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. Search for Related Content PubMed PubMed Citation Articles by Ford, E. S. Social Bookmarking                What's this?

Prevalence of the Metabolic Syndrome Defined by the International Diabetes Federation Among Adults in the U.S.

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 Hwy., MS K66, Atlanta, GA 30341. E-mail: eford{at}cdc.gov

	ABSTRACT

TOP ABSTRACT INTRODUCTION RESEARCH DESIGN AND METHODS RESULTS CONCLUSIONS References

 
OBJECTIVE—The International Diabetes Federation (IDF) has proposed a new definition of the metabolic syndrome that emphasizes central adiposity as determined by ethnic group–specific thresholds of waist circumference. The objective of this study was to estimate the prevalence of this syndrome using the IDF definition among U.S. adults and to compare it with the prevalence estimated using the definition of the National Cholesterol Education Program (NCEP).

RESEARCH DESIGN AND METHODS—A total of 3,601 men and women aged 20 years from the National Health and Nutrition Examination Survey 1999–2002 were included in the analyses.

RESULTS—Based on the NCEP definition, the unadjusted prevalence of the metabolic syndrome was 34.5 ± 0.9% (percent ± SE) among all participants, 33.7 ± 1.6% among men, and 35.4 ± 1.2% among women. Based on the IDF definition, the unadjusted prevalence of the metabolic syndrome was 39.0 ± 1.1% among all participants, 39.9 ± 1.7% among men, and 38.1 ± 1.2% among women. The IDF definition led to higher estimates of prevalence in all of the demographic groups, especially among Mexican-American men. The two definitions similarly classified 93% of the participants as having or not having the metabolic syndrome.

CONCLUSIONS—In the U.S., the use of the IDF definition of the metabolic syndrome leads to a higher prevalence estimate of the metabolic syndrome than the estimate based on the NCEP definition.

Abbreviations: IDF, International Diabetes Federation • NCEP, National Cholesterol Education Program • NHANES, National Health and Nutrition Examination Survey • WHO, World Health Organization

	INTRODUCTION

TOP ABSTRACT INTRODUCTION RESEARCH DESIGN AND METHODS RESULTS CONCLUSIONS References

 
In 1998, the World Health Organization (WHO) was the first organization to provide a definition of the metabolic syndrome (1). In response, the European Group for the Study of Insulin Resistance countered with a modification of the WHO definition (2). In 2001, the National Cholesterol Education Program (NCEP) released its definition (3). Subsequently, the American Association of Clinical Endocrinologists offered its views regarding the definition of the metabolic syndrome (4). The proliferation of definitions suggested that a single unifying definition was desirable (5). In the hope of accomplishing this, the International Diabetes Federation (IDF) proposed a new definition of the metabolic syndrome in April 2005 (6).

The main focus in this new definition is central obesity. To have the metabolic syndrome, a person must have central adiposity defined on the basis of waist circumference and two or more of the following four factors: elevated concentrations of triglycerides, reduced concentrations of HDL cholesterol, elevated blood pressure, and dysglycemia.

This new definition requires a fresh assessment of the prevalence of the metabolic syndrome as well as of the magnitude of the morbidity and mortality associated with the metabolic syndrome. The objectives of this article were 1) to estimate the prevalence of the metabolic syndrome using the new IDF definition among U.S. adults, 2) to compare the prevalence of the metabolic syndrome with that based on the NCEP definition, and 3) to examine the concordance of the two definitions.

	RESEARCH DESIGN AND METHODS

TOP ABSTRACT INTRODUCTION RESEARCH DESIGN AND METHODS RESULTS CONCLUSIONS References

 
In the National Health and Nutrition Examination Survey (NHANES) 1999–2002, the sample was recruited using a multistage, stratified sampling design. The survey was specifically designed to produce results that are representative of the civilian, noninstitutionalized U.S. population. The participants were interviewed at home and were invited to attend the mobile examination center, where they were asked to complete additional questionnaires, to undergo various examinations, and to provide a blood sample. Details about the survey may be found elsewhere (7).

