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?

Methods:

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.

Results:

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.

Conclusions:

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.

Perspective:

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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