HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ford, E. S. Articles by Mokdad, A. H. Search for Related Content PubMed PubMed Citation Articles by Ford, E. S. Articles by Mokdad, A. H. Social Bookmarking                What's this?

Increasing Prevalence of the Metabolic Syndrome Among U.S. Adults

From the Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia

Address correspondence and reprint requests to Earl Ford, MD, MPH, Centers for Disease Control and Prevention, 4770 Buford Highway, MS K66, Atlanta, GA 30341. E-mail: eford{at}cdc.gov

	ABSTRACT

TOP ABSTRACT INTRODUCTION RESEARCH DESIGN AND METHODS RESULTS CONCLUSIONS References

 
OBJECTIVE—The prevalence of the metabolic syndrome is high among U.S. adults. Our purpose was to determine whether the prevalence of this syndrome has changed since 1988–1994.

RESEARCH DESIGN AND METHODS—A total of 6,436 men and women aged 20 years from the National Health and Nutrition Examination Survey (NHANES) III (1988–1994) and 1,677 participants from NHANES 1999–2000 were included in the analyses. We used the definition of the metabolic syndrome developed by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults.

RESULTS—The unadjusted prevalence of the metabolic syndrome was 23.1% in NHANES III and 26.7% in NHANES 1999–2000 (P = 0.043), and the age-adjusted prevalences were 24.1 and 27.0% (P = 0.088), respectively. The age-adjusted prevalence increased by 23.5% among women (P = 0.021) and 2.2% among men (P = 0.831). Increases in high blood pressure, waist circumference, and hypertriglyceridemia accounted for much of the increase in the prevalence of the metabolic syndrome, particularly among women.

CONCLUSIONS—The increased prevalence of the metabolic syndrome is likely to lead to future increases in diabetes and cardiovascular disease.

Abbreviations: NCEP/ATP III, Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults • NHANES, National Health and Nutrition Examination Survey

	INTRODUCTION

TOP ABSTRACT INTRODUCTION RESEARCH DESIGN AND METHODS RESULTS CONCLUSIONS References

 
In 2001, the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP/ATP III) provided a working definition of the metabolic syndrome based on five commonly measured clinical criteria that clinicians could implement in their practices (1). Using these criteria, we estimated that the unadjusted prevalence of the metabolic syndrome among U.S. adults was 21.7% during 1988–1994 (2). Since then, the prevalence of the metabolic syndrome using NCEP/ATP III criteria has been described for other study populations. The prevalence of the metabolic syndrome among participants of the Framingham Offspring Study and San Antonio Heart Study ranged from 21.3 to 32.8% during the early to mid-1990s (3). High prevalences have been noted among patients infected with the human immunodeficiency virus (4), Filipina women (5), and Native Americans (6). In addition, the NCEP/ATP III criteria have been applied in other countries (7–9). Recent work has shown that people with the metabolic syndrome based on the NCEP/ATP III criteria are at increased risk for diabetes and cardiovascular disease (7,8,10,11).

Obesity and physical activity are two important determinants of the metabolic syndrome (12–15). Because the prevalence of obesity has continued to increase in the U.S. during the 1990s (16,17), we theorized that the prevalence of the metabolic syndrome among adults had increased as well. To test this hypothesis, we used data from two national surveys: the National Health and Nutrition Examination Survey (NHANES) III and NHANES 1999–2000.

	RESEARCH DESIGN AND METHODS

TOP ABSTRACT INTRODUCTION RESEARCH DESIGN AND METHODS RESULTS CONCLUSIONS References

 
According to the NCEP/ATP III report, participants who had three or more of the following criteria were defined as having the metabolic syndrome: abdominal obesity: waist circumference >102 cm in men and >88 cm in women; hypertriglyceridemia: 150 mg/dl (1.695 mmol/l); low HDL cholesterol: <40 mg/dl (<1.036 mmol/l) in men and <50 mg/dl (<1.295 mmol/l) in women; high blood pressure: 130/85 mmHg; and high fasting glucose: 110 mg/dl (6.1 mmol/l). Because a revision of the glucose criterion of the metabolic syndrome was recently announced (18), we also report the prevalence of the metabolic syndrome using a glucose cut point of 100 mg/dl (5.6 mmol/l).