According to the IDF definition, someone has the metabolic syndrome if he or she has central adiposity plus two or more of the following four factors (6): 1) raised concentration of triglycerides: 150 mg/dl (1.7 mmol/l) or specific treatment for this lipid abnormality; 2) reduced concentration of HDL cholesterol: <40 mg/dl (1.03 mmol/l) in men and <50 mg/dl (1.29 mmol/l) in women or specific treatment for this lipid abnormality; 3) raised blood pressure: systolic blood pressure 130 mmHg or diastolic blood pressure 85 mmHg or treatment of previously diagnosed hypertension; and 4) raised fasting plasma glucose concentration 100 mg/dl (5.6 mmol/l) or previously diagnosed type 2 diabetes.

The IDF lists the following ethnic group–specific thresholds for waist circumference to define central adiposity: Europid, sub-Saharan African men, and Eastern- and Middle-Eastern men, 94 cm; South Asian, Chinese, and ethnic South- and Central-American men, 90 cm; Japanese men, 85 cm; women except Japanese women, 80 cm; and Japanese women, 90 cm. In this analysis, the following thresholds for waist circumference were used: white men, 94 cm; African-American men, 94 cm; Mexican-American men, 90 cm; white women, 80 cm; African-American women, 80 cm; and Mexican-American women, 80 cm. For participants whose designation was "other race–including multiracial," thresholds that were once based on Europid cut points (94 cm for men and 80 cm for women) and once based on South Asian cut points (90 cm for men and 80 cm for women) were used. For participants who were considered "other Hispanic," the IDF thresholds for ethnic South and Central Americans were used.

According to the NCEP report, participants who had three or more of the following criteria were defined as having the metabolic syndrome (3,8): 1) abdominal obesity (waist circumference >102 cm in men and >88 cm in women), 2) concentration of triglycerides 150 mg/dl (1.7 mmol/l), 3) concentration of HDL cholesterol <40 mg/dl (1.03 mmol/l) in men and <50 mg/dl (1.29 mmol/l) in women, 4) a systolic blood pressure 130 mmHg or a diastolic blood pressure 85 mmHg), and 5) fasting glucose: 100 mg/dl (5.6 mmol/l). The participants who currently reported using antihypertensive or antidiabetic medication (insulin or oral agents) were counted as having high blood pressure or diabetes, respectively.

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 four blood pressure readings were obtained in the mobile examination center. The average of the last two measurements of blood pressure for the participants who had three or four measurements, the last measurement for the participants with only two measurements, and the only measurement for the participants who had one measurement were used to establish high blood pressure status.

The prevalence of the metabolic syndrome was examined according to strata of BMI, degree of glucose impairment, hypertension, smoking status, hypercholesterolemia, concentrations of C-reactive protein, and coronary heart disease status. BMI was calculated from measured height and weight. Four categories of glucose impairment were created: normoglycemia (fasting plasma glucose concentration <100 mg/dl), impaired fasting glucose (fasting plasma glucose concentration 100 to <126 mg/dl), undiagnosed diabetes (fasting plasma glucose concentration 126 mg/dl without self-reported diabetes), and diagnosed diabetes (based on self-report). Hypertension was defined as a systolic blood pressure 140 mmHg or a diastolic blood pressure 90 mmHg or the current use of antihypertensive medication. Current smokers were defined as participants who had smoked 100 cigarettes during their lifetime and were still smoking. Former smokers were defined as participants who had smoked 100 cigarettes during their lifetime but had stopped. Participants who had smoked <100 cigarettes during their lifetime were classified as never having smoked. Participants whose concentration of total cholesterol was 200 mg/dl or who reported currently using cholesterol-lowering medications were defined as having hypercholesterolemia. C-reactive protein was measured by a high-sensitivity assay (latex-enhanced nephelometry). Questions about doctor-diagnosed coronary heart disease, myocardial infarction, and angina pectoris were used to determine the presence of these conditions.

Concentrations of plasma glucose and serum triglycerides were measured using reference analytic methods only for the participants who attended the morning examination. Therefore, the analyses were limited to men and nonpregnant women aged 20 years who attended the morning medical examination and who had fasted for 8 h. Because of limited sample size for the racial or ethnic groups designated as "other race–including multiracial" and "other Hispanic," no results were reported separately for these subgroups. To age adjust statistics, direct adjustment to the U.S. population aged 20 years in the year 2000 was performed (9). SUDAAN (Software for the Statistical Analysis of Correlated Data) was used for the analyses to account for the complex sampling design.

