Metabolic syndrome in the Ragama Health Study: definitions and controversies

Abstract

Although there is agreement that the Metabolic Syndrome (MetS) is a major public health challenge worldwide and consistent evidence stresses the need for intervention, the definition of the syndrome remains a matter of debate. Currently, several different definitions of MetS exist which share several features but also include important differences and limitations. Prevalence of MetS in the RHS was estimated using the two most widely used definitions of MetS: International Diabetes Federation (IDF) and revised National Cholesterol Education Program Adult Treatment Panel III (revised NCEP ATP III). Age and sex-adjusted prevalences of MetS in the RHS were 46.1% and 38.9% by revised NCEP and IDF definitions, respectively. IDF criteria failed to identify 21% of men and 7% of women identified by the revised NCEP criteria. The discrepant group had more adverse metabolic profiles despite having a lower waist circumference than those diagnosed by both criteria. This discrepancy was mainly caused by waist circumference criterion which is a prerequisite for the diagnosis of MetS based on IDF definition. In contrast, the revised NCEP definition considers abdominal obesity as one of the equally weighted criteria. The discrepant group in our study included a metabolically obese, normal weight (MONW) group of individuals who are predisposed to diabetes and CVD like people with overt obesity. MONW individuals are common in the general population and they probably represent one end of the spectrum with MetS. The study highlights the need for a unified definition of MetS which would identify individuals with an increased risk of diabetes and CVD.