Classifying Africans with the Metabolic Syndrome

Dec 24, 2008Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme

Identifying metabolic syndrome in African populations

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Abstract

Metabolic syndrome prevalence among urban African women ranged from 5.4% to 25.5% depending on the classification criteria used.

Prevalence rates varied significantly between different definitions: 5.4% (EGIR), 15.7% (ATPIII), >19.4% (WHO), 24.8% (IDF), and 25.5% (ACE).
Only 2.9% of participants had triglyceride levels above 1.69 mmol/l, while 58.8% had HDL levels below 1.29 mmol/l.
Insulin resistance was observed in 27% of the women, and 22.3% had blood pressure readings of 140/90 or higher or were on hypertension medication.
Classification of hypertension, insulin resistance, and hyperglycemia appeared adequate; however, criteria for body composition and dyslipidemia may need adjustments for this population.
No single definition was found to be completely suitable for classifying metabolic syndrome in Africans, suggesting a focus on treating specific cardiovascular risk factors instead.

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This study was aimed to compare prevalences of the metabolic syndrome in Africans using five definitions as proposed by the World Health Organization (WHO), the European Group for the Study of Insulin Resistance (EGIR), the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults [Adult Treatment Panel (ATPIII)], the American College of Endocrinology (ACE), and the International Diabetes Federation (IDF). A further objective was to identify difficulties in classifying Africans with the metabolic syndrome and to suggest specific areas where criteria adjustments for identifying Africans should be made. A case-case-control cross-sectional study involved 102 urban African women. Except for microalbumin data, all data necessary for classification of the metabolic syndrome were collected, including fasting and 2-h glucose and insulin, anthropometric measurements, blood pressure, and lipids. The metabolic syndrome prevalences ranged from 5.4% (EGIR), 15.7% (ATPIII), >or=19.4% (WHO), 24.8% (IDF) to 25.5% (ACE). Only 2.9% (n=3) had a triglyceride level >or=1.69 mmol/l, but 58.8% (n=60) had a HDL-level <1.29 mmol/l, whereas 27% (n=26) were insulin resistant, 22.3% (n=21), had a blood pressure >or=140/90 or used hypertension medication. It seems as if the classification of hypertension, insulin resistance and hyperglycemia might have been adequate, but body composition and dyslipidemia criteria need adjustment for Africans. Since neither definition seems completely suitable for Africans it is suggested that clinical emphasis should rather be on treating any specific cardiovascular disease risk factor that is present, than on diagnosing a patient with the metabolic syndrome.

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Classifying Africans with the Metabolic Syndrome

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