	RESULTS

TOP ABSTRACT INTRODUCTION RESEARCH DESIGN AND METHODS RESULTS CONCLUSIONS References

 
A total of 4,059 participants attended the morning mobile examination center. Excluding those who reported fasting for <8 h and the women who were pregnant left 3,821 participants. Of these, 3,601 had the data needed to define their metabolic syndrome status.

Using the NCEP definition, the unadjusted prevalence of the metabolic syndrome was 34.5% (men 33.7 ± 1.6% [percent ± SE]; women 35.4 ± 1.2%) and the age-adjusted prevalence was 34.6% (men 34.4 ± 1.5%; women 34.5 ± 1.4%) (Table 1). In comparison, the unadjusted and age-adjusted prevalences of the metabolic syndrome defined according to IDF criteria were 39.0% (men 39.9 ± 1.7%; women 38.1 ± 1.2%) and 39.1% (men 40.7 ± 1.6%; women 37.1 ± 1.3%). The IDF definition did not change the sex and racial or ethnic patterns other than that for Mexican-American men having a higher prevalence of the metabolic syndrome than Mexican-American women. The largest difference in prevalence was found among Mexican-American men, among whom the age-adjusted prevalence was 40.3% using the NCEP definition and 50.6% using the IDF definition. When the IDF criteria for waist circumference are used with the NCEP definition, the unadjusted prevalence of the metabolic syndrome was 40.3%, which was similar to the estimate produced by the IDF definition. Using NCEP criteria for waist circumference in conjunction with the IDF definition yielded an unadjusted prevalence of 29.4% (Table 1).

View this table: [in this window] [in a new window]   Table 1— Prevalence of the metabolic syndrome among U.S. adults aged 20 years, NHANES 1999–2002

For both of the definitions, the prevalence of the metabolic syndrome increased strongly with increasing levels of BMI (P for linear trend < 0.001 for both of the definitions), levels of dysglycemia (P for linear trend < 0.001 for both of the definitions), and concentrations of C-reactive protein (P for linear trend < 0.001 for both of the definitions) (Table 2). Participants with hypertension had more than twice the prevalence of the metabolic syndrome than those who did not have hypertension (P < 0.001 for both of the definitions). In addition, participants with hypercholesterolemia had a higher prevalence of the metabolic syndrome than participants who had concentrations of total cholesterol <200 mg/dl (P < 0.005 for both of the definitions). However, the prevalence of the metabolic syndrome did not vary by smoking status (P for all comparisons > 0.05 for both of the definitions). In addition, the participants who reported having coronary heart disease had more than twice the age-adjusted prevalence as did those who did not report having coronary heart disease (P < 0.001 for both definitions). However, the participants who had experienced a myocardial infarction had a similar prevalence of the metabolic syndrome as participants who had not had a myocardial infarction (P > 0.05 for both definitions). The participants who reported having angina pectoris were also more likely to report having the metabolic syndrome than the participants who did not have it (P = 0.020 for the NCEP definition and P = 0.073 for the IDF definition).

View this table: [in this window] [in a new window]   Table 2— Age-adjusted prevalence of the metabolic syndrome among U.S. adults aged 20 years by cardiovascular risk factors and conditions, NHANES 1999–2002

	CONCLUSIONS

TOP ABSTRACT INTRODUCTION RESEARCH DESIGN AND METHODS RESULTS CONCLUSIONS References

The two definitions similarly classified 93% of the participants as having or not having the metabolic syndrome. The high degree of overlap is not surprising considering the fact that the two definitions use the same five components and that four of the five criteria are defined identically or nearly identically. However, there are several noteworthy differences. The IDF definition requires the presence of central obesity. In contrast, the NCEP definition makes central obesity one of the five equally weighted criteria. Furthermore, the thresholds for central obesity under the IDF definition are far lower than those under the NCEP definition and vary according to ethnicity. The thresholds for concentrations of triglycerides, HDL cholesterol, and glucose and for systolic and diastolic blood pressure are the same. However, the IDF definition explicitly allows for the treatment of hypertriglyceridemia, a low concentration of HDL cholesterol, and hypertension to be counted. Furthermore, under the IDF definition people who have diagnosed type 2 diabetes are automatically considered to have hyperglycemia even if their concentration of glucose is <100 mg/dl.