In both NHANES III (1988–1994) and NHANES 1999–2000, the sample was recruited using a multistage stratified sampling design. Both surveys were specifically designed to produce results that are representative of the civilian noninstitutionalized U.S. population. Participants were interviewed at home and were invited to attend the mobile examination center, where they were asked to complete additional questionnaires, undergo various examinations, and provide a blood sample. Details about the surveys may be found elsewhere (19–21).

In both surveys, the waist circumference was measured at the high point of the iliac crest at minimal respiration to the nearest 0.1 cm. Serum triglyceride concentration was measured enzymatically after hydrolyzation to glycerol, and HDL cholesterol was measured after the precipitation of other lipoproteins with a heparin-manganese chloride mixture. Plasma glucose concentration was measured using an enzymatic reaction.

Up to three blood pressure readings were obtained in the mobile examination center in NHANES III and up to four such readings in NHANES 1999–2000. To maintain consistency between the two surveys, we used the average of the last two measurements of blood pressure for participants who had three or four measurements, the last measurement for participants with only two measurements, and the only measurement for participants who had one measurement to establish high blood pressure status. For both surveys, we counted participants who reported currently using antihypertensive or antidiabetic medication (insulin or oral agents) as participants with high blood pressure or diabetes, respectively. Because of increases in the percentage of participants who reported using cholesterol-lowering medications between the two surveys (22) and because these medications can also reduce triglyceride concentration, we calculated the prevalence of the metabolic syndrome using hypertriglyceridemia once based on serum triglyceride concentration alone and again based on serum triglyceride concentration or the use of cholesterol-lowering medications.

Concentrations of plasma glucose and serum triglycerides were measured using reference analytic methods only for NHANES 1999–2000 participants who attended the morning examination. Therefore, we limited the analyses of both surveys to men and nonpregnant women aged 20 years who attended the morning medical examination and who had fasted 8 h. We calculated the prevalence of the metabolic syndrome by age and sex. Because of the limited sample size for the racial or ethnic groups in NHANES 1999–2000, we do not present results for these subgroups. To age-adjust statistics, we directly adjusted to the U.S. population aged 20 years in the year 2000. To test the statistical significance of the changes in the prevalence of the metabolic syndrome between the two surveys, we performed a t test. The pooled standard error for the difference in means was calculated by taking the square root of the sum of the squared standard errors. We used Software for the Statistical Analysis of Correlated Data (SUDAAN) for analyses to account for the complex sampling design. Prevalence estimates were calculated using the sampling weights so that the estimates are representative of the civilian noninstitutionalized U.S. population. Although we focus the presentation of results on the revised NCEP/ATP III definition of the metabolic syndrome, we also present results for the original definition of the metabolic syndrome.

	RESULTS

TOP ABSTRACT INTRODUCTION RESEARCH DESIGN AND METHODS RESULTS CONCLUSIONS References

 
The number of participants who were included in the analyses based on participants who attended the morning examination were 6,436 for NHANES III and 1,677 for NHANES 1999–2000. The age, sex, racial or ethnic, and educational status composition of the two analytic samples was similar.

Of the five metabolic syndrome components, significant increases in the prevalences of abdominal obesity, hypertriglyceridemia, and high blood pressure occurred among women between the two surveys (Table 1). Increases in the prevalences of abdominal obesity and high blood pressure were of borderline significance among men. Changes in hypertriglyceridemia, low HDL cholesterol concentration, and hyperglycemia were not statistically significant.

