Prevalence and Trends of Metabolic Syndrome in the Adult US Population, 1999-2010

Study Questions:

Has the prevalence of metabolic syndrome and associated treatment changed over time?


Prevalence estimates for metabolic syndrome (MetS) were estimated in adults (≥20 years) from the National Health and Nutrition Examination Survey (NHANES) from 1999-2010 (in 2-year survey waves). The biological thresholds, defined by the 2009 Joint Scientific Statement, were: 1) waist circumference ≥102 cm (males), and ≥88 cm (females); 2) fasting plasma glucose ≥100 mg/dl; 3) blood pressure of ≥130/85 mm Hg; 4) triglycerides ≥150 mg/dl; 5) high-density lipoprotein cholesterol (HDL-C) <40 mg/dl (males), and <50 mg/dl (females). Prescription drug use was estimated for lipid-modifying agents, antihypertensives, and antihyperglycemic medications.


Approximately one fifth of the adult US population remains at high cardiometabolic risk. From 1999/2000 to 2009/2010, the age-adjusted prevalence of MetS decreased from 25.5% (95% confidence interval [CI], 22.5-28.6) to 22.9% (95% CI, 20.3-25.5) (p-trend = 0.024). During this period, hypertriglyceridemia prevalence decreased (33.5% to 24.3%), as did elevated blood pressure (32.3% to 24.0%). The prevalence of hyperglycemia increased (12.9% to 19.9%). The prevalence of abdominal obesity for the total population increased from 45.4% (95% CI, 40.7-50.0%) in 1999/2000 to 56.1% (95% CI, 52.8-59.4%) in 2009/2010. However, baseline rates of abdominal obesity were much higher among females than males. Mexican-Americans, particularly females, had a higher MetS prevalence than other subgroups. Estimates of elevated blood pressure for the total population declined over time, from 32.3% (95% CI, 29.0-35.6) in 1999/2000 to 24.0% (95% CI, 20.9-27.1) (p-trend < 0.001) in 2009/2010. Among males, only non-Mexican-American whites experienced a decline in elevated blood pressure, while among females, both non-Mexican-American whites and Mexican-Americans showed a decline. The prevalence of hypertriglyceridemia also declined in the total population over the study period, from 33.5% (95% CI, 29.8-37.3) to 24.3% (95% CI, 21.6-26.9) (p-trend < 0.001). All racial/ethnic groups experienced a decline in elevated triglycerides except for non-Mexican-American blacks, although the latter group showed the lowest baseline prevalence of hypertriglyceridemia. Decreases in elevated blood pressure, suboptimal triglycerides, and HDL-C prevalence have corresponded with increases in antihypertensive and lipid-modifying drugs, respectively.


The authors concluded that an increasing prevalence of abdominal obesity, particularly among females, highlights the urgency of addressing abdominal obesity as a health care priority. The use of therapies for MetS components aligns with favorable trends in their prevalence.


Encouraging trends toward treatment of several components of MetS were observed in this examination of NHANES data; however, it remains concerning that particularly among women, abdominal obesity remains highly prevalent without signs of decline.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Hypertriglyceridemia, Lipid Metabolism, Nonstatins, Diet

Keywords: Obesity, Abdominal, Hyperglycemia, Hypertriglyceridemia, European Continental Ancestry Group, Transcription Factors, Glucose, Metabolic Syndrome X, Prevalence, Waist Circumference, Cholesterol, Cardiovascular Diseases, Hypoglycemic Agents, Confidence Intervals, Blood Pressure Determination, African Continental Ancestry Group, Fasting

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