Epidemiology

The prevalence of metabolic syndrome depends on the criteria used to determine inclusion and the composition (age, sex, race, ethnicity) of the population studied. The most widely used criteria are those of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) and the International Diabetes Federation (IDF).[4]

In a large study of the US population using the NCEP-ATP III criteria in 2002, the unadjusted and age-adjusted prevalences of metabolic syndrome were 21.8% and 23.7%, respectively.[5] Similar results were found in a Greek study based on the NCEP-ATP III criteria, in which the age-standardized prevalence of metabolic syndrome was 23.6%.[6] Prevalence seems to be higher using the IDF criteria than using the NCEP-ATP III criteria.[4] In a comparison of IDF with NCEP-ATP III criteria, the age-adjusted prevalence of metabolic syndrome defined by NCEP-ATP III was 24.5%, whereas that defined by IDF was 43.4% (P <0.0001), although the calculated vascular event risk was lower in those with IDF-defined metabolic syndrome.[7] One study using American Heart Association/National Heart, Lung, and Blood Institute criteria found that from 1999-2000 to 2017-2018, the prevalence of metabolic syndrome in the US increased from 36.2% to 47.3%.​[8] The study also found that in 2017-2018 the prevalence was higher in older adults, those with lower education, and those with lower income.[8]​​

The prevalence of metabolic syndrome increases consistently with increasing age (independently of sex), from 6.7% for patients ages 20 to 29 years, to 43.5% for ages 60 to 69 years, and 42% for ages 70 years and older.[5][6]

The prevalence of metabolic syndrome seems to be similar for men and women, but lower in white, non-Hispanic women than men, and higher in African-American women than men.[4][5][6]​​

The incidence of metabolic syndrome components defined by the same criteria varies by ethnicity. In particular, obesity-related conditions (type 2 diabetes mellitus, hypertension, dyslipidemia) occur more frequently at a lower body mass index in Asians than in white people, and people of Far East Asian origin have a higher risk of cardiovascular disease.[9][10] In Canada the age-standardized proportional rates of death from coronary artery disease were much higher among Canadians of South Asian origin than among Canadians of European origin, but the reason for this higher prevalence is unknown.[11]

Metabolic syndrome is more frequent with: current smoking; heavy (>60% of total calories) compared with moderate carbohydrate intake; physical inactivity; alcohol intake; lower household income; and residence in an urban area.[4]

Commonly associated comorbid conditions (which are also related to obesity and insulin resistance but are not components of metabolic syndrome required for diagnosis) include polycystic ovary syndrome, hypogonadism, obstructive sleep apnea, and metabolic dysfunction-associated steatotic liver disease (previously known as nonalcoholic fatty liver disease).[4]

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