Prevalence and Incidence of the Metabolic Syndrome and its Development in Taiwan: Focus on Gender Differences
Date Issued
2006
Date
2006
Author(s)
Hwang, Lee-Ching
DOI
en-US
Abstract
Cardiovascular diseases (CVD), including coronary heart disease and cerebral vascular disease, and diabetes mellitus (DM) are the principal causes of death in Taiwan, currently contributing 25.9% of national mortality and 14.5% of medical expenditure in the 2004 National Health Insurance budget. The metabolic syndrome (MetS) is a clustering of cardiovascular disease risk factors including dyslipidemia, hypertension, hyperglycemia and abdominal obesity. Individuals with the MetS have increased incidence of DM and coronary heart disease, and mortality from CVD. The prevalence of the MS has been observed in many ethnic groups but not yet by a nationwide survey in Taiwan. This thesis attempts to describe the prevalence and incidence of the MetS in Taiwanese adults, and this should provide valuable data for early identification and appropriate management of high risk people of CVD and DM.
Onset of CVD such as coronary heart disease begins approximately 10 years later in women than men. Cardiovascular gender differences are apparent long before CVD appears in men and women. Until the age of 50 years, women have lower systolic and diastolic BPs, lower TG, higher HDL and less visceral fat than men, but this protection disappears rapidly with increasing age. Two hypotheses, the estrogen protective effects and iron depletion effects, were raised to explain the phenomenon of gender differences. Therefore, this thesis also attempts to describe the development of the MetS, focusing on gender differences.
There were a high prevalence of the MetS and its components in TwSHHH study population (aged 20-79.9 years). The four MetS criteria sets were met by the following percentages of subjects: modified ATP III definition by 18.3% of men and 13.6% of women; MetS-IDF(C) by 16.1% of men and 13.3% of women, MetS-TW by 19.5% of men and 13.8% of women, and MetS-AHA(C) by 20.4% of men and 15.3% of women. Using the MetS-IDF(C) criteria in Taiwan might lead to underestimation of the risk of CVD. In KCIS study population those who did not have CVD, age-adjusted incidence rates of the MetS were 93.8 and 81.7 per 1000 person-years in men and in women, respectively. The resolution rates of the MetS were 148.7 and 143.9 per 1000 person-years in men and in women, respectively, during 3.8-year follow up, according to the MetS-AHA(C) definition. Men had significantly higher prevalence and incidence before the age group of 50 years because men had more high TG and high BP components than women did. The prevalence and incidence of the MetS in women increased rapidly beyond the age group of 50 years and became higher than in men, due to increasing WC. Data from TwSHHH study revealed that lipid components of the MetS appeared the earliest. Women had the first isolated component earlier, but the full feature of the MetS showed up later than men. We found that a BMI <23kg/m2 and exercise behavior could delay the development of the MetS in both genders, but more significantly in men than in women.
The Markov model was established for the prediction of the MetS development The model initiated with no component state would expect to have the MetS in 42.1% men and in 34.7% women after passing 10 cycles in young age group; contrarily, in 45.9% men and in 55.1% women in old age group. The model initiated with no component state and reducing WC for 1 inch in large WC group retarded the development of the MetS about 11%.
Older age, higher baseline BMI and physical inactivity were associated with increased hazard ratios of the MetS in both genders However, current smoking habit for men and family histories of diabetes for women, respectively, were significant different risk factors. Increased weight gain had a significant positive association with the risk of developing the MetS Increased weight loss had a significant positive association with the resolution of the MetS.
In conclusion, we could not wait the individuals attain their large WC to take action, because large WC was always not the first component. We need to attach importance to high TG (≥150 mg/dL) and high BP (≥130/85 mmHg) in men and low HDL (<50 mg/dL) in women before their middle age. Women of perimenopasual or postmenopausal age should pay much attention to their WC increasing problems. Detecting these individuals with the MetS and implementing preventive lifestyle interventions—diet education, physical activity, weight control, smoking cessation, and related behavior modification—is a high priority of preventive medicine of controlling for chronic metabolic diseases.
Subjects
代謝症候群
盛行率
發生率
性別差異
Markov 模式
metabolic syndrome
prevalence
incidence
gender difference
Markov model.
SDGs
Type
thesis
File(s)![Thumbnail Image]()
Loading...
Name
ntu-95-D88842006-1.pdf
Size
23.31 KB
Format
Adobe PDF
Checksum
(MD5):616c5f8bcbeba8800541673e72c2f79a