Risk Factors for the Metabolic Syndrome: The Coronary Artery Risk Development in Young Adults (CARDIA) study, 1985–2001

Mercedes R. Carnethon; Catherine M. Loria; James O. Hill; Stephen Sidney; Peter J. Savage; Kiang Liu

doi:10.2337/diacare.27.11.2707

Metabolic Syndrome/Insulin Resistance Syndrome/Pre-Diabetes

Risk Factors for the Metabolic Syndrome

The Coronary Artery Risk Development in Young Adults (CARDIA) study, 1985–2001

Mercedes R. Carnethon, PHD1,
Catherine M. Loria, PHD2,
James O. Hill, PHD3,
Stephen Sidney, MD4,
Peter J. Savage, MD3 and
Kiang Liu, PHD1

¹Department of Preventive Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois
²Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
³Center for Human Nutrition, University of Colorado Health Sciences Center, Denver, Colorado
⁴Division of Research, Kaiser Permanente Medical Care Program, Oakland, California

Diabetes Care 2004 Nov; 27(11): 2707-2715. https://doi.org/10.2337/diacare.27.11.2707

Article Figures & Tables

Tables

Table 1—

Distribution of characteristics in the population

Characteristics	Total	Men			Women
Characteristics	Total			Black	White	Black	White
n	4192	881	988	1185	1138
Baseline
Age (years)	24.9 ± 3.6	24.2 (3.7	25.4 (3.3	24.4 (3.8	25.5 (3.4
Sex (% male)	44.6
High school education or less (%)	66.7	81.8	53.7	80.4	51.9
BMI (kg/m²)	24.2 ± 4.7	24.3 ± 3.9	24.0 ± 3.1	25.6 ± 6.2	22.9 ± 4.1
Baseline physical activity score (units)	421.3 ± 299.5	531.3 ± 344.4	513.0 ± 297.2	279.1 ± 229.4	404.6 ± 263.4
Smoking status (%)
Never	58.1	56.0	59.6	61.2	55.4
Former	13.2	9.1	15.1	8.7	19.3
Current	28.7	34.9	25.3	30.1	25.4
Alcohol intake
No drinks/day	22.9	23.7	14.9	34.4	17.2
One to three drinks/day	70.7	64.3	73.9	63.3	80.5
Three or more drinks/day	6.5	12.0	11.2	2.3	2.4
Energy from carbohydrates (%)	46.7 ± 7.3	45.9 ± 7.1	44.9 ± 6.8	48.3 ± 7.4	47.2 ± 7.3
Energy from total fat (%)	37.1 ± 5.8	37.9 ± 5.6	37.3 ± 5.4	37.3 ± 5.8	36.2 ± 6.3
Crude fiber (g)	5.6 ± 3.2	6.1 ± 3.5	6.5 ± 3.1	4.7 ± 3.0	5.4 ± 3.0
Metabolic syndrome components
Waist circumference (cm)	77.1 ± 10.7	79.9 ± 9.1	82.3 ± 8.0	76.0 ± 12.5	71.4 ± 8.7
Glucose (mg/dl)	82.0 ± 12.7	83.3 ± 10.0	84.7 ± 10.9	80.1 ± 17.1	80.8 ± 10.1
HDL cholesterol (mg/dl)	53.6 ± 12.9	54.0 ± 13.3	47.5 ± 11.0	55.6 ± 12.6	56.5 ± 12.9
Triglycerides (mg/dl)	69.8 ± 41.9	67.8 ± 40.5	83.6 ± 57.2	61.8 ± 28.7	67.6 ± 35.6
Systolic blood pressure (mmHg)	110.0 ± 10.7	115.5 ± 10.4	113.9 ± 10.0	107.9 ± 9.6	104.6 ± 9.1
Diastolic blood pressure (mmHg)	68.4 ± 9.4	70.7 ± 10.0	70.4 ± 9.1	67.2 ± 9.3	66.1 ± 8.3
Change in weight and physical activity
Weight change from baseline to year 15 (kg)	12.8 ± 12.1	14.1 ± 12.1	11.1 ± 9.4	16.2 ± 13.8	10.1 ± 11.7
Physical activity over time (%)*
Regular	16.3	26.6	25.1	3.2	13.4
Moderate	53.3	54.5	56.7	47.6	54.7
Low	30.4	18.9	18.2	49.3	31.9

Data are means ±SD unless otherwise indicated.
*
↵* Regular physical activity, a physical activity score above the median (364) at all four examinations; moderately active, activity fluctuated around the median; low activity, physical activity score below the median at all four examinations.

