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Geographical variation in the prevalence of obesity, metabolic syndrome, and diabetes among US adults.

ABSTRACT: Cardiovascular disease (CVD) and type 2 diabetes remain significant public health concerns. Targeting of prevention efforts by geographical location has been suggested by the Institute of Medicine to coincide with the presence of area-based risk. The metabolic syndrome (MetS) is a stronger risk factor than is obesity for the prediction of future CVD and diabetes, yet its prevalence has not previously been described geographically. Our objective is to determine geographical variation in the prevalence of obesity, MetS, and diabetes among US adults. We assessed the prevalence of obesity, MetS, and diabetes by US census division, and the prevalence of obesity, MetS, and diabetes for each sex and racial/ethnic group by US region among 9826 US non-Hispanic white, non-Hispanic black, and Hispanic adults aged 20-65 years participating in the National Health and Nutrition Examination Survey 1999-2014. We also compared a sex- and race/ethnicity-specific MetS severity score by geographical area. The prevalence of obesity, MetS, and diabetes varied by US census division and region, with overall similarity by geographical area in the prevalence of each of these conditions. The prevalence of MetS was particularly high (?35%) in the West North Central, West South Central, and East South Central and low (30%) in the Pacific, New England, and Mid-Atlantic divisions. Some of the geographical variation appeared due to differences among non-Hispanic white females, who had a high prevalence of MetS (>32%) in the Midwest and South and a low prevalence of MetS (24%) in the West and Northeast. Geographical differences in MetS imply variation in the risk for future CVD and diabetes, with more elevated risk in the center of the United States. As MetS is a stronger risk factor for prediction of CVD and T2DM than is obesity, these differences are potentially important for prompting public health efforts toward surveillance and prevention in high-risk areas.

SUBMITTER: Gurka MJ

PROVIDER: S-EPMC5856741 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Geographical variation in the prevalence of obesity, metabolic syndrome, and diabetes among US adults.

Gurka Matthew J MJ Filipp Stephanie L SL DeBoer Mark D MD

Nutrition & diabetes 20180313 1

Cardiovascular disease (CVD) and type 2 diabetes remain significant public health concerns. Targeting of prevention efforts by geographical location has been suggested by the Institute of Medicine to coincide with the presence of area-based risk. The metabolic syndrome (MetS) is a stronger risk factor than is obesity for the prediction of future CVD and diabetes, yet its prevalence has not previously been described geographically. Our objective is to determine geographical variation in the preva ...[more]

PMID: 29549249

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Project description:Metabolic Syndrome (MS) increases the risk for Coronary Artery Disease, stroke and diabetes. MS is twice more common amongst South Asian immigrants in US compared to native Caucasians. There are no nationally representative studies on prevalence of MS from any of the South Asian countries. The present study aims to evaluate the prevalence of MS among Sri Lankan adults and investigates its relationships with socio-demographic, clinical and biochemical parameters. Data on MS and its associated details were obtained from a population-based cross-sectional study conducted between years 2005-2006. MS was defined according to the International Diabetes Federation criteria. A binary logistic regression analysis was performed using the dichotomous variable MS (0?=?absent, 1?=?present). The independent co-variants were: gender, age category, area of residence, ethnicity, level of education, income and physical activity. Sample size was 4,485 (Response rate-89.7%), 39.5% were males and mean age was 46.1?±?15.1?years. The crude prevalence of MS was 27.1% (95% CI: 25.8-28.5), and age-adjusted prevalence was 24.3% (95% CI: 23.0-25.6). Prevalence in males and females were 18.4% (95% CI: 16.5-20.3) and 28.3% (95% CI: 26.6-30.0) respectively (p?<?0.001). Urban adults (34.8% [95% CI: 31.8-37.9]) had a significantly higher prevalence than rural adults (21.6% [95% CI: 20.2-23.0]). Among ethnic groups, the highest prevalence of MS was observed in Sri Lankan Moors (43.0% [95% CI: 37.2-48.9]). In all adults, MS was observed in those with the highest level of education and monthly household income. Prevalence of MS in the different physical activity categories of the IPAQ were; 'inactive'-38.8% (95% CI 34.5-43.2), 'moderately active'-33.5% (95% CI 30.9-36.1) and 'active'-21.1% (95% CI 19.6-22.7). The results of the binary logistic regression analysis indicates that female gender (OR:1.7), increasing age, urban living (OR:1.7), Moor ethnicity (OR:2.6), secondary (OR:1.5) and tertiary levels of education (OR:2.3), monthly household income LKR 7,000-24,999 (OR:1.5) and >50,000 (OR:2.1), and physical inactivity (OR:1.6), all significantly increased risk of developing MS. MS is common among Sri Lankan adults affecting nearly one-fourth of the population. Female gender, increasing age, urban living, higher socio-economical status and physical inactivity were important associated factors.

