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The prevalence of metabolic syndrome has increased significantly in recent years among U.S. adults and, perhaps more troubling, among overweight adolescents, according to two studies recently reported in Diabetes Care.
Researchers from the Centers for Disease Control and Prevention (CDC), reported that the increased prevalence of metabolic syndrome in adults is likely to lead to future increases in diabetes and cardiovascular disease.1
A second study, by University of Washington researchers, concluded that the incidence of metabolic syndrome increased significantly over the past decade among U.S. adolescents and is particularly prevalent in overweight adolescents.2
The initial sample for the University of Washington study consisted of 2,165 individuals aged 12 to 19 who had a fasting plasma glucose value recorded. The increase in metabolic syndrome was evident in both sexes and in all three major race/ethnic groups analyzed in the study. Nevertheless, researchers found it was more prevalent in male than female adolescents.
"We are seeing more obesity problems in adolescents who are not getting enough exercise and have the beginnings of glucose abnormalities," says Glen E. Duncan, PhD, RCEPSM, principal investigator on the study. It follows that "primary care doctors should be more prudent in referring children and adolescents to follow-up with an endocrinologist or internist," he adds.
In the CDC study, researchers set out to determine whether the prevalence of metabolic syndrome has changed since 1988 through 1994. They reported a significant increase in the syndrome among U.S. adults aged 20 and older, particularly women.
In addition, increases in high blood pressure, waist circumference, and high triglycerides accounted for much of the increase in the prevalence of the syndrome.
Earl S. Ford, MD, MPH, lead investigator on the CDC study, reported that health care professionals have a critical role to play in preventing the development of metabolic syndrome in their patients through weight management and achieving proper physical activity levels. "Physicians are uniquely situated to assume this job," he says.
The research in the University of Washington study reinforces what primary care physicians are seeing in their practices, says Michael Fleming, MD, FAAFP, board chair of the American Academy of Family Physicians.
"There is an increasing incidence of type 2 diabetes in young people
and an alarming increase in childhood and adolescent obesity." Fleming
agrees that risk factor awareness and intervention among primary care
physicians is therefore vital. 
Coming to Terms with Metabolic Syndrome
For many primary care professionals, metabolic syndrome is like art; difficult to define, but they know it when they see it. When asked whether they treat metabolic syndrome, doctors invariably answer in the affirmative. Ask about diagnostic criteria, and concepts quickly become fuzzy and vague. Since first described in the late 1980s, the condition has been known variously as "syndrome X" and "dysmetabolic syndrome," among other terms. Whatever the label, the designations recognize a cluster of risk factors—including hypertension, elevated triglycerides, and central obesity—that raise the risk of cardiovascular disease.
Because of a lack of widely accepted diagnostic criteria, in 1999 the World Health Organization (WHO) proposed a working definition of metabolic syndrome that includes several key measures:
140/90 mmHg) 150 mg/dl) and/or low HDL cholesterol
(<35 mg/dl for men; <39 mg/dl for women) 20 µg/min or
albumin:creatinine ratio 30 mg/g By the WHO criteria, metabolic syndrome is diagnosed by the presence of two or more of these signs.
In 2001, the National Cholesterol Education Program (NCEP) published a slightly different definition of metabolic syndrome1:
150 mg/dl 130, 85 mmHg 110 mg/dl The diagnosis of metabolic syndrome is made when a person has three or more signs under the NCEP criteria.
Clinical Confusion
The emergence of different diagnostic criteria for metabolic syndrome has
resulted in confusion in the clinical arena, says Jorge Plutzky, MD, of
Harvard Medical School, who moderated a panel on the subject at the American
Heart Association Scientific Sessions in New Orleans, La.
"There are different definitions of metabolic syndrome, and that is a challenge for us to best define the syndrome," says Plutzky.
The scaled-down NCEP guidelines, which lack testing for glucose response, are a "very good starting point" for clinicians, says Plutzky. "I think we will continue to fine-tune the criteria over time."
Is one set of criteria better than another for diagnosing metabolic syndrome? According to a recent report from researchers at University of Texas Health Science Center, San Antonio, the answer is no.2 Kelly J. Hunt, PhD, and colleagues reviewed records of more than 2,800 patients enrolled in the San Antonio Heart Study to compare the utility of the WHO and NCEP definitions.
Both definitions are predictive in general populations, according to Hunt and colleagues, although the simpler NCEP definition "tended to be more predictive in the lower-risk subjects."
References
2. Duncan GE, Li SM, Zhou XH: Prevalence and trends of a metabolic
syndrome phenotype among U.S. adolescents, 1999–2000.
Diabetes Care 27:2438–2443, 2004.
1. Executive summary of the third report of the National Cholesterol
Education Program (NCEP) expert panel on detection, evaluation, and treatment
of high blood cholesterol in adults. JAMA 285: 2486–2497, 2001.
2. Hunt KJ, Resendez RG, Williams K, Haffner SM, Stern MP: National
Cholesterol Education Program versus World Health Organization metabolic
syndrome in relation to all-cause and cardiovascular mortality in the San
Antonio Heart Study. Circulation 110: 1251–1257, 2004.
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