Table 2—

RRs of baseline characteristics and incident metabolic syndrome

	Total	Men			Women
	Total			Black	White	Black	White
Model 1
Age (per 5 years)	1.32 (1.17–1.48)	1.31 (1.01–1.70)	1.19 (0.93–1.52)	1.40 (1.16–1.69)	1.29 (0.98–1.68)
Race
Black	1.28 (1.08–1.51)
White	1.00 (referent)
Sex
Men	1.12 (0.95–1.32)
Women	1.00 (referent)
Model 2 and model 1 + each variable individually
Education
High school or less	1.66 (1.36–2.03)	0.79 (0.50–1.24)	1.61 (1.15–2.25)	1.88 (1.25–2.83)	2.39 (1.60–3.57)
More than high school	1.00 (referent)	1.00	1.00	1.00	1.00
BMI (per 4.7 kg/m²)	1.89 (1.79–2.00)	2.32 (2.03–2.65)	3.00 (2.46–3.65)	1.58 (1.46–1.72)	2.19 (1.96–2.44)
Physical activity (per 299.5 units)	0.84 (0.76–0.92)	0.86 (0.72–1.03)	0.87 (0.73–1.03)	1.01 (0.84–1.22)	0.64 (0.50–0.82)
Smoking status
Current	1.16 (0.96–1.40)	0.85 (0.56–1.30)	1.11 (0.76–1.62)	1.31 (0.95–1.80)	1.36 (0.91–2.03)
Former	1.00 (0.77–1.29)	0.64 (0.29–1.40)	1.26 (0.81–1.96)	1.23 (0.77–1.98)	0.76 (0.45–1.28)
Never	1.00 (referent)	1.00	1.00	1.00	1.00
Alcohol intake
No drinks/day	1.69 (1.41–2.03)	1.57 (1.03–2.41)	2.41 (1.67–3.49)	1.14 (0.84–1.54)	2.43 (1.65–3.58)
One to three drinks/day	1.00 (referent)	1.00	1.00	1.00	1.00
Three or more drinks/day	1.13 (0.79–1.60)	0.79 (0.39–1.59)	1.25 (0.74–2.09)	1.72 (0.76–3.92)	1.41 (0.45–4.47)
Carbohydrate intake (% energy)
Q1 (25–41%)	1.00 (referent)	1.00	1.00	1.00	1.00
Q2 (41–45%)	1.03 (0.79–1.34)	1.83 (1.05–3.18)	0.77 (0.49–1.21)	1.09 (0.63–1.89)	0.85 (0.47–1.56)
Q3 (45–48%)	0.95 (0.73–1.25)	0.95 (0.50–1.79)	0.86 (0.54–1.38)	1.41 (0.83–2.38)	0.71 (0.38–1.33)
Q4 (48–52%)	1.32 (1.02–1.70)	1.46 (0.78–2.72)	1.23 (0.79–1.91)	1.68 (1.02–2.77)	1.04 (0.59–1.81)
Q5 (52–85%)	1.27 (0.98–1.64)	1.54 (0.85–2.81)	0.81 (0.46–1.43)	1.48 (0.91–2.41)	1.34 (0.79–2.27)
Crude fiber (g)
Q1: F (0.3–2.7)/M (0.6–3.6)	1.41 (1.09–1.82)	2.02 (1.15–3.56)	1.08 (0.64–1.82)	1.08 (0.70–1.68)	2.07 (1.16–3.71)
Q2: F (2.8–3.8)/M (3.6–5.0)	1.32 (1.02–1.71)	1.58 (0.86–2.88)	1.24 (0.77–2.02)	1.13 (0.71–1.80)	1.48 (0.84–2.59)
Q3: F (3.8–5.0)/M (5.0–6.4)	1.26 (0.97–1.64)	0.85 (0.42–1.70)	1.33 (0.81–2.17)	1.36 (0.87–2.13)	1.37 (0.78,2.41)
Q4: F (5.0–6.9)/M (6.4–8.5)	0.99 (0.75–1.31)	0.93 (0.45–1.90)	0.82 (0.49–1.38)	1.14 (0.71–1.84)	1.05 (0.58–1.89)
Q5: F (6.9–33)/M (8.6–29.8)	1.00 (referent)	1.00	1.00	1.00	1.00
Total fat intake (% energy)
Q1 (11–33%)	1.26 (0.97–1.64)	1.63 (0.85–3.11)	1.27 (0.74–2.18)	1.26 (0.80–2.00)	0.95 (0.57–1.58)
Q2 (33–36%)	1.31 (1.01, 1.70)	1.60 (0.83, 3.08)	1.24 (0.74, 2.10)	1.52 (0.98–2.37)	0.94 (0.56–1.59)
Q3 (36–39%)	1.00 (referent)	1.00	1.00	1.00	1.00
Q4 (39–42%)	0.97 (0.74–1.28)	1.36 (0.73–2.55)	1.19 (0.71–1.99)	0.98 (0.61–1.59)	0.44 (0.21–0.91)
Q5 (42–59%)	1.37 (1.06–1.77)	1.74 (0.95–3.18)	1.86 (1.15–3.01)	1.02 (0.63–1.63)	1.15 (0.67–2.00)

