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Can We Apply the National Cholesterol Education Program Adult Treatment Panel Definition of the Metabolic Syndrome to Asians?

¹ Department of Endocrinology, Singapore General Hospital, Singapore
² Ministry of Health, College of Medicine Building, Singapore

Address correspondence and reprint requests to Dr. C.E. Tan, Department of Endocrinology, Singapore General Hospital, Block 6 Level 6, Outram Road, Singapore 169608, Republic of Singapore. E-mail: ce_tan{at}sgh.com.sg

OBJECTIVE—Limited information is available about the metabolic syndrome in Asians. Furthermore, the definition of central obesity using waist circumference may not be appropriate for Asians. The objectives of this study were to determine the optimal waist circumference for diagnosing central obesity in Asians and to estimate the prevalence of the metabolic syndrome in an Asian population.

RESEARCH DESIGN AND METHODS—We used data from the 1998 Singapore National Health Survey, a cross-sectional survey involving 4,723 men and women of Chinese, Malay, and Asian-Indian ethnicity aged 18–69 years. Receiver operating characteristic analysis suggested that waist circumference >80 cm in women and >90 cm in men was a more appropriate definition of central obesity in this population. The prevalence of the metabolic syndrome was then determined using the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria with and without the modified waist circumference criteria.

RESULTS—In Asians, decreasing waist circumference increased the crude prevalence of the metabolic syndrome from 12.2 to 17.9%. Using the modified Asian criteria, the prevalence of the metabolic syndrome increased from 2.9% in those aged 18–30 years to 31.0% in those aged 60–69 years. It was more common in men (prevalence 20.9% in men versus 15.5% in women; P < 0.001) and Asian Indians (prevalence 28.8% in Asian-Indians, 24.2% in Malays, and 14.8% in Chinese; P < 0.001).

CONCLUSIONS— NCEP ATP III criteria, applied to an Asian population, will underestimate the population at risk. With a lower waist circumference cutoff, the prevalence of the metabolic syndrome is comparable to that in Western populations. Ethnic differences are likely to exist between populations across Asia.

Abbreviations: CVD, cardiovascular disease • IGT, impaired glucose tolerance • NCEP ATP III, National Cholesterol Education Program Adult Treatment Panel III • NHANES III, Third National Health and Nutrition Examination Survey • ROC, receiver operating characteristic • WHO, World Health Organization

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