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Epidemiology of Metabolic syndrome

It is a worldwide growing health problem Metabolic syndrome (MetS), is a matter of concern in both the developed and the developing countries It is a worldwide growing health problem

Approximately 20 – 25 percent of the world’s adult population has metabolic syndrome

People with the MetS have twice the dying and more than seven times developing diabetes compared to those with no MetS

Different definitions of the metabolic syndrome have been proposed by different public health organizations The rapid changes in the definition over time make it very difficult to compare studies and therefore also to evaluate temporal trends and regional variations in the prevalence of the metabolic syndrome

The most recent definitions have introduced region-specific cut-points for the level of obesity (waist circumference) defining the metabolic syndrome. The introduction of region-specific cut-points is rational from the point of view that the association between obesity and glucose intolerance

Ethnic specific values for waist circumference Country / Ethnic group 94 cm 80 cm Male Female Europids* In the USA, the ATP III values ( 102 cm male; 88 cm female) are likely to continue to be used for clinical purposes 90 cm South Asians Based on a Chinese , Malay and Asian-Indian population Chinese Japanese** Use South Asian recommendations until more specific data are available Ethnic South and Central Americans Use European data until more specific data are available Sub-Saharan Africans EMME ( Arab) populations

The optimal cutoff point of waist circumference for predicting at least two other components of the metabolic syndrome as defined by the IDF was 89 cm for men & 91 cm for women. Delavari A, Hossein M, Alikhani S, Sharifian A. The First Nationwide study of the prevalence of the metabolic syndrome and optimal cut-off points of waist circumference in the Middle East: The national survey of risk factors for non-communicable diseases of Iran. Diabetes Care. 2009;32:1092–7

MetS is increasing because glucose intolerance is increasing because Waist Circumference is increasing

between 20% and 30% of the adult population in most countries have MetS Asians have a specific situation to MetS and it is of special concern for Middle Eastern populations, which are predicted to experience the greatest global burden of diabetes by 2020

As a country in this region, Iran is reported to have one of the highest prevalence rates of MetS worldwide

prevalence of MetS in Iranian adults From the 43 studies that was reviewed, the rate of MetS varied from 10% to 60% depending on sex, age and region

higher than 30% in Iranian adults Although, a few studies reported the prevalence of MetS about 10- 20% but in the majority of studies, the rate was higher than 30% in Iranian adults

the data of 27 local studies and one national study showed that the overall estimation of MetS prevalence was 36.9% based on the Adult Treatment Panel III (ATP III), 34.6% according to the International Diabetes Federation (IDF), and 41.5% based on the Joint Interim Societies (JIS) criteria These prevalence rates are noticeably higher than the estimated prevalence around the world, which is between 20% and 25% Iran Red Crescent Med J. 2015

The mean prevalence of MetS in Iran is higher than in many other countries (e.g., Portugal [27.6%], Spain [26.6%], France [25% in males and 15.3% in females], and Italy [22% in males and 18% in females]) it was also higher than in the United States of America (22.9%)

The prevalence of MetS in Iran is much closer to that in North Africa (30%), China (33.9%), Turkey (36.6%), Colombia (34.8%) and Venezuela (35.3%)

The highest rate was reported among the postmenopausal women in Shiraz The lowest rate was in Esfahan

The rate in Tehran adult population was 33.2%

There is almost a consistent finding that the rate of MetS was higher among women compared with men across the national level Only one study reported by Jamshidi in Hamedan in which a higher rate of MetS was observed in men compared with women (25.6% vs. 19.2%) (2014)

A clear pattern of gender relationship with Mets was present in Iranian studies The rate is almost higher in women compared with men

The higher rate of MetS in Iranian women are attributed to the greater rate of abdominal obesity because of lower physical activity level, higher order of live births, and going – through menopause

Generation to generation A very sharp difference (43.3% women vs. 17.1% men) was observed in Kordestan (2012) Thrifty gens Generation to generation Energy dense

A large difference in the prevalence of Mets was observed between the north and the South of Iran

The higher rate in the north may be associated with the difference in physical activity and habitual food patterns in particular the high consumption of rice among people living in the north

Aging: The prevalence of Mets increased with aging Socioeconomic status: It was shown that Mets is more prevalent in low socioeconomic status particularly the low-educated adults

Habitual foods and MetS The habitual Iranian foods including high consumption of rice and bread may have an important role in apparent high rate of Mets and its major components Tehran Lipid Glucose study reported the higher BMI and higher TG with high consumption of sugar (HFCS) dietary legume intake is inversely associated with MetS fruit and vegetable intakes were inversely associated with the risk of MetS

In a population-based cross-sectional study of Tehranian adults, dietary calcium levels and dietary vitamin D level were inversely associated with MetS after adjusting several potential confounding factors

The rate of MetS such as cancer in Iran is more than other countries specially western counterparts and this rate is increasing why? who is responsible?

It can be assumed that some reasons other than urbanization and inactivity have resulted in this relatively high prevalence of MetS in Iran

In a study conducted by Delavari et al In a study conducted by Delavari et al., greater waist circumference values and lower HDL cholesterol have also been reported in Iranian communities than in Western populations, which support the idea of an ethnic predisposition of the Iranian community to MetS

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