Data are RR (95% CI). Q, quintile.

Table 3—

Multivariable RRs of baseline characteristics and incident metabolic syndrome

	Total	Men			Women
	Total			Black	White	Black	White
Age (per 5 years)	1.26 (1.11–1.42)	1.18 (0.88–1.58)	1.09 (0.83–1.44)	1.31 (1.07–1.61)	1.53 (1.14–2.05)
Race
Black	0.73 (0.60–0.87)
White	1.00 (referent)
Sex
Men	1.55 (1.28–1.88)
Women	1.00 (referent)
Education
High school or less	1.52 (1.24–1.87)	1.10 (0.67–1.83)	1.34 (0.94–1.93)	1.84 (1.20–2.82)	1.63 (1.05–2.52)
More than high school	1.00 (referent)	1.00	1.00	1.00	1.00
BMI (per 4.7 kg/m²)	1.89 (1.77–2.00)	2.44 (2.06–2.88)	2.95 (2.37–3.67)	1.63 (1.50–1.77)	2.18 (1.89–2.51)
Physical activity (per 299.5 units)	0.95 (0.86–1.05)	0.99 (0.82–1.20)	0.92 (0.77–1.11)	1.08 (0.88–1.32)	0.93 (0.72–1.21)
Smoking status
Current	1.18 (0.97–1.45)	1.52 (0.93–2.47)	1.14 (0.75–1.73)	1.28 (0.91–1.79)	0.99 (0.62–1.56)
Former	1.02 (0.79–1.33)	0.73 (0.33–1.64)	1.45 (0.91–2.31)	1.12 (0.69–1.82)	0.76 (0.44–1.31)
Never	1.00 (referent)	1.00	1.00	1.00	1.00
Alcohol intake
No drinks/day	1.36 (1.11–1.66)	1.40 (0.88–2.23)	2.05 (1.34–3.13)	1.06 (0.76–1.48)	1.46 (0.92–2.30)
One to three drinks/day	1.00 (referent)	1.00	1.00	1.00	1.00
More than three drinks/day	1.24 (0.83–1.85)	1.04 (0.45–2.42)	1.26 (0.68–2.32)	2.10 (0.78–5.70)	1.58 (0.47–5.35)
Carbohydrate intake (% energy)
Q1 (25–41%)	1.00 (referent)	1.00	1.00	1.00	1.00
Q2 (41–45%)	1.28 (0.96–1.70)	1.30 (0.69–2.45)	1.13 (0.67–1.89)	1.56 (0.87–2.82)	1.15 (0.57–2.29)
Q3 (45–48%)	1.30 (0.94–1.80)	1.25 (0.61–2.56)	1.10 (0.58–2.07)	2.10 (1.11–3.97)	0.79 (0.37–1.68)
Q4 (48–52%)	1.85 (1.30–2.65)	2.41 (1.09–5.32)	1.91 (0.95–3.86)	2.56 (1.28–5.12)	0.99 (0.46–2.13)
Q5 (52–85%)	1.63 (1.06–2.51)	1.98 (0.70–5.55)	1.22 (0.48–3.14)	2.17 (0.98–4.81)	1.16 (0.50–2.70)
Crude fiber (g)
Q1: F (0.3–2.7)/M (0.6–3.6)	1.12 (0.86–1.47)	1.73 (0.90–3.33)	0.88 (0.50–1.53)	0.88 (0.55–1.40)	1.53 (0.81–2.88)
Q2: F (2.8–3.8)/M (3.6–5.0)	1.14 (0.87–1.49)	1.43 (0.74–2.78)	1.23 (0.73–2.07)	1.02 (0.63–1.66)	1.01 (0.55–1.88)
Q3: F (3.8–5.0)/M (5.0–6.4)	1.00 (0.76–1.32)	0.95 (0.45–1.97)	1.24 (0.74–2.08)	0.97 (0.60–1.57)	1.05 (0.57–1.90)
Q4: F (5.0–6.9)/M (6.4–8.5)	0.92 (0.69–1.22)	0.80 (0.37–1.75)	0.93 (0.54–1.59)	0.95 (0.58–1.55)	1.14 (0.61–2.11)
Q5: F (6.9–33)/M (8.6–29.8)	1.00 (referent)	1.00	1.00	1.00	1.00
Total fat intake (% energy)
Q1 (11–33%)	1.00 (0.71–1.41)	1.37 (0.58–3.24)	1.23 (0.62–2.46)	0.96 (0.51–1.80)	0.85 (0.44–1.62)
Q2 (33–36%)	1.18 (0.89–1.57)	1.70 (0.83–3.46)	1.21 (0.67–2.18)	1.37 (0.84–2.25)	0.81 (0.44–1.47)
Q3 (36–39%)	1.00 (referent)	1.00	1.00	1.00	1.00
Q4 (39–42%)	1.04 (0.77–1.39)	1.19 (0.61–2.35)	1.18 (0.67–2.09)	1.17 (0.68–2.01)	0.32 (0.14–0.73)
Q5 (42–59%)	1.64 (1.19–2.25)	2.15 (1.08–4.31)	2.09 (1.12–3.87)	1.60 (0.86–2.99)	1.02 (0.51–2.04)