Project description:BACKGROUND:Metabolic syndrome (MetS) is defined as the presence of central obesity plus any two of the following markers: high triglycerides (>?150 mg/dl), low high density lipoprotein (HDL) cholesterol <?40 mg/dl in men and?<?50 mg/dl in women, hypertension (blood pressure?>?130/85 mmHg or use of antihypertensive medication), high fasting blood glucose (>?100 mg/dl or use of treatment for diabetes mellitus). Since recently, metabolic syndrome and obesity have become emerging problems of both low and middle income countries, although they have been the leading cause of morbidity and mortality in high income countries for the past decades. It has been indicated that the international anthropometric cut-off for detecting obesity is not appropriate for Ethiopians. This study developed optimal cut off values for anthropometric indicators of obesity and markers of metabolic syndrome for Ethiopian adults to enhance preventive interventions. METHODS:A total of 704 employees of Jimma University were randomly selected using their payroll as a sampling frame. Data on socio-demographic, anthropometry, clinical and blood samples were collected from February to April 2015. Receiver Operating Characteristic Curve analyses were used to determine optimal anthropometric cut-off values for obesity and markers of the metabolic syndrome. WHO indicators of obesity based on body fat percent (>?25% for males and?>?35% for females) were used as binary classifiers for developing anthropometric cut-offs. Optimal cut-off values were presented using sensitivity, specificity and area under the curve. RESULTS:The optimal cut-off for obesity using body mass index was 22.2 k/m2 for males and 24.5 kg/m2 for females. Similarly, the optimal waist circumference cut-off for obesity was 83.7 cm for males and 78.0 cm for females. The cut-off values for detecting obesity using waist to hip ratio and waist to height ratio were: WHR (0.88) and WHtR (0.49) for males, while they were 0.82 and 0.50 for females, respectively. Anthropometric cut-off values for markers of metabolic syndrome were lower compared to the international values. For females, the optimal BMI cut-offs for metabolic syndrome markers ranged from 24.8 kg/m2 (triglycerides) to 26.8 kg/m2 (fasting blood sugar). For WC the optimal cut-off ranged from of 82.1 cm (triglyceride) to 96.0 cm(HDL); while for WHtR the optimal values varied from 0.47(HDL) to 0.56(fasting blood sugar). Likewise, the optimal cut-offs of WHR for markers of metabolic syndrome ranged from 0.78(fasting blood sugar) to 0.89(HDL and blood pressure). For males, the optimal BMI cut-offs for metabolic syndrome markers ranged from 21.0 kg/m2 (HDL) to 23.5 kg/m2 (blood pressure). For WC, the optimal cut-off ranged from 85.3 cm (triglyceride) to 96.0 cm(fasting blood sugar); while for WHtR the optimal values varied from 0.47(BP, FBS and HDL) to 0.53(Triglyceride). Similarly, the optimal cut-offs of WHR form markers of metabolic syndrome ranged from 0.86(blood pressure) to 0.95(fasting blood sugar). CONCLUSION:The optimal anthropometric cut-offs for obesity and markers of metabolic syndrome in Ethiopian adults are lower than the international values. The findings imply that the international cut-off for WC, WHtR, WHR and BMI underestimate obesity and metabolic syndrome markers among Ethiopian adults, which should be considered in developing intervention strategies. It is recommended to use the new cut-offs for public health interventions to curb the increasing magnitude of obesity and associated metabolic syndrome and diet related non-communicable diseases in Ethiopia.

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Geographical variation in the prevalence of obesity, metabolic syndrome, and diabetes among US adults.

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Geographical variation in the prevalence of obesity, metabolic syndrome, and diabetes among US adults.

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