View this table: [in this window] [in a new window]   Table 1— Age-adjusted prevalence of individual metabolic abnormalities of the metabolic syndrome among U.S. adults aged 20 years: NHANES III (1988–1994) and NHANES 1999–2000

View this table: [in this window] [in a new window]   Table 2— Unadjusted and age-adjusted prevalence (%) of the metabolic syndrome among U.S. adults aged 20 years: NHANES III (1988–1994) and NHANES 1999–2000

The NCEP/ATP III criteria include people with diabetes. In our analytic samples, 6.7 ± 0.4% (±SE) of participants in NHANES III and 6.6 ± 0.8% of participants in NHANES 1999–2000 reported having diabetes or had a fasting glucose concentration 126 mg/dl (6.99 mmol/l). Furthermore, 5.4 ± 0.4% of NHANES III participants and 5.6 ± 0.8% of NHANES 1999–2000 participants had both diabetes and the metabolic syndrome. Because there has been a debate about the appropriateness of including people with diabetes in prevalence estimates of the metabolic syndrome, we recalculated the prevalence estimates after excluding participants with self-reported diabetes or a fasting plasma glucose concentration 126 mg/dl (6.99 mmol/l) (Table 3). The unadjusted prevalence was 18.9% in NHANES III and 22.6% in NHANES 1999–2000 (P = 0.019), whereas the age-adjusted prevalence increased from 20.3 to 23.3% (P = 0.044). The relative increases in prevalence among participants without diabetes exceeded the increases for all participants shown in Table 2.

View this table: [in this window] [in a new window]   Table 3— Unadjusted and age-adjusted prevalence (%) of the metabolic syndrome among U.S. adults aged 20 years who did not have diabetes: NHANES III (1988–1994) and NHANES 1999–2000

To examine the impact of the increase of obesity on the prevalence of the metabolic syndrome, we conducted two sets of analyses. First, after eliminating waist circumference as one of the criteria of the metabolic syndrome, the age-adjusted prevalence of having three or four of the remaining four criteria was 13.5% in NHANES III and 13.0% in NHANES 1999–2000. Second, we examined the prevalence of the metabolic syndrome stratified by BMI categories (<25, 25 to <30, 30 to <35, and 35 kg/m²) and calculated the prevalence adjusted for the BMI distribution from NHANES III. In NHANES III, the prevalence adjusted for the four categories of BMI was 23.1% among all participants, 22.8% among men, and 23.8% among women. In NHANES 1999–2000, the prevalences were 23.5, 21.3, and 26.9%, respectively.

Because it is unclear how commonly health care professionals measure waist circumference on their patients and because the use of BMI to assess obesity has been heavily promoted, we examined what cut points for BMI would generate equivalent prevalences of the metabolic syndrome. A BMI 29.2 kg/m² among men and 24.9 kg/m² among women in NHANES III and a BMI 28.7 kg/m² among men and 24.8 kg/m² among women in NHANES 1999–2000 provided very close agreement in prevalence estimates using BMI instead of waist circumference. Although the cut points we identified for BMI may result in similar prevalence estimates for the population, using BMI instead of waist circumference to identify the metabolic syndrome in an individual may result in wrongly classifying that individual as having or not having the metabolic syndrome according to the NCEP/ATP III criteria.

	CONCLUSIONS

TOP ABSTRACT INTRODUCTION RESEARCH DESIGN AND METHODS RESULTS CONCLUSIONS References

 
Between 1988–1994 and 1999–2000, a significant increase in the prevalence of the metabolic syndrome occurred among U.S. adults aged 20 years, particularly women. Among people without diabetes, the relative increase exceeded that among all participants. Increases in the prevalence of abdominal obesity and high blood pressure, and to a lesser degree hypertriglyceridemia and low HDL cholesterol concentration, most likely accounted for much of this increase.

Recently, the American Diabetes Association changed the definition of impaired fasting glucose by lowering the glucose threshold to 100 mg/dl from 110 mg/dl (23). This change, which was incorporated into the NCEP/ATP III definition of the metabolic syndrome (18), raised the prevalence of this syndrome by about an absolute 5%. Under the original NCEP/ATP III definition, the unadjusted prevalence in this analysis was 23.1% in NHANES III and 26.7% in NHANES 1999–2000. With the modification of the glucose threshold, the prevalence increased to 28.0 and 31.9%, respectively.

