition.

Key words

Metabolic syndrome - type 2 diabetes - prevalence

References

• 1 Isomaa B, Almgren P, Tuomi T. et al . Cardiovascular morbidity and mortality associated with the metabolic syndrome.  Diabetes Care. 2001;  24 683-689
• 2 Laaksonen DE, Lakka HM, Niskanen LK, Kaplan GA, Salonen JT, Lakka TA. 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
• 3 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 Intern Med. 2004;  164 1066-1076
• 4 Hanefeld M, Leonhardt W. Das metabolische Syndrom.  Dtsch Ges Wesen. 1981;  36 545-551
• 5 World Health Organization .Definition, diagnosis and classification of diabetes mellitus and its complications. Report of WHO consultation 1999
• 6 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
• 7 Grundy SM, Cleeman JI, Daniels SR, Donato KA. 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
• 8 International Diabetes Federation . Worldwide definition of the metabolic syndrome.  , Available at: http://www.idf.org/webdata/docs/IDF_Meta-syndrome_definition.pdf , Accessed August 24 2005; 
• 9 Guize L, Thomas F, Pannier B, Bean K, Jego B, Benetos A. All-cause mortality associated with specific combinations of the metabolic syndrome according to recent definitions.  Diabetes Care. 2007;  , in press
• 10 The DECODE Study Group, . Qiao Q. Comparison of different definitions of the metabolic syndrome in relation to cardiovascular mortality in European men and women.  Diabetologia. 2006;  49 2837-2846
• 11 The Metascreen Writing Committee . The metabolic syndrome is a risk indicator of microvascular and macrovascular complications in diabetes.  Diabetes Care. 2006;  29 2701-2707
• 12 Hanefeld M, Koehler C, Gallo S, Benke I, Ott P. Combinations versus single traits of the metabolic syndrome as risk factors for atherosclerotic vascular disease in type 2 diabetes: The Diabetes in Germany (DIG) Study.  Cardiovac Diab. 2007;  6 13
• 13 Gimeno Orna JA, Lou Arnal LM, Molinero Herguedas E, Boned Julian B, Portilla Cordoba DP. Metabolic syndrome as a cardiovascular risk factor in patients with type 2 diabetes.  Rev Esp Cardiol. 2004;  57 507-513
• 14 Costa LA, Canani LH, Lisboa HR, Tres GS, Gross JL. Aggregation of features of the metabolic syndrome is associated with increased prevalence of chronic complications in Type 2 diabetes.  Diabet Med. 2004;  21 252-255
• 15 Bruno G, Merletti F, Biggeri A, Bargero G, Ferrero S. et al . Metabolic syndrome as a predictor of all-cause and cardiovascular mortality in type 2 diabetes: the Casale Monferrato Study.  Diabetes Care. 2004;  27 2689-2694
• 16 Marchesini G, Forlani G, Cerrelli F, Manini R, Natale S. et al . WHO and ATPIII proposals for the definition of the metabolic syndrome in patients with Type 2 diabetes.  Diabet Med. 2004;  21 383-387
• 17 Ilanne-Parikka P, Eriksson JG, Lindstrom J, Hamalainen H, Keinanen-Kiukaanniemi S. et al . Finnish Diabetes Prevention Study Group: Prevalence of the metabolic syndrome and its components: findings from a Finnish general population sample and the Diabetes Prevention Study cohort.  Diabetes Care. 2004;  27 2135-2140
• 18 Alexander CM, Landsman PB, Teutsch SM, Haffner SM. Third National Health and Nutrition Examination Survey (NHANES III) . NCEP-defined metabolic syndrome, diabetes, and prevalence of coronary heart disease among NHANES III participants age 50 years and older.  Diabetes. 2003;  52 1210-1214

Correspondence