Data are RR (95% CI). Q, quintile.

Table 4—

Association of weight change and physical activity change with incident metabolic syndrome

	Total	Men			Women
	Total			Black	White	Black	White
Model 1*
Weight gain (per 4.54 kg/10 lb)	1.24 (1.21–1.27)	1.34 (1.27–1.42)	1.39 (1.31–1.47)	1.11 (1.05–1.16)	1.26 (1.20–1.31)
Model 2†
Physical activity over time‡
Regular vs. no activity	0.40 (0.28–0.57)	0.47 (0.25–0.88)	0.45 (0.27–0.75)	0.22 (0.03–1.60)	0.19 (0.06–0.59)
Moderate vs. no activity	0.82 (0.69–0.97)	0.82 (0.55–1.24)	0.76 (0.54–1.08)	0.96 (0.71–1.31)	0.75 (0.52–1.08)
Model 3§
Weight gain (per 4.54 kg/10 lb)	1.23 (1.20–1.27)	1.35 (1.27–1.42)	1.38 (1.30–1.46)	1.10 (1.05–1.16)	1.24 (1.19–1.30)
Physical activity over time
Regular vs. no activity	0.49 (0.34–0.70)	0.50 (0.26–0.96)	0.61 (0.36–1.04)	0.28 (0.04–2.03)	0.22 (0.05–0.91)
Moderate vs. no activity	0.89 (0.74–1.07)	0.72 (0.46–1.12)	0.82 (0.57–1.18)	1.03 (0.75–1.42)	0.90 (0.62–1.32)
Model 4‖
Weight gain (per 4.54 kg/10 lb)	1.17 (1.14–1.20)	1.26 (1.17–1.35)	1.26 (1.18–1.35)	1.10 (1.05–1.15)	1.17 (1.11–1.24)
Physical activity over time
Regular vs. no activity	0.65 (0.43–0.98)	0.76 (0.35–1.66)	0.74 (0.39–1.41)	0.50 (0.07–3.80)	0.38 (0.08–1.76)
Moderate vs. no activity	0.93 (0.76–1.14)	0.94 (0.56–1.59)	0.85 (0.56–1.30)	0.93 (0.64–1.35)	1.14 (0.70–1.87)

Data are RR (95% CI).
*
↵* Model 1: age, race, sex, and weight gain.
†
↵† Model 2: age, race, sex, and physical activity over time.
‡
↵‡ Regular physical activity, physical activity score above the median (364) at all four examinations; moderately active, activity fluctuated around the median; low activity, physical activity score below the median at all four examinations.
§
↵§ Model 3: age, race, sex, weight gain, and physical activity over time.
‖
↵‖ Model 4: Model 3 plus education, baseline BMI, baseline physical activity, smoking status, drinking status, crude fiber (quintiles), total dietary fat intake (quintiles), and carbohydrate intake (quintiles).