On the basis of the 1990 census numbers for U.S. adults aged 20 years (177 million) and the prevalence of the metabolic syndrome based on the original definition calculated from NHANES III data, about 41 million people had the metabolic syndrome in 1990. Because of growth of the population (201 million people were aged 20 years in 2000) and the increase in the prevalence of the metabolic syndrome, 55 million people had the metabolic syndrome in 2000. Using prevalence estimates of the metabolic syndrome based on the revised definition, we estimate that 50 million people had the metabolic syndrome in 1990 and 64 million people in 2000.

The five components of the metabolic syndrome were measured similarly in the two surveys. Thus, the changes in the prevalence of the metabolic syndrome were not due to methodological changes. Because we only included participants who attended the morning examination in this analysis, the estimates of the prevalence of the metabolic syndrome differ slightly from those of our previous analysis of NHANES III data. The smaller sample size of NHANES 1999–20000 reduced the statistical power to detect significant changes in many demographic subgroups.

A noteworthy finding was the large increases in the prevalence of the metabolic syndrome among women compared with men. In particular, the prevalence of this syndrome escalated rapidly among women aged 20–39 years. Large increases in the prevalences of hypertriglyceridemia and high blood pressure were largely responsible for the increase among women.

Two important determinants of the metabolic syndrome are obesity and physical activity. The prevalence of obesity increased from 22.9 to 30.5% in the U.S. between NHANES III and NHANES 1999–2000 (16). Our analyses show that the increase in BMI accounted for much of the increase in the prevalence of the metabolic syndrome. Leisure-time physical activity levels have been relatively stable from 1990 to 1998 (24). Little is known about trends in other components of physical activity such as occupational physical activity and transportation-related physical activity. Some information suggests that people are relying increasingly on their cars for transportation instead of nonmotorized forms of transportation such as walking or bicycling (25).

The clinical significance of the metabolic syndrome remains controversial, and much remains to be learned about it. It is not clear if the syndrome is a disease or simply a constellation of risk factors (26). The etiology of the metabolic syndrome is also controversial, with obesity, insulin resistance, and other etiologies being advocated. By focusing on the metabolic syndrome, the NCEP/ATP III reinforced the need for health care professionals to take a more comprehensive approach to their patients and to address all relevant risk factors that increase the risk for type 2 diabetes and cardiovascular events. The metabolic syndrome may be viewed as a useful window on the health of the U.S. population. Consequently, the increase in the prevalence of this syndrome is a worrisome indicator of future increases in diabetes and cardiovascular disease.

Because the metabolic syndrome is extremely common in the U.S. population and its prevalence is increasing, health care professionals are likely to encounter patients with this syndrome in their practice. It remains unknown to what extent health care professionals have adopted the recommendations concerning the metabolic syndrome made by the NCEP/ATP III and are screening their patients for this syndrome. Measurements of blood pressure and concentrations of triglycerides, HDL cholesterol, and glucose are commonly collected in clinical practice. Whether waist circumference is routinely measured at present is unknown.

To stem the rising tides of obesity and the metabolic syndrome, comprehensive approaches for improving nutrition and physical activity habits that target both individuals and the population are required (27). Health care professionals have a critical role in preventing the development of the metabolic syndrome in their patients through weight management and the achievement of proper physical activity levels. Because the syndrome is reversible, health care professionals can help their patients with this syndrome adopt preventive lifestyles that are conducive to developing and reversing this syndrome. In addition, health care professionals must assist patients with the metabolic syndrome in averting or delaying progression to diabetes, cardiovascular disease, and other complications. Although pharmacological therapy for each of the components of this syndrome is available, the role of such therapy in the absence of lifestyle changes deserves clarification. Furthermore, pharmacological approaches specific to patients with this syndrome await development.

	Footnotes

 
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

Received for publication May 10, 2004. Accepted for publication July 12, 2004.