Only three major ethnic groups in the NHANES 1999–2000 dataset had sufficient numbers to allow for results to be presented separately. Identification of participants of South Asian, Chinese, or Japanese descent who were included in the category "other race–including multiracial" was not possible. Although the Europid waist circumference thresholds were used for this ethnic group to generate the results shown in this article, the unadjusted prevalence estimate changed little (39.1%) when thresholds of 90 cm for men and 80 cm for women were used.

Only time will tell whether medical professionals and researchers will embrace this new definition of the metabolic syndrome. Prospective studies will be needed to determine the risks for adverse events associated with the metabolic syndrome as defined by the IDF. Because of the similarities between the NCEP and IDF definitions, risk estimates for all-cause mortality, cardiovascular disease, diabetes, and other adverse events based on the IDF definition are likely to be similar to those observed for the NCEP definition. The evolution of definitions of the metabolic syndrome since 1998 suggests that the future will probably bring further changes. In addition, the development of a classification scheme of the metabolic syndrome that correlates with the degree of risk of experiencing adverse events and the development of a formal pediatric definition merit consideration. Regardless of which definition is used, large numbers of U.S. adults have the metabolic syndrome. This fact underscores the importance of promoting healthy lifestyles (proper nutrition, weight management, and adequate physical activity) among U.S. adults.

	Footnotes

 
The findings and conclusions in this article are those of the authors and do not represent the views of the Centers of Disease Control and Prevention.

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

Received for publication May 19, 2005. Accepted for publication July 30, 2005.

	References

TOP ABSTRACT INTRODUCTION RESEARCH DESIGN AND METHODS RESULTS CONCLUSIONS References

 

1. Alberti KG, Zimmet PZ: Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 15:539–553, 1998[Medline]
   
2. Balkau B, Charles MA: Comment on the provisional report from the WHO consultation: European Group for the Study of Insulin Resistance (EGIR). Diabet Med 16:442–443, 1999[Medline]
   
3. National Institutes of Health: Executive summary. In 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). Washington, DC, U.S. Govt. Printing Office, 2001 (NIH publ. no. 01-3670)
   
4. Einhorn D, Reaven GM, Cobin RH, Ford E, Ganda OP, Handelsman Y, Hellman R, Jellinger PS, Kendall D, Krauss RM, Neufeld ND, Petak SM, Rodbard HW, Seibel JA, Smith DA, Wilson PW: American College of Endocrinology position statement on the insulin resistance syndrome. Endocr Pract 9:237–252, 2003[Medline]
   
5. Ford ES: Prevalence of the metabolic syndrome in US populations. Endocrinol Metab Clin North Am 33:333–350, 2004[Medline]
   
6. International Diabetes Federation: The IDF consensus worldwide definition of the metabolic syndrome. Available from http://www.idf.org/webdata/docs/Metabolic_syndrome_definition.pdf. Accessed 2 September 2005
   
7. Centers for Disease Control and Prevention: NHANES 1999–2004. Available from http://www.cdc.gov/nchs/about/major/nhanes/nhanes99–02.htm. Accessed 18 May 2005
   
8. 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]
   
9. Klein RJ, Schoenborn CA: Age adjustment using the 2000 projected U.S. population. In Healthy People 2010 Statistical Notes. Hyattsville, MD, National Center for Health Statistics, 2001 (no. 20)
   
10. Ford ES, Mokdad AH, Giles WH: Trends in waist circumference among U.S. adults. Obes Res 11:1223–1231, 2003[Medline]
    
11. Molarius A, Seidell JC, Sans S, Tuomilehto J, Kuulasmaa K: Varying sensitivity of waist action levels to identify subjects with overweight or obesity in 19 populations of the WHO MONICA Project. J Clin Epidemiol 52:1213–1224, 1999[Medline]
    
12. Patel S, Unwin N, Bhopal R, White M, Harland J, Ayis SA, Watson W, Alberti KG: A comparison of proxy measures of abdominal obesity in Chinese, European and South Asian adults. Diabet Med 16:853–860, 1999[Medline]
    
13. Thomas GN, Ho SY, Janus ED, Lam KS, Hedley AJ, Lam TH, the Hong Kong Cardiovascular Risk Factor Prevalence Study Steering Committee: The US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) prevalence of the metabolic syndrome in a Chinese population. Diabetes Res Clin Pract 67:251–257, 2005[Medline]
    
