Metabolic syndrome in Canadian adults

Background: There is limited information available about the prevalence of Metabolic Syndrome (MetS), its trend over time and its predisposing risk factors according to different definitions in Canadian adults. No studies have compared the ability of the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP III) and the International Diabetes Federation (IDF) definitions to predict Cardiovascular Disease (CVD) mortality among Canadian adults. Objectives: a) To examine the age and sex specific prevalence of the Metabolic Syndrome in Canadian adults by using the ATP III and the IDF definitions. b) To examine the risk factors for Metabolic Syndrome in Canadian adults by using the ATP III and the IDF definitions. c) To examine the association between Metabolic Syndrome and cardiovascular disease mortality in Canadian adults by using the ATP III and the IDF definitions. Methods: The Canadian Heart Health Survey was a cross-sectional probability sample survey conducted in all 10 Canadian provinces between 1986 and 1992.The first two studies in this thesis were based on individuals for whom full anthropometric measurements were obtained and for whom data on all components of MetS were available (provinces of Alberta, Manitoba, Ontario, Quebec and Saskatchewan). Statistics Canada linked the CHHS data set to Canadian Mortality Database. The third study was based on three provinces (Alberta, Manitoba, and Saskatchewan) for whom full anthropometric measurements, mortality data, and data on all components of MetS were available. MetS was defined according to ATP III and IDF definitions. A weighted analysis using SPSS PASW Complex Samples (version18) was used to conduct stepwise logistic regression analysis to identify risk factors significantly associated with MetS (p < 0.05). Cox-regression analyses using the STATA (version11) was conducted to predict CVD mortality. Results: According to ATP III, 17.9% and 15.3% of men and women have MetS, while according to IDF, 23.8% and 17.3% of men and women have MetS, respectively. Kappa agreement between the definitions is 72 % for men and 80% for women (p≤0.05). Older age and low level of physical activity are significant risk factors for the MetS regardless of gender and definition. Higher level of education and alcohol consumption are additional significant protective factors for women, whereas retirement and being unemployed are additional significant risk factors for men. The hazards of death due to CVD events in women with the syndrome according to the ATP III and the IDF definitions are 3.96(1.30-12.09) and 2.56 (1.32-4.97), respectively. The comparable numbers for men are 2.21(1.16-4.02) and 2.50(1.50-4.17). Conclusion: In Canadian adults the prevalence of MetS is higher when the IDF definition is applied but the metabolic derangement of individuals identified is less severe. Demographic, socio economic factors, and lifestyle habits are significantly associated with MetS among the Canadian adults. The ATP III definition predicts CVD mortality better in women, while the IDF definition predicts CVD mortality better in men.

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