	References

TOP ABSTRACT INTRODUCTION RESEARCH DESIGN AND METHODS RESULTS CONCLUSIONS References

 

1. National Institutes of Health: Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Executive Summary. Bethesda, MD, National Institutes of Health, 2001 (NIH publ. no. 01-3670)
   
2. Ford ES, Giles WH, Dietz WH: Prevalence of the metabolic syndrome among US adults: findings from the Third National Health and Nutrition Examination Survey. JAMA 287:356–359, 2002[Abstract/Free Full Text]
   
3. Meigs JB, Wilson PW, Nathan DM, D’Agostino RB Sr, Williams K, Haffner SM: Prevalence and characteristics of the metabolic syndrome in the San Antonio Heart and Framingham Offspring Studies. Diabetes 52:2160–2167, 2003[Abstract/Free Full Text]
   
4. Gazzaruso C, Sacchi P, Garzaniti A, Fratino P, Bruno R, Filice G: Prevalence of metabolic syndrome among HIV patients. Diabetes Care 25:1253–1254, 2002[Free Full Text]
   
5. Araneta MR, Wingard DL, Barrett-Connor E: Type 2 diabetes and metabolic syndrome in Filipina-American women: a high-risk nonobese population. Diabetes Care 25:494–499, 2002[Abstract/Free Full Text]
   
6. Resnick HE: Metabolic syndrome in American Indians. Diabetes Care 25:1246–1247, 2002[Free Full Text]
   
7. Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, Salonen JT: The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 288:2709–2716, 2002[Abstract/Free Full Text]
   
8. Onat A, Ceyhan K, Basar O, Erer B, Toprak S, Sansoy V: Metabolic syndrome: major impact on coronary risk in a population with low cholesterol levels: a prospective and cross-sectional evaluation. Atherosclerosis 165:285–292, 2002[Medline]
   
9. Alvarez Leon EE, Ribas Barba L, Serra Majem L: Prevalence of the metabolic syndrome in the population of Canary Islands, Spain. Med Clin (Barc )120:172–174, 2003[Medline]
   
10. Laaksonen DE, Lakka HM, Niskanen LK, Kaplan GA, Salonen JT, Lakka TA: Metabolic syndrome and development of diabetes mellitus: application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study. Am J Epidemiol 156:1070–1077, 2002[Abstract/Free Full Text]
    
11. Resnick HE, Jones K, Ruotolo G, Jain AK, Henderson J, Lu W, Howard BV: Insulin resistance, the metabolic syndrome, and risk of incident cardiovascular disease in nondiabetic American Indians: the Strong Heart Study. Diabetes Care 26:861–867, 2003[Abstract/Free Full Text]
    
12. Irwin ML, Ainsworth BE, Mayer-Davis EJ, Addy CL, Pate RR, Durstine JL: Physical activity and the metabolic syndrome in a tri-ethnic sample of women. Obes Res 10:1030–1037, 2002[Medline]
    
13. Kullo IJ, Hensrud DD, Allison TG: Relation of low cardiorespiratory fitness to the metabolic syndrome in middle-aged men. Am J Cardiol 90:795–797, 2002[Medline]
    
14. Case CC, Jones PH, Nelson K, O’Brian Smith E, Ballantyne CM: Impact of weight loss on the metabolic syndrome. Diabetes Obes Metab 4:407–414, 2002[Medline]
    
15. Gazzaruso C, Giordanetti S, La Manna A, Celsa M, De Amici E, Turpini C, Catona A, Fratino P: Weight loss after Swedish adjustable gastric banding: relationships to insulin resistance and metabolic syndrome. Obes Surg 12:841–845, 2002[Medline]
    
16. Flegal KM, Carroll MD, Ogden CL, Johnson CL: Prevalence and trends in obesity among US adults, 1999–2000. JAMA288:1723–1727, 2002
    
17. Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, Marks JS: Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA289:76–79, 2003
    
18. Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C: Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 109:433–438, 2004[Free Full Text]
    
19. Centers for Disease Control and Prevention: Plan and operation of the Third National Health and Nutrition Examination Survey, 1988–94. Vital Health Stat 1:1–407, 1994
    
