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Geographic Variations of the International Diabetes Federation and the National Cholesterol Education Program–Adult Treatment Panel III Definitions of the Metabolic Syndrome in Nondiabetic Subjects

¹ Department of Medicine, University of Texas Health Science Center, San Antonio, Texas
² Department of Medicine, Hospital Universitario San Carlos, Red de Centros de Metabolismo y Nutricion (RCMN) 03/08, Madrid, Spain
³ Diabetes Clinic, Cayetano Heredia Peruvian University, Lima, Peru
⁴ Centro de Estudios en Diabetes, Centro de Investigacion en Salud Poblacional, Instituto Nacional de la Salud Publica, Instituto Mexicano del Seguro Social, American British Cowdray Medical Center, Mexico City, Mexico

Address correspondencereprint requests to Dr. Carlos Lorenzo, Division of Clinical Epidemiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78284-7873. E-mail: lorenzo{at}uthscsa.edu

OBJECTIVE—We have carried out international comparisons of the metabolic syndrome using the International Diabetes Federation (IDF) and National Cholesterol Education Program–Adult Treatment Panel III (ATP III) definitions. This analysis could help to discern the applicability of these definitions across populations.

RESEARCH DESIGN AND METHODS—Nondiabetic subjects aged 35–64 years were eligible for analysis in population-based studies from San Antonio (Mexican Americans and non-Hispanic whites, n = 2,473), Mexico City (n = 1,990), Spain (n = 2,540), and Peru (n = 346). Statistics examined the agreement between metabolic syndrome definitions.

RESULTS—Because of the lower cutoff points for elevated waist circumference, the IDF definition of the metabolic syndrome generated greater prevalence estimates than the ATP III definition. Prevalence difference between definitions was more significant in Mexican-origin and Peruvian men than in Europid men from San Antonio and Spain because the IDF definition required ethnic group–specific cutoff points for elevated waist circumference. ATP III and IDF definitions disagreed in the classification of 13–29% of men and 3–7% of women. In men, agreement between these definitions was 0.54 in Peru, 0.43 in Mexico City, 0.62 in San Antonio Mexican Americans, 0.69 in San Antonio non-Hispanic whites, and 0.64 in Spain. In women, agreement between definitions was 0.87, 0.89, 0.86, 0.87, and 0.93, respectively.

CONCLUSIONS—The IDF definition of the metabolic syndrome generates greater prevalence estimates than the ATP III definition. Agreement between ATP III and IDF definitions was lower for men than for women in all populations and was relatively poor in men from Mexico City.

Abbreviations: ATP III, Adult Treatment Panel III • IDF, International Diabetes Federation • MCDS, Mexico City Diabetes Study • PIRS, Peruvian Insulin Resistance Study • SAHS, San Antonio Heart Study • SIRS, Spanish Insulin Resistance Study

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