Prevalence
of metabolic syndrome in primary health care
- An
area based study
..........................................................................................................................
Huda Al-Ghareeb
Qurain Health Centre, Ahmadi Health Area, Ministry
of Health, Kuwait
Correspondence to:
Dr Huda Alghareeb
Family Physician & Head of Qurain special
Clinic
PO Box 707
Jaber Alali City
Kuwait
Tel: (965) 3842345
Mobile: 9842252
Fax: (965) 3832345
..........................................................................................................................
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ABSTRACT
Objective:
The aim of our study was to estimate
the prevalence of metabolic syndrome among
selected Kuwaiti patients in Ahmadi &
Mubarak Al-Kabir area attending a primary
health care clinic.
Subjects and
Methods: A cross-sectional study of
consecutive Kuwaiti participants who attended
the Qurain special clinic by call, aged
between 20-60 years during March, April,
May, June 2006. Four-hundred and ninety
five participants 214 (43.2%) males and
281(56.7%) females were interviewed in detail
about their social, demographic, socioeconomic,
life style and health diseases status. This
was done using the WHO stepwise approach
to surveillance of non communicable diseases
step s, after translation to Arabic. Diagnosis
of MS was based on NCEP-ATP 111 criteria.
Results: The
total number who met the ATP111 guidelines
for diagnosis of metabolic syndrome was
194 (39.19%). 106 (37.7%) of them were females
and 88(41.1%) males. Significantly MS increased
by age.
MS criteria were
significantly commoner in men than women
for increased waist circumference and increased
triglyceride and diastolic BP.
Conclusion: The
prevalence of metabolic syndrome is high
among Kuwaiti participants attending a primary
health clinic in Kuwait.
It is recommended
that doctors in primary care settings should
be aware of the five risk factors related
to metabolic syndrome with a view to offering
appropriate treatment.
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Key
words: Metabolic
Syndrome, prevalence, Kuwait, Primary care
...........................................................................................................................
The metabolic syndrome is a
common disorder characterized by central obesity,
impaired glucose tolerance, hypertension and atherogenic
dyslipidemia (including the combination of hyper-triglyceridemia,
low levels of high-density lipoprotein cholesterol,
and a preponderance of small, dense low-density
lipoprotein particles.[3,4,30]
Metabolic syndrome was described first in 1988
[10]. In recent years MS has attracted muchattention
and definitions of metabolic syndrome have been
proposed by various medical societies.
Recently, the third report of the National Cholesterol
Education Programme Adult Treatment Panel 111(NCEP-ATP
111) drew attention to the importance of metabolic
syndrome and provides a working definition of
this syndrome. [2, 13, 14, 20, 26 and 30].
The diagnosis of metabolic syndrome is based
upon the demonstration of at least three of the
following five criteria to make a diagnosis as
shown in Table 1[9 26, 30].
A recent report from the independent market analyst,
Datamonitor, revealed that 115 million people
in the US, Japan, France, Germany, Italy, Spain
and the UK suffer from metabolic syndrome .It
is a global epidemic that is growing fast due
to increasing obesity and sedentary life styles.
The metabolic syndrome is a constellation of
interrelated risk factors of metabolic origin
- metabolic risk factors that appear to directly
promote the development of atherosclerotic cardiovascular
disease[1,2,4,5,6,9,10,15,17,20,23,26,30,33] and
development of type 2 diabetes mellitus [2, 6,
20,23,33] as well as increased mortality from
cardiovascular disease and all its causes [2,
5, 14, and 21, 30].
Although ATP 111 did not make any single risk
factor (e.g. abdominal obesity) a requirement
for diagnosis, it nonetheless espoused the position
that abdominal obesity is an important underlying
risk factor for the syndrome [6].
The growth in prevalence of the metabolic syndrome
parallels the dramatic rise in the prevalence
of obesity. [30]
A population-based cross-sectional
study was conducted during March, April, May and
June 2006 from two primary health areas (Ahmadi
and Mubarak Al-kabir area) in a primary health
centre Qurain clinic.
A stratified sampling method was used to select
the participants of a total 495 (214 males and
281 females)' of Kuwaiti nationality.