20. Centers for Disease Control and Prevention: The Third National Health and Nutrition Examination Survey (NHANES III 1988–94) Reference Manuals and Reports. Bethesda, MD, National Center for Health Statistics, 1996 (CD-ROM)
    
21. Centers for Disease Control and Prevention: NHANES 1999–2000 public data release file documentation. Available at http://www.cdc.gov/nchs/about/major/nhanes/currentnhanes.htm. Accessed 25 September 2003
    
22. Ford ES, Mokdad AH, Giles WH, Mensah GA: Serum total cholesterol concentrations and awareness, treatment, and control of hypercholesterolemia among US adults: findings from the National Health and Nutrition Examination Survey, 1999 to 2000. Circulation107:2185–2189, 2003[Abstract/Free Full Text]
    
23. Genuth S, Alberti KG, Bennett P, Buse J, Defronzo R, Kahn R, Kitzmiller J, Knowler WC, Lebovitz H, Lernmark A, Nathan D, Palmer J, Rizza R, Saudek C, Shaw J, Steffes M, Stern M, Tuomilehto J, Zimmet P, the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 26:3160–3167, 2003[Free Full Text]
    
24. Centers for Disease Control and Prevention: Physical activity trends: United States, 1990–1998. MMWR50:166–169, 2001[Medline]
    
25. Frank LD, Engelke P: How land use and transportation systems impact public health: a literature review of the relationship between physical activity and built form. Available at http://www.cdc.gov/nccdphp/ dnpa/pdf/aces-workingpaper1.pdf. Accessed 25 September 2003
    
26. Reaven G: Metabolic syndrome: pathophysiology and implications for management of cardiovascular disease. Circulation 106:286–288, 2002[Free Full Text]
    
27. Swinburn B, Egger G: Preventive strategies against weight gain and obesity. Obes Rev 3:289–301, 2002[Medline]
    

CiteULike

Del.icio.us

Digg

Reddit

Technorati

This article has been cited by other articles:

				R. G. Ramos and K. Olden The Prevalence of Metabolic Syndrome Among US Women of Childbearing Age Am J Public Health, June 1, 2008; 98(6): 1122 - 1127. [Abstract] [Full Text] [PDF]

				H. Taylor, J. Liu, G. Wilson, S. H. Golden, E. Crook, C. D. Brunson, M. Steffes, W. D. Johnson, and J. H. Sung Distinct Component Profiles and High Risk Among African Americans With Metabolic Syndrome: The Jackson Heart Study Diabetes Care, June 1, 2008; 31(6): 1248 - 1253. [Abstract] [Full Text] [PDF]

				I. N. Bratz, G. M. Dick, J. D. Tune, J. M. Edwards, Z. P. Neeb, U. D. Dincer, and M. Sturek Impaired capsaicin-induced relaxation of coronary arteries in a porcine model of the metabolic syndrome Am J Physiol Heart Circ Physiol, June 1, 2008; 294(6): H2489 - H2496. [Abstract] [Full Text] [PDF]

				S. M. Grundy Metabolic Syndrome Pandemic Arterioscler. Thromb. Vasc. Biol., April 1, 2008; 28(4): 629 - 636. [Abstract] [Full Text] [PDF]

				R. J Kaaja Metabolic syndrome and the menopause Menopause Int, March 1, 2008; 14(1): 21 - 25. [Abstract] [Full Text] [PDF]

				G. Hu, J. Lindstrom, P. Jousilahti, M. Peltonen, L. Sjoberg, R. Kaaja, J. Sundvall, and J. Tuomilehto The Increasing Prevalence of Metabolic Syndrome among Finnish Men and Women over a Decade J. Clin. Endocrinol. Metab., March 1, 2008; 93(3): 832 - 836. [Abstract] [Full Text] [PDF]

				C. M. Patterson, A. A. Dunn-Meynell, and B. E. Levin Three weeks of early-onset exercise prolongs obesity resistance in DIO rats after exercise cessation Am J Physiol Regulatory Integrative Comp Physiol, February 1, 2008; 294(2): R290 - R301. [Abstract] [Full Text] [PDF]