14. Kim MH, Kim MK, Choi BY, Shin YJ: Prevalence of the metabolic syndrome and its association with cardiovascular diseases in Korea. J Korean Med Sci 19:195–201, 2004[Medline]
    
15. Lee WY, Park JS, Noh SY, Rhee EJ, Kim SW, Zimmet PZ: Prevalence of the metabolic syndrome among 40,698 Korean metropolitan subjects. Diabetes Res Clin Pract 65:143–149, 2004[Medline]
    
16. Misra A, Wasir JS, Vikram NK: Waist circumference criteria for the diagnosis of abdominal obesity are not applicable uniformly to all populations and ethnic groups. Nutrition 21:969–976, 2005[Medline]
    

CiteULike

Del.icio.us

Digg

Reddit

Technorati

This article has been cited by other articles:

				K. Espinosa de los Monteros, L. C. Gallo, J. P. Elder, and G. A. Talavera Individual and Area-Based Indicators of Acculturation and the Metabolic Syndrome Among Low-Income Mexican American Women Living in a Border Region Am J Public Health, November 1, 2008; 98(11): 1979 - 1986. [Abstract] [Full Text] [PDF]

				A. Agouni, A. H. Lagrue-Lak-Hal, P. H. Ducluzeau, H. A. Mostefai, C. Draunet-Busson, G. Leftheriotis, C. Heymes, M. C. Martinez, and R. Andriantsitohaina Endothelial Dysfunction Caused by Circulating Microparticles from Patients with Metabolic Syndrome Am. J. Pathol., October 1, 2008; 173(4): 1210 - 1219. [Abstract] [Full Text] [PDF]

				S. Nakata, M. Tsutsui, H. Shimokawa, O. Suda, T. Morishita, K. Shibata, Y. Yatera, K. Sabanai, A. Tanimoto, M. Nagasaki, et al. Spontaneous Myocardial Infarction in Mice Lacking All Nitric Oxide Synthase Isoforms Circulation, April 29, 2008; 117(17): 2211 - 2223. [Abstract] [Full Text] [PDF]

				J. R. Churilla and R. F. Zoeller Jr Physical Activity: Physical Activity and the Metabolic Syndrome: A Review of the Evidence American Journal of Lifestyle Medicine, April 1, 2008; 2(2): 118 - 125. [Abstract] [PDF]

				G. Ferns and V. Keti HDL-cholesterol modulation and its impact on the management of cardiovascular risk Ann Clin Biochem, March 1, 2008; 45(2): 122 - 128. [Abstract] [Full Text] [PDF]

				F. Saad, L. J. Gooren, A. Haider, and A. Yassin A Dose-Response Study of Testosterone on Sexual Dysfunction and Features of the Metabolic Syndrome Using Testosterone Gel and Parenteral Testosterone Undecanoate J Androl, January 1, 2008; 29(1): 102 - 105. [Abstract] [Full Text] [PDF]

				K. D. DuBose, J. C. Eisenmann, and J. E. Donnelly Aerobic Fitness Attenuates the Metabolic Syndrome Score in Normal-Weight, at-Risk-for-Overweight, and Overweight Children Pediatrics, November 1, 2007; 120(5): e1262 - e1268. [Abstract] [Full Text] [PDF]

				R. Barazzoni, M. Zanetti, C. Ferreira, P. Vinci, A. Pirulli, M. Mucci, F. Dore, M. Fonda, B. Ciocchi, L. Cattin, et al. Relationships between Desacylated and Acylated Ghrelin and Insulin Sensitivity in the Metabolic Syndrome J. Clin. Endocrinol. Metab., October 1, 2007; 92(10): 3935 - 3940. [Abstract] [Full Text] [PDF]

				N. Echahidi, P. Pibarot, J.-P. Despres, J.-M. Daigle, D. Mohty, P. Voisine, R. Baillot, and P. Mathieu Metabolic Syndrome Increases Operative Mortality in Patients Undergoing Coronary Artery Bypass Grafting Surgery J. Am. Coll. Cardiol., August 28, 2007; 50(9): 843 - 851. [Abstract] [Full Text] [PDF]

