Should Central Obesity Be an Optional or Essential Component of the Metabolic Syndrome?

Abstract

OBJECTIVE -The International Diabetes Federation (IDF) proposes that central obesity is an "essential" component of the metabolic syndrome, while the American Heart Association/ National Heart, Lung, and Blood Institute (AHA/NHLBI) proposes that central obesity is an "optional" component. This study examines the effect of the metabolic syndrome with and without central obesity in an Asian population with ischemic heart disease (IHD). RESEARCH DESIGN AND METHODS-From the population-based cohort study (baseline 1992-1995), 4,334 healthy individuals were grouped by the presence or absence of the metabolic syndrome and central obesity and followed up for an average of 9.6 years by linkage with three national registries. Cox's proportional hazards model was used to obtain adjusted hazard ratios (HRs) for risk of a first IHD event.RESULTS -The prevalence of metabolic syndrome was 17.7% by IDF criteria and 26.2% by AHA/NHLBI criteria using Asian waist circumference cutoff points for central obesity. Asian Indians had higher rates than Chinese and Malays. There were 135 first IHD events. Compared with individuals without metabolic syndrome, those with central obesity/metabolic syndrome and no central obesity/metabolic syndrome were at significantly increased risk of IHD, with adjusted HRs of 2.8 (95% CI 1.8 -4.2) and 2.5 (1.5-4.0), respectively. CONCLUSIONS -Having metabolic syndrome either with or without central obesity confers IHD risk. However, having central obesity as an "optional" rather than "essential" criterion identifies more individuals at risk of IHD in this Asian cohort.

Anthropometry and physical activity level in the prediction of metabolic syndrome in children

“…The conicity index was accurate in the prediction of MetS for boys only, with a cut-off point of 1?16 (AUC 5 0?737; 95 % CI 0?520, 0?955). The conicity index predominantly assesses central fat that is highly correlated with components of the MetS (37) . However, as the conicity index was created for adults and with sex-specific cut-off points, its use in children has remained somewhat controversial.…”

Risk of Chronic Kidney Disease in Non-Obese Individuals with Clustering of Metabolic Factors: A Longitudinal Study

“…For example, non-obese MS, a seemingly healthy condition satisfying the NCEP criteria, but not obesity-based criteria, has been reported to be a precursor to type 2 diabetes and CVD (33). In recent years, the risk of CVD has been reported to be higher for non-obese MS patients than for obese MS patients (20,24,25). However, the risk of CKD in these individuals remains unclear.…”

“…The relative superiority of the NCEP and IDF criteria for predicting CVD remains controversial. According to the use of obesity-based criteria for MS, concerns have been raised over the possibility of overlooking normal-weight individuals with multiple risk factors at high risk of CVD and carotid atherosclerosis (20)(21)(22)(23)(24)(25)(26). However, no longitudinal studies have compared the risk of CKD between obese and non-obese individuals with metabolic disorders.…”

Components of Metabolic Syndrome and their Combinations as Predictors of Cardiovascular Disease in Japanese Patients with Type 2 Diabetes. Implications for Improved Definition. Analysis from Japan Diabetes Complications Study (JDCS)

“…The poor prognostic power of the IDF definition in diabetic subjects has also been reported for other ethnic groups, such as Hong Kong Chinese . Lack of a rationale for excess WC as a mandatory component of MetS was also shown in recent studies of non-diabetic subjects 14,28) . Table 3 shows the suggested definitions of MetS for Japanese patients with type 2 diabetes based on our current and previous results.…”