				H. Siilin, J. Rastad, O. Ljunggren, and E. Lundgren Disturbances of Calcium Homeostasis Consistent with Mild Primary Hyperparathyroidism in Premenopausal Women and Associated Morbidity J. Clin. Endocrinol. Metab., January 1, 2008; 93(1): 47 - 53. [Abstract] [Full Text] [PDF]

				G. P. Van Guilder, G. L. Hoetzer, J. J. Greiner, B. L. Stauffer, and C. A. DeSouza Metabolic syndrome and endothelial fibrinolytic capacity in obese adults Am J Physiol Regulatory Integrative Comp Physiol, January 1, 2008; 294(1): R39 - R44. [Abstract] [Full Text] [PDF]

				C. E. O'Neil and T. A. Nicklas State of the Art Reviews: Relationship Between Diet/ Physical Activity and Health American Journal of Lifestyle Medicine, December 1, 2007; 1(6): 457 - 481. [Abstract] [PDF]

				V. Hirschler, M. I. Roque, M. L. Calcagno, C. Gonzalez, and C. Aranda Maternal Waist Circumference and the Prediction of Children's Metabolic Syndrome Arch Pediatr Adolesc Med, December 1, 2007; 161(12): 1205 - 1210. [Abstract] [Full Text] [PDF]

				E. S. Ford and S. Capewell Coronary Heart Disease Mortality Among Young Adults in the U.S. From 1980 Through 2002: Concealed Leveling of Mortality Rates J. Am. Coll. Cardiol., November 27, 2007; 50(22): 2128 - 2132. [Abstract] [Full Text] [PDF]

				C A Daly, P Hildebrandt, M Bertrand, R Ferrari, W Remme, M Simoons, K M Fox, and on behalf of the EUROPA investigators Adverse prognosis associated with the metabolic syndrome in established coronary artery disease: data from the EUROPA trial Heart, November 1, 2007; 93(11): 1406 - 1411. [Abstract] [Full Text] [PDF]

				J. W. Newcomer and C. H. Hennekens Severe Mental Illness and Risk of Cardiovascular Disease JAMA, October 17, 2007; 298(15): 1794 - 1796. [Full Text] [PDF]

				C. Schindler Review: The metabolic syndrome as an endocrine disease: is there an effective pharmacotherapeutic strategy optimally targeting the pathogenesis? Therapeutic Advances in Cardiovascular Disease, October 1, 2007; 1(1): 7 - 26. [Abstract] [PDF]

				J. J Fogli-Cawley, J. T Dwyer, E. Saltzman, M. L McCullough, L. M Troy, J. B Meigs, and P. F Jacques The 2005 Dietary Guidelines for Americans and risk of the metabolic syndrome Am. J. Clinical Nutrition, October 1, 2007; 86(4): 1193 - 1201. [Abstract] [Full Text] [PDF]

				P. E. McBride Triglycerides and Risk for Coronary Heart Disease JAMA, July 18, 2007; 298(3): 336 - 338. [Full Text] [PDF]

				I. H. Schulman, M.-S. Zhou, E. A. Jaimes, and L. Raij Dissociation between metabolic and vascular insulin resistance in aging Am J Physiol Heart Circ Physiol, July 1, 2007; 293(1): H853 - H859. [Abstract] [Full Text] [PDF]

				J. F. Arenillas, M. A. Moro, and A. Davalos The Metabolic Syndrome and Stroke: Potential Treatment Approaches Stroke, July 1, 2007; 38(7): 2196 - 2203. [Full Text] [PDF]

				I. M. Wahba and R. H. Mak Obesity and Obesity-Initiated Metabolic Syndrome: Mechanistic Links to Chronic Kidney Disease Clin. J. Am. Soc. Nephrol., May 1, 2007; 2(3): 550 - 562. [Abstract] [Full Text] [PDF]

