Do Different Dimensions of the Metabolic Syndrome Change Together Over Time?
Evidence supporting obesity as the central feature
- Patrick Maison, MB12,
- Christopher D. Byrne, MB, PHD3,
- C. Nicholas Hales, MD, PHD3,
- Nicholas E. Day, PHD2 and
- Nicholas J. Wareham, MB, PHD2
- 1Department of Clinical Pharmacology, Henri Mondor’s Hospital, Créteil, France; and the Departments of
- 2Public Health and Primary Care and
- 3Clinical Biochemistry, University of Cambridge, Cambridge, U.K.
Abstract
OBJECTIVE—The metabolic syndrome is a loosely defined cluster of cardiovascular risk factors including low HDL cholesterol, hypertriglyceridemia, glucose intolerance, and hypertension. Evidence for inclusion of these features in the syndrome has mostly come from cross-sectional studies, and a few studies have examined how the various factors change together over time.
RESEARCH DESIGN AND METHODS—We conducted a prospective population-based cohort study of 937 individuals aged 40–65 years who underwent oral glucose tolerance testing on two occasions at 4.5-year intervals. Changes in the components of the metabolic syndrome were analyzed by principal component analysis in the entire population and in a subgroup of 471 individuals who did not receive pharmaceutical therapy for hypertension and dyslipidemia.
RESULTS—Principal component analysis identified three independent factors in men: a blood pressure factor (systolic and diastolic blood pressure and BMI), a glucose factor (fasting and 120-min postload glucose, BMI, waist-to-hip ratio [WHR], and fasting insulin level), and a lipid factor (triglycerides and HDL cholesterol, BMI, WHR, and fasting insulin level). In women, an additional factor was identified, which included BMI, WHR, fasting insulin, and triglycerides. Analysis of the contribution of these variables to the different subdimensions indicated that BMI was the central feature of the syndrome in both sexes.
CONCLUSIONS—This analysis of change in the features of the metabolic syndrome over time provides evidence of the fundamental importance of obesity in the origin of this disorder.
Footnotes
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Address correspondence and reprint requests to Dr. N. J. Wareham, Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Robinson Way, Cambridge CB2 2SR, U.K. E-mail: njw1004{at}medschl.cam.ac.uk.
Received for publication 15 December 2000 and accepted in revised form 7 June 2001.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
