Diagnostic criteria for metabolic syndrome: caucasians versus African-Americans
Stacey A Zeno1, Patricia A Deuster, Jennifer L Davis
1Departments of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
Insights
Current metabolic syndrome definitions may miss at-risk African Americans. Including body fat percentage and fitness levels could improve early cardiovascular disease risk identification in this population.
Area of Science:
- Cardiovascular disease research
- Metabolic health and risk assessment
- Ethnic health disparities
Background:
- Metabolic syndrome identifies individuals at high risk for cardiovascular disease (CVD).
- African Americans (AA) exhibit higher CVD prevalence and mortality than Caucasians (CA).
- Early CVD diagnosis is crucial for AA, necessitating accurate metabolic syndrome classification.
Purpose of the Study:
- To evaluate metabolic syndrome classification in healthy AA and CA using two different definitions.
- To assess the impact of cardiovascular disease risk factors (CRP, body fat, fitness, insulin resistance, non-HDL-C) on metabolic syndrome classification across ethnic groups.
Main Methods:
- Healthy AA (n=97) and CA (n=51) aged 18-45 without hypertension or diabetes were assessed.
- Measurements included cardiorespiratory fitness, body composition, anthropometrics, blood pressure, and fasting blood markers (glucose, insulin, lipids, CRP).
- Participants were classified using National Cholesterol Education Program Adult Treatment Panel III 2004 (NCEP ATP III) and International Diabetes Federation (IDF) criteria.
Main Results:
- Significant ethnic differences in metabolic syndrome classification were observed for both NCEP ATP III (CA 16.7% vs. AA 5.7%) and IDF (CA 23.5% vs. AA 8.2%) definitions (P < 0.01).
- These ethnic disparities in classification were eliminated when fitness level or percent body fat was incorporated as a criterion.
Conclusions:
- Existing metabolic syndrome definitions may fail to identify healthy AA at risk for CVD.
- Assessing percent body fat and regular exercise participation is recommended for better risk identification in AA.
- Incorporating these factors can aid healthcare providers in the early recognition and management of CVD risk in African Americans.
Background:
Metabolic syndrome is a constellation of risk factors used to identify individuals at greatest risk for developing cardiovascular disease (CVD). Early diagnosis of CVD would benefit African-Americans (AA), who have a higher prevalence of and mortality rate from CVD compared to Caucasians (CA). Two definitions for metabolic syndrome were used to classify healthy CA and AA, and evaluate how other CVD risk factors [C-reactive protein (CRP), percent body fat, fitness level, insulin resistance, and non-high-density lipoprotein cholesterol (HDL-C)] changed metabolic syndrome classification.
Methods:
Healthy AA (n = 97) and CA (n = 51) ranging from normal weight to obese, 18-45 years of age, with neither hypertension nor diabetes, were evaluated for cardiorespiratory fitness, height, weight, percent body fat, hip and waist circumference, blood pressure (BP), and fasting blood glucose, insulin, triglycerides, HDL, non-HDL-C, and CRP. Participants were classified as meeting the criteria for metabolic syndrome according to the National Cholesterol Education Program Adult Treatment Panel III 2004 (NCEP ATP III) and the International Diabetes Federation (IDF) definitions.
Results:
Significant ethnic differences (P < 0.01) in classification were noted for both metabolic syndrome definitions (NCEP ATP III, CA = 16.7% vs. AA = 5.7%; IDF, CA = 23.5% vs. AA = 8.2%). Ethnic differences were eliminated when fitness level or percent body fat was included as a criterion.
Conclusions:
If diagnosis of metabolic syndrome is intended for early recognition of CVD risk and slowing CVD development, current definitions for metabolic syndrome will not capture healthy AA. Health-care providers may consider assessing percent body fat and participation in regular exercise, because these criteria would help identify AA at risk.
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