The participants were invited by Telephone call;
all participants gave informed consent at baseline
and answered a structural questionnaire by using
WHO stepwise approach to surveillance of non communicable
diseases steps after translation to Arabic. The
questionnaire contained items on social, demographic
data (birth date and sex), lifestyle (smoking,
alcohol consumption, physical activity), socioeconomic
status (education level, occupation) self reported
health conditions (disease status as hypertension,
diabetes, cardiovascular diseases, cancer) and
family history of disease. Examinations were performed
including weight, height and waist circumference
while the participant was lightly clothed.
Blood pressure was measured 3 times after the
subject had been seated for = 5 minutes, and the
mean of the last 2 readings was used for analysis.
All subjects were asked to fast overnight for
= 8 hours before blood specimen collection. Venous
blood was collected without anticoagulant in vacutainer
tubes. Fasting glucose, cholesterol and triglyceride
and all lab tests were done in Amiri hospital
using Synchron LX 20 clinical systems.
According to NCEP ATP criteria, a participant
has metabolic syndrome if he or she has three
or more of the following criteria: [4, 8, and
21]
1. High blood pressure: = 130\85 mmHg
2. Hypertriglyceridemia: = 150mg\dl (=1.70 mmol\l
3. Low HDL cholesterol : < 40 mg\dl (<1.04mmol\l)
in men and <50 mg\dl (<1.30 mmol\l) in women.
4. Abdominal obesity: waist circumference >102cm
in men and >88cm in women
5. -High fasting glucose: =110 mg\dl (=6.1)
The data were analyzed using the Statistical
Package of Social Study SPSS version12. The p
value was derived using the Chi-square test.
Of the 495 participants recruited
into the study, 194 (39.19%) met the ATP111 guidelines
for diagnosis of metabolic syndrome as shown in
Table 1. The prevalence of metabolic syndrome
increased by age among different age groups as
shown in Table 4.The prevalence of MS was 11.9%
for those aged 20-29, 27.4% for those aged 30-39,
50.9% for those aged 40-49 and 69% for those aged
55-60, and the difference between the age group
is statistically significant (p< 0.000).
The prevalence of patients
with and without metabolic syndrome by gender
is shown in Table 3. The prevalence of metabolic
syndrome differed little among men and women (p<
0.192), which are not statistically significant.
The prevalence of each of the five ATP 111 criteria
for diagnosis of metabolic syndrome is shown in
Table 2.
In our study the criteria with
the highest prevalence was low HDL-c (75.5%) of
the screened population while the lowest was that
of impaired fasting blood sugar (23.03%). Raised
plasma TG was found in 24.8%, increased waist
circumference was found in 52.4%, and high BP
was found in 39.4%.The difference between males
and females for increased waist circumference
and increased triglyceride were statistically
significant (p<0.05) while the difference between
genders for the remaining criteria was not statistically
significant as shown in Table 2. Diastolic BP
was statistically more significant than systolic
BP as shown in Table 6.
A survey of
495 Kuwaiti citizens ofAhmdi &Mubarak Al-kabir
area attending Qurain special clinic by call,
aged between 20 and 60 years showed that the
prevalence of metabolic syndrome was relatively
high. The prevalence of metabolic syndrome is
194 (39.19%) in this study, which was remarkably
high, by using ATP 111 criteria for analysis.
Our data showed
a significant relationship between age and metabolic
syndrome (df =15,p value= 0.000). This result
is consistent with other authors in other studies
{7,12,19,20,22, ,24}. Also our study showed
that metabolic syndrome increases with age {2,
8, 18, 30, and 31}. There was no significant
difference in the prevalence of metabolic syndrome
by sex (df =5,p value 0.192). This result is
consistent with other authors in other studies
{2,29} and different to yet other studies which
showed significant relationship between gender
and metabolic syndrome [32]: men had higher
incidence than women {8,11,19,28,30}. Women
had a higher incidence than men {16, 18, 20,
24, and 27} in our study.This study has certain
limitations. This is an area-based study conducted
in two health districts. The result of this
study may therefore be stronger and more significant
if it included several additional health districts
of Kuwait.