				A. Farooki and S. H. Schneider Insulin Resistance and Cancer-Related Mortality J. Clin. Oncol., April 20, 2007; 25(12): 1628 - 1629. [Full Text] [PDF]

				J. A. Mendoza, A. Drewnowski, and D. A. Christakis Dietary Energy Density Is Associated With Obesity and the Metabolic Syndrome in U.S. Adults Diabetes Care, April 1, 2007; 30(4): 974 - 979. [Abstract] [Full Text] [PDF]

				L. Azadbakht, M. Kimiagar, Y. Mehrabi, A. Esmaillzadeh, M. Padyab, F. B Hu, and W. C Willett Soy inclusion in the diet improves features of the metabolic syndrome: a randomized crossover study in postmenopausal women Am. J. Clinical Nutrition, March 1, 2007; 85(3): 735 - 741. [Abstract] [Full Text] [PDF]

				X. Gao, M. E. Nelson, and K. L. Tucker Television Viewing Is Associated With Prevalence of Metabolic Syndrome in Hispanic Elders Diabetes Care, March 1, 2007; 30(3): 694 - 700. [Abstract] [Full Text] [PDF]

				D. M. Lloyd-Jones, K. Liu, L. A. Colangelo, L. L. Yan, L. Klein, C. M. Loria, C. E. Lewis, and P. Savage Consistently Stable or Decreased Body Mass Index in Young Adulthood and Longitudinal Changes in Metabolic Syndrome Components: The Coronary Artery Risk Development in Young Adults Study Circulation, February 27, 2007; 115(8): 1004 - 1011. [Abstract] [Full Text] [PDF]

				K. Scott Baker, K. K. Ness, J. Steinberger, A. Carter, L. Francisco, L. J. Burns, C. Sklar, S. Forman, D. Weisdorf, J. G. Gurney, et al. Diabetes, hypertension, and cardiovascular events in survivors of hematopoietic cell transplantation: a report from the bone marrow transplantation survivor study Blood, February 15, 2007; 109(4): 1765 - 1772. [Abstract] [Full Text] [PDF]

				G. R Hajer, Y. van der Graaf, J. K Olijhoek, M. C Verhaar, F. L J Visseren, and for the SMART Study Group Levels of homocysteine are increased in metabolic syndrome patients but are not associated with an increased cardiovascular risk, in contrast to patients without the metabolic syndrome Heart, February 1, 2007; 93(2): 216 - 220. [Abstract] [Full Text] [PDF]

				A. S. Gami, B. J. Witt, D. E. Howard, P. J. Erwin, L. A. Gami, V. K. Somers, and V. M. Montori Metabolic Syndrome and Risk of Incident Cardiovascular Events and Death: A Systematic Review and Meta-Analysis of Longitudinal Studies J. Am. Coll. Cardiol., January 30, 2007; 49(4): 403 - 414. [Abstract] [Full Text] [PDF]

				P. S. Masand Differential pharmacology of atypical antipsychotics: Clinical implications Am. J. Health Syst. Pharm., January 15, 2007; 64(2_Supplement_1): S3 - S8. [Abstract] [Full Text] [PDF]

				C. Lorenzo, K. Williams, K. J. Hunt, and S. M. Haffner The National Cholesterol Education Program-Adult Treatment Panel III, International Diabetes Federation, and World Health Organization Definitions of the Metabolic Syndrome as Predictors of Incident Cardiovascular Disease and Diabetes Diabetes Care, January 1, 2007; 30(1): 8 - 13. [Abstract] [Full Text] [PDF]

				G. A. Mensah and D. W. Brown An Overview Of Cardiovascular Disease Burden In The United States Health Aff., January 1, 2007; 26(1): 38 - 48. [Abstract] [Full Text] [PDF]

C. Shibao, A. Gamboa, A. Diedrich, A. C. Ertl, K. Y. Chen, D. W. Byrne, G. Farley, S. Y. Paranjape, S. N. Davis, and I. Biaggioni Autonomic Contribution to Blood Pressure and Metabolism in Obesity Hypertension, January 1, 2007; 49(1): 27 - 33.