Top

Journal of Public Health

Published in:

01-06-2008 | Original Article

Estimation of the metabolic syndrome prevalence in the general population in Germany

Authors: Hannelore Neuhauser, Ute Ellert

Published in: Journal of Public Health | Issue 3/2008

Abstract

Aim

The purpose of this study was to estimate the order of magnitude of the metabolic syndrome (MetS) prevalence in Germany despite a lack of sufficient fasting participants in representative national studies.

Subjects and methods

This analysis was based on 6,666 participants of the National Health Examination Survey (NHIES) 1998 aged 18–79, using the criteria of the National Cholesterol Education Program (NCEP), hemoglobin A_1c (HbA_1c), non-fasting triglycerides and fasting time.

Results

Among 6,666 participants, 26.3% were fasting for at least 8 h and an additional 60.4% could be classified according to the NCEP criteria based on their waist circumference, HDL cholesterol and blood pressure alone (if all three parameters were above or all below the NCEP thresholds). MetS determination in the remaining 13.3% of the sample according to the NCEP criteria would have required fasting glucose and triglyceride values that were not available (inconclusive cases). The metabolic syndrome prevalence in the overall sample was therefore estimated to be at least 13.6%, if all inconclusive cases did not have the MetS, and at most 26.9%, if all inconclusive cases had the MetS. We narrowed down this range by classifying the inconclusive cases stepwise, first by adding information on HbA_1c with cutoffs >6.1% and >6.0% and then by including information on non-fasting triglycerides with three different cutoffs (≥250 mg/dl, ≥200 mg/dl and ≥75th percentile of the population distribution stratified by fasting time). Based on these different cutoffs, the prevalence of the MetS in adults aged 18–79 in Germany was estimated to lie between 20.0 to 22.5%. Using one of the more conservative scenarios (HbA1c >6.1% and triglycerides ≥75th population percentile), the presence of the MetS was associated with living in East compared to West Germany (OR 1.4, 95% CI 1.2–1.6), with lower education (OR 1.7, 95% CI 1.4–2.0 compared to higher education) and with male sex (OR 1.5, 95% CI 1.3–1.7) in an analysis additionally adjusting for age, current daily smoking and non-HDL cholesterol.

Conclusions

Despite imperfect data for prevalence estimation, a high prevalence and an uneven East-West and socioeconomic distribution of the MetS phenotype in Germany can be shown and should be used in order to improve national preventive strategies.

Alberti KG, Zimmet P, Shaw J (2005) The metabolic syndrome–a new worldwide definition. Lancet 366:1059–1062PubMedCrossRef

Alberti KG, Zimmet PZ for the World Health Organization (WHO) Consultation (1998) Definition, diagnosis and classification of diabetes mellitus and its complication. Part I: diagnosis and classification of diabetes mellitus: provisional report of a WHO consultation. Diabet Med 15:539–553

Balkau B, Charles MA, Drivsholm T, Borch-Johnsen K, Wareham N, Yudkin JS, Morris R, Zavaroni I, van Dam R, Feskins E, Gabriel R, Diet M, Nilsson P, Hedblad B (2002) Frequency of the WHO metabolic syndrome in European cohorts, and an alternative definition of an insulin resistance syndrome. Diabetes Metab 28:364–376PubMed

Balkau B, Charles MA, the European Group for the Study of Insulin Resistance (EGIR) (1999) Comment on the provisional report from the WHO consultation. Diabet Med 16:442–443

Barr RG, Nathan DM, Meigs JB, Singer DE (2002) Tests of glycemia for the diagnosis of type 2 diabetes mellitus. Ann Intern Med 137:263–272PubMed

Bellach BM, Knopf H, Thefeld W (1998) [The German Health Survey. 1997/98]. Gesundheitswesen 60(Suppl 2):59–68

Bennett CM, Guo M, Dharmage SC (2007) HbA(1c) as a screening tool for detection of type 2 diabetes: a systematic review. Diabet Med 24:333–343PubMedCrossRef

Bergmann KE, Mensink GBM (1999) Anthropometric data and overweight. Gesundheitswesen 61 (Suppl 2):115–120

Cameron AJ, Shaw JE, Zimmet PZ (2004) The metabolic syndrome: prevalence in worldwide populations. Endocrinol Metab Clin N Am 33:351–375CrossRef

de Ferranti SD, Gauvreau K, Ludwig DS, Neufeld EJ, Newburger JW, Rifai N (2004) Prevalence of the metabolic syndrome in American adolescents: findings from the Third National Health and Nutrition Examination Survey. Circulation 110:2494–2497PubMedCrossRef

Eberly LE, Stamler J, Neaton JD for the Multiple Risk Factor Intervention Trial Research Group (2003) Relation of triglyceride levels, fasting and nonfasting, to fatal and nonfatal coronary heart disease. Arch Intern Med 163:1077–1083

Engelgau MM, Thomsen TJ, Herman WH, Boyle JP, Aubert RE, Kenny SJ, Badran A, Sous ES, Ali MA (1997) Comparison of fasting and 2-hour glucose and HbA1c levels for diagnosing diabetes. Diabetes Care 20:785–791PubMedCrossRef

Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (1997) Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 20:1183–1197

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (2001) 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 (Adult Treatment Panel III). JAMA 285:2486–2497

Flegal KM, Carroll MD, Ogden CL, Johnson CL (2002) Prevalence and trends in obesity among US adults, 1999–2000. JAMA 288:1723–1727PubMedCrossRef

Ford ES, Wayne HG (2003) A comparison of the prevalence of the metabolic syndrome using two proposed definitions. Diabetes Care 26:575–581PubMedCrossRef