Table 5—

RRs of developing the metabolic syndrome without abdominal adiposity*

	Model 1†	Model 2‡	Model 3§
Age (per 5 years)	1.36 (1.12–1.65)	1.34 (1.09–1.65)	1.42 (1.14–1.77)
Race
Black	0.87 (0.67–1.14)	0.54 (0.40–0.73)	0.51 (0.37–0.70)
White	1 (referent)	1.00	1.00
Sex
Men	2.54 (1.93–3.35)	3.52 (2.55–4.88)	3.89 (2.77–5.47)
Women	1 (referent)	1.00	1.00
Education
High school or less	1.73 (1.26–2.36)	1.55 (1.12–2.15)	1.52 (1.07–2.14)
More than high school	1 (referent)	1.00	1.00
BMI (per 4.7 kg/m²)	1.79 (1.62–1.97)	1.76 (1.58–1.96)	1.66 (1.46–1.88)
Physical activity (per 299.5 units)	0.89 (0.78–1.03)	1.00 (0.86–1.16)	1.01 (0.84–1.20)
Smoking status
Current	1.06 (0.79–1.44)	1.08 (0.77–1.50)	1.01 (0.71–1.44)
Former	0.86 (0.56–1.31)	0.86 (0.55–1.32)	0.86 (0.54–1.36)
Never	1 (referent)	1.00	1.00
Alcohol intake
No drinks/day	2.22 (1.66–2.97)	1.83 (1.32–2.53)	1.56 (1.10–2.22)
One to three drinks/day	1 (referent)	1.00	1.00
Three or more drinks/day	1.04 (0.60–1.77)	1.01 (0.54–1.87)	1.04 (0.55–1.98)
Carbohydrate intake (% energy)
Q1 (25–41%)	1 (referent)	1.00	1.00
Q2 (41–45%)	1.19 (0.80–1.77)	1.31 (0.85–2.02)	1.25 (0.80–1.96)
Q3 (45–48%)	0.88 (0.57–1.37)	0.96 (0.56–1.64)	0.82 (0.46–1.46)
Q4 (48–52%)	1.22 (0.80–1.84)	1.26 (0.70–2.28)	1.25 (0.67–2.32)
Q5 (52–85%)	1.43 (0.95–2.14)	1.45 (0.72–2.94)	1.41 (0.67–2.98)
Crude fiber (g)
Q1: F (0.3–2.7)/M (0.6–3.6)	1.25 (0.81–1.93)	1.06 (0.67–1.68)	1.06 (0.65–1.74)
Q2: F (2.8–3.8)/M (3.6–5.0)	1.44 (0.95–2.18)	1.22 (0.79–1.89)	1.20 (0.75–1.92)
Q3: F (3.8–5.0)/M (5.0–6.4)	1.36 (0.89–2.08)	1.13 (0.72–1.76)	1.32 (0.82–2.12)
Q4: F (5.0–6.9)/M (6.4–8.5)	1.11 (0.72–1.73)	1.10 (0.70–1.73)	1.24 (0.77–2.00)
Q5: F (6.9–33)/M (8.6–29.8)	1 (referent)	1.00	1.00
Total fat intake (% energy)
Q1 (11–33%)	1.56 (0.98–2.49)	1.50 (0.82–2.75)	1.37 (0.72–2.62)
Q2 (33–36%)	1.99 (1.28–3.10)	2.12 (1.28–3.53)	2.06 (1.21–3.49)
Q3 (36–39%)	1 (referent)	1.00	1.00
Q4 (39–42%)	1.48 (0.94–2.35)	1.79 (1.08–2.99)	1.75 (1.02–2.99)
Q5 (42–59%)	1.83 (1.17–2.86)	1.94 (1.11–3.39)	1.82 (1.02–3.25)
Weight change from baseline to year 15 per 4.54 kg (10 lb)	1.23 (1.17–1.28)		1.16 (1.11–1.21)
Physical activity over time‖
Regular	0.49 (0.30–0.81)		0.72 (0.40–1.30)
Moderate	0.97 (0.73–1.29)		1.10 (0.79–1.54)
Low	1 (referent)	1.00	1.00

Data are RR (95% CI).
*
↵* Metabolic syndrome components without large waist: high blood pressure and high triglyceride level, low HDL cholesterol, and high glucose levels (cumulative incidence = 223).
†
↵† All variables adjusted for age, race, and sex. Estimates for age, race, and sex are generated from one model with each of those three characteristics. All variables are from the baseline examination only except for weight change and physical activity change.
‡
↵‡ Multivariable 1 model with all variables listed in the model.
§
↵§ Multivariable 2 model with all variables listed in the model including weight gain and physical activity over time.
‖
↵‖ Regular physical activity, physical activity score above the median (364) at all four examinations; moderately active, activity fluctuated around the median; low activity, physical activity score below the median at all four examinations. Q, quintile.