				G. Matfin Review: Challenges in developing therapies for the metabolic syndrome The British Journal of Diabetes & Vascular Disease, July 1, 2007; 7(4): 152 - 156. [Abstract] [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]

				F. Chang, L. A Jaber, H. D Berlie, and M. B. O'Connell Evolution of Peroxisome Proliferator-Activated Receptor Agonists Ann. Pharmacother., June 1, 2007; 41(6): 973 - 983. [Abstract] [Full Text] [PDF]

				R. Kelishadi Childhood Overweight, Obesity, and the Metabolic Syndrome in Developing Countries Epidemiol. Rev., May 3, 2007; (2007) mxm003v1. [Abstract] [Full Text] [PDF]

				J.-P. Empana, P. Duciemetiere, B. Balkau, and X. Jouven Contribution of the metabolic syndrome to sudden death risk in asymptomatic men: the Paris Prospective Study I Eur. Heart J., May 1, 2007; 28(9): 1149 - 1154. [Abstract] [Full Text] [PDF]

				J. B. Meigs, M. K. Rutter, L. M. Sullivan, C. S. Fox, R. B. D'Agostino Sr., and P. W.F. Wilson Impact of Insulin Resistance on Risk of Type 2 Diabetes and Cardiovascular Disease in People With Metabolic Syndrome Diabetes Care, May 1, 2007; 30(5): 1219 - 1225. [Abstract] [Full Text] [PDF]

				K. Raikkonen, K. A. Matthews, and L. H. Kuller Depressive Symptoms and Stressful Life Events Predict Metabolic Syndrome Among Middle-Aged Women: A comparison of World Health Organization, Adult Treatment Panel III, and International Diabetes Foundation definitions Diabetes Care, April 1, 2007; 30(4): 872 - 877. [Abstract] [Full Text] [PDF]

				H. J. Schneider, H. Glaesmer, J. Klotsche, S. Bohler, H. Lehnert, A. M. Zeiher, W. Marz, D. Pittrow, G. K. Stalla, H.-U. Wittchen, et al. Accuracy of Anthropometric Indicators of Obesity to Predict Cardiovascular Risk J. Clin. Endocrinol. Metab., February 1, 2007; 92(2): 589 - 594. [Abstract] [Full Text] [PDF]

				C. Li, E. S Ford, L. C McGuire, and A. H Mokdad Association of metabolic syndrome and insulin resistance with congestive heart failure: findings from the Third National Health and Nutrition Examination Survey J Epidemiol Community Health, January 1, 2007; 61(1): 67 - 73. [Abstract] [Full Text] [PDF]

				M. A. Abdul-Ghani, M. Matsuda, B. Balas, and R. A. DeFronzo Muscle and Liver Insulin Resistance Indexes Derived From the Oral Glucose Tolerance Test Diabetes Care, January 1, 2007; 30(1): 89 - 94. [Abstract] [Full Text] [PDF]

				C. A. Aguilar-Salinas, R. Rojas, C. Gonzalez-Villalpando, F. J. Gomez-Perez, R. Mehta, G. Olaiz, J. A. Rull, and D. R. Cox Design and validation of a population-based definition of the metabolic syndrome. Diabetes Care, November 1, 2006; 29(11): 2420 - 2426. [Abstract] [Full Text] [PDF]

				C. H. Saely, L. Koch, F. Schmid, T. Marte, S. Aczel, P. Langer, G. Hoefle, and H. Drexel Adult Treatment Panel III 2001 but Not International Diabetes Federation 2005 Criteria of the Metabolic Syndrome Predict Clinical Cardiovascular Events in Subjects Who Underwent Coronary Angiography Diabetes Care, April 1, 2006; 29(4): 901 - 907. [Abstract] [Full Text] [PDF]

				G. T.C. Ko Metabolic syndrome or "central obesity syndrome"? Diabetes Care, March 1, 2006; 29(3): 752 - 752. [Full Text] [PDF]

				N. D Wong Review: Cardiovascular risk assessment in the metabolic syndrome, screening for subclinical disease, and implications for treatment The British Journal of Diabetes & Vascular Disease, November 1, 2005; 5(6): 305 - 313. [Abstract] [PDF]

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. Search for Related Content PubMed PubMed Citation Articles by Ford, E. S. Social Bookmarking                What's this?