Comparison Of Three Diagnosis Criterias For Metabolic Syndrome In Mongolian People In Tongliao City And Association Between C-Reactive Protein And Metabolic Syndrome

Objective1. To compare application in Mongolian people of agricultural and pastoral areas in Tongliao city, using the diagnosis criterias for metabolic syndrome(MS)proposed by the IDF in 2005,ATPⅢin 2005 and CDS in 2004.2. To investigate the prevalence of metabolic syndrome and its risk factors of Mongolian people in Tongliao City.3. To further analyze the association between C-reactive protein (CRP) concentration and individual MetS components and their accumulation.MethodsMongolian people aged 20 and elder from agricultural and pastoral areas in Tongliao City were included in this study. A cross-sectional survey was conducted to collect data by personal interview with local residents using a standard questionnaire, meanwhile fasting blood samples were drawn, and height, weight, waist circumference, hip circumference, blood pressure, fasting plasma glucose, blood fat and CRP were measured. T test was used for the comparison of measurement data, chi-square test was used for the comparison of categorical data, and rank test was used for the comparison of data of abnormal distribution. The agreement of the prevalence of 2 MS definitions and their kappa values were calculated. The sensitivity and specificity of the three MS diagnostic criterias were compared using one of the three criterias for the relative gold standard. The area of ROC curve by different cut-off points of waist circumference for identifying two components of MS were estimated to find the cut-off points with the largest area of ROC curve for men and women in Mongolian people. According to IDF diagnosis criteria, the risk factors of MS in Mongolian people was evaluated, and multivarable Logistic regression was adopted to control confounding factors. Participants were divided into 4 grades according to the quartiles of CRP, and were classified as exhibiting 0, 1, 2, 3, 4, and 5 components of MS, in order to analyze the association between CRP and the accumulation of MS components, ordinal logistic regression analysis was performed to estimate the risk effect of different CRP levels for the MetS components accumulation. The cumulative odds model was adopted for ordinal logistic regression analyses. All statistical analyses were performed in SPSS 13.0 Statistical Software.Results1.The age adjusted prevalence of MS in Mongolian people were 17.1% for IDF criterion(man11.4%, woman 21.6%), 22.9% for ATPⅢcriterion (man19.6%, woman25.8%) and 8.1% for CDS criterion(man7.6%,woman8.6%)respectively.2.The agreement in the diagnosis of MS using IDF and ATPⅢ, IDF and CDS, ATPⅢa nd CDS were 93.5%, 85.0% and 81.6%, and Kappa values were 0.822, 0.434 and 0.419 respectively.3.Among the subjects who had three or more than three MS components, there were 100% subjects screened by ATPⅢcriteria, 76.1% by IDF criteria(man57.3%,woman85.7%)and 33.5% by CDS criteria(man38.9%,woman30.7%)respectively.4.The sensitivity of ATPIII criteria of the three diagnosis criteria was highest, 100%(IDF criteria as relative gold standard) and 98.7%(CDS criteria as relative gold standard)respectively; The specificity of CDS was the highest, 99.8%(ATPⅢcriteria as relative gold standard)and 97.9%(CDS criteria as relative gold standard)respectively.5.The optimal cut-points were WC≥84cm, BMI≥23 kg/m2 for men, and WC≥81cm, BMI≥23 kg/m2 for women for diagnosing Mongolian adults at high risk of MS components accumulation, with the largest area under the Receiver Operator Curve (ROC), and the best sensitivity and specificity.6.After controlling confounding factors, age, female, LDL-C, CRP, hip circumference, waist-hip rate and BMI index were risk factors of MS (according to IDF definition) (P<0.05). There were dose response relationship between age, LDL-C, CRP, hip circumference, BMI and risk to MS ( P-trend<0.001). 7.After adjusting for gender, age, cigarette use, alcohol use, and the other individual MetS components, compared to the lowest CRP quartile, OR (95% CIs) of the highest CRP quartile were 1.62 (1.24~2.12) for raised BP, 2.45 (1.84~3.27) for central obesity, 6.33 (4.21~9.50) for raised TG, 2.00 (1.53~2.60) for reduced HDL, and 2.68 (2.01~3.56) for raised FPG.8.The means of lnCRP for those with 0, 1, 2, 3, 4, and 5 components of metabolic syndrome were 1.56(1.50~1.62), 1.66(1.61~1.71), 1.91(1.85~1.97), 2.16(2.09~2.24), 2.50(2.32~2.56) and 2.74(2.51~2.99)mg/L, respectively. There was a strong linear increase in ln CRP compared to the increasing number of MetS components (P-trend < 0.001).9.After adjusting for confounding factors, the risk of the third quartile CRP and the forth quartile CRP to accumulate at least one MetS component were 2.45(1.99~3.01)and 7.19(5.80~8.93)times the lowest quartile of CRP. The risk of MS components accumulation was increasing with CRP levels increasing (P-trend < 0.001).Conclusions1.The age-standardized prevalence of MS in Mongolian People of Agricultural and Pastoral Region according to the three diagnosis criterias (ATPⅢ, IDF and CDS) were 22.9%, 17.1%, and 8.1% respectively, and the prevalence of women higher than men under ATPⅢand IDF criteria.2.The agreement of ATPIII and IDF definition was very high, and the agreement of between CDS and other two criteria were moderate.3.Mongolian men WC≥84cm, BMI≥23 kg/m2, and women WC≥81cm, BMI≥23 kg/m2 were the the best cut-points to identify the clustering of MS risk components. Therefore, the cut-points of WC for men in IDF and ATPⅢcriteria seemed high, and 85cm may be proper.4.Age, gender, LDL-C, CRP, hip circumference, waist-hip rate and BMI index were independent risk factors of MS of Mongolian people in agricultural and pastoral region.5.WC, hip circumference, waist-hip rate and BMI index were both interrelated and mutually independent for diagnosing center obesity. Therefore, single indicator to identify center obesity is limited, and compound indicators may increase the detectable rate of center obesity. 6.Increased CRP levels were independent risk factors of individual MS component, and the CRP levels increased with the number of MS components increasing.7.Increased CRP levels were independent risk factors of accumulating one