The increased
prevalence of metabolic syndrome is likely to
lead to future increases in cardiovascular disease
and Diabetes.
It is important
to identify and follow subjects with MS, even
in apparently healthy populations, to enable
early disease management.
People indicate
the need to focus attention on public health
strategies that target adolescents and young
adults to reduce the burden of the syndrome
in the future. It also means clinical strategies
are needed to identify and provide interventions
for the substantial number of persons already
affected by the syndrome.
Education and
training will be critical to ensure that health
care providers have the knowledge and the skills
necessary to properly treat patients with the
metabolic syndrome.
| Table
1. Criteria
for diagnosing metabolic syndrome (three
or more of the risk factors) according to
the National Cholesterol Educational Program's
ATP 111 Criteria {3, 4} |
|
Risk factor
|
Defining level
|
|
Abdominal obesity
Men
Women
TG
HDL-C
Men
Women
Blood Pressure
Fasting Blood glucose
|
Waist circumference
>102 cm
>88 cm
≥ 1.70 mmol\l (150mg/dl)
< 1.04mmol\l (40 mg/dl)
<1.30(50 mg/dl)
≥130/85
≥ 6.11mmol\l (110 mg/dl)
|
| Table
2. Prevalence
of each of the ATP 111 criteria for diagnosis
of metabolic syndrome among the screened
population (n=495) |
|
Criteria
|
Sex
|
Total
|
P value
|
|
F
|
M
|
|
Impaired FBS
0
+
Total
Increased waist circumference
0
+
Total
Elevated plasma TG
0
+
Total
Reduced HDL
0
+
Total
Elevated Bp
0
+
Total
|
218
63
281
106
164
270*
223
58
281
67
214
281
177
103
280**
|
163
51
214
124
90
214
149
65
214
54
160
214
122
92
214
|
381
114
495
230
254
484
372
123
495
121
374
495
299
195
494
|
0.712
0.000
0.013
0.721
0.162
|
*11 pregnant ladies excluded,
** 1 lady refused to check
| Table
3: Prevalence of each of the ATP111
criteria for diagnosis of metabolic syndrome
by sex. |
|
Criteria
|
Sex
|
Total
|
P value
|
|
F
|
M
|
|
Criteria No
+
++
+++
++++
+++++
Total
|
37
66
72
52
34
20
281
|
21
61
44
52
27
9
214
|
58
127
116
104
61
29
495
|
0.192
|
| Table
4. Prevalence of each of the ATP111
criteria for diagnosis of metabolic syndrome
by age groups. |
|
Age gp
|
Criteria
|
Total
|
P value
|
|
No
|
+
|
++
|
+++
|
++++
|
+++++
|
|
20-
30-
40-
''50-60
Total
|
33
11
11
3
58
|
65
35
20
7
127
|
20
28
47
21
116
|
11
17
53
23
104
|
5
11
18
27
61
|
0
0
10
19
29
|
134
102
159
100
495
|
0.000
|
| Table
5. Prevalence of each of the ATP111
criteria for diagnosis of metabolic syndrome
by age-sex groups |
|
Age-sex gp
|
Criteria
|
Total
|
P value
|
|
No
|
+
|
++
|
+++
|
++++
|
+++++
|
|
200
201
300
301
400
401
500
501
Total
|
22
11
6
5
6
5
3
0
58
|
34
31
19
16
11
9
2
5
127
|
12
8
18
10
29
18
13
8
116
|
4
7
8
9
26
27
14
9
104
|
1
4
6
5
11
7
16
11
61
|
0
0
0
0
8
2
12
7
29
|
73
61
57
45
91
68
60
40
495
|
0.000
|
| Table
6. Prevalence
of each of Bp of the ATP 111 criteria for
diagnosis of metabolic syndrome among the
screened population (n=494) |
|
|
Sex
|
Total
|
P value
|
|
F
|
M
|
|
Sys o
+
Total
Dias o
+
Total
|
182
98
280
216
64
280
|
137
77
214
148
66
214
|
319
175
494
364
130
494
|
0.821
0.046
|
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