Ford ES, Giles WH, Dietz WH (2002) Prevalence of the metabolic syndrome among US adults. Finding from the Third National Health and Nutrition Examination Survey. JAMA 287:356–359PubMedCrossRef

Hokanson JE, Austin MA (1993) Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol level: a meta-analysis of population-based prospective studies. J Cardiovasc Risk 3:213–219CrossRef

Iso H, Naito Y, Sato S, Kitamura A, Okamura T, Sankai T, Shimamoto T, Iida M, Momachi Y (2001) Serum triglycerides and risk of coronary heart disease among Japanese men and women. Am J Epidemiol 153:490–499PubMedCrossRef

James WPT, Jackson-Leach R, Mhurchu CN (2004). Overweight and obesity (high body mass index). Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors. M. Ezzati, A. D. Lopez, A. Rodgers, C. J. L. Murray. Geneva, WHO. 1:497–596

Kahn R, Ferrannini E, Buse J, Stern M (2005) The metabolic syndrome: time for a critical appraisal. Joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 28:2289–2304PubMedCrossRef

McCance DR, Hanson RL, Charles MA, Jacovsson LTH, Pettitt DJ, Bennett PH, Knowler WC (1994) Comparison of tests of glycated haemoglobin and fasting and two hour plasma glucose concentrations as diagnostic methods for diabetes. BMJ 1994:1323–1328

Müller-Nordhorn J, Rossnagel K, Mey W, Willich SN (2004) Regional variation and time trends in mortality from ischaemic heart disease: East and West Germany 10 years after reunification. J Epidemiol Community Health 58:481–485PubMedCrossRef

Neuhauser HK (2005) The metabolic syndrome. Lancet 366:1922–1923PubMedCrossRef

NIH Consensus Development Panel on Triglyceride H-DL, and Coronary Heart Disease, (1993) NIH consensus conference: triglyceride, high-density lipoprotein, and coronary heart disease. JAMA 269:505–510

Nilsson PM, Engstrom G, Hedblad B (2007) The metabolic syndrome and incidence of cardiovascular disease in non-diabetic subjects-a population-based study comparing three different definitions. Diabet Med 24:464–472PubMedCrossRef

Patsch JR, Miesenbock G, Hopferwieser T, Muhlberger V, Knapp E, Dunn JK, Gotto AM, Patsch W (1992) Relation of triglyceride metabolism and coronary artery disease. Studies in the postprandial state. Arteioscler Thromb 12:1336–1345

Peters AL, Davidson MB, Schriger DL, Hasselblad V (1996) A clinical approach for the diagnosis of diabetes mellitus: an analysis using glycosylated hemoglobin levels. Meta-analysis Research Group on the Diagnosis of Diabetes Using Glycated Hemoglobin Levels. JAMA 276:1246–1252PubMedCrossRef

Rathmann W, Haastert B, Icks A, Giani G, Holle R, Koenig W, Lowel H, Meisinger C (2006) Prevalence of the metabolic syndrome in the elderly population according to IDF, WHO, and NCEP definitions and associations with C-reactive protein: the KORA Survey 2000. Diabetes Care 29:461PubMedCrossRef

Rohlfing CL, Little RR, Wiedmeyer H, England JD, Madsen R, Harris MI, Flegal KM, Eberhardt MS, Goldstein DE (2000) Use of GHb (HbA1c) in screening for undiagnosed diabetes in the U.S. population. Diabetes Care 23:187–191PubMedCrossRef

Ryu JE, Howard G, Craven TE, Bond MG, Hagaman AP, Crouse JR (1992) Postprandial triglyceridemia and carotid atherosclerosis in middle-aged subjects. Stroke 23:823–828PubMed

Stampfer MJ, Krauss RM, Ma J, Blanche PJ, Holl LG, Sacks FM, Hennekens CC (1996) A prospective study of triglyceride level, low-density lipoprotein particle diameter, and risk of myocardial infarction. JAMA 276:882–888PubMedCrossRef

Stensvold I, Tverdal A, Urdal P, Graff-Iversen S (1993) Non-fasting serum triglyceride concentration and mortality from coronary heart disease and any cause in middle aged Norvegian women. BMJ 307:1318–1322PubMedCrossRef

Wolf-Maier K, Cooper RS, Banegas JR, Giampaoli S, Hense HW, Joffres M, Kastarinen M, Poulter N, Primatesta P, Rodriguez-Artalejo F, Stegmayr B, Thamm M, Tuomilehto J, Vanuzzo D, Vescio F (2003) Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA 289:2363–2369PubMedCrossRef

Title: Estimation of the metabolic syndrome prevalence in the general population in Germany
Authors: Hannelore Neuhauser
Ute Ellert
Publication date: 01-06-2008
Publisher: Springer-Verlag
Published in: Journal of Public Health / Issue 3/2008
Print ISSN: 2198-1833
Electronic ISSN: 1613-2238
DOI: https://doi.org/10.1007/s10389-007-0168-3

2024 ASCO Annual Meeting

Springer Medicine

Estimation of the metabolic syndrome prevalence in the general population in Germany

Abstract

Aim

Subjects and methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Aim

Subjects and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2008

Knowledge, perception and acceptability of microbicides among non-health care workers in Lagos, Nigeria

The Romanian model of hospital financing reform

Prevention, health promotion and workplace health management in German banks: Results from a nationwide representative survey

Evidence-based public health: a critical perspective

The Armenian healthcare system: recent changes and challenges

Public awareness of the abuse of herbs and drugs to decrease body weight: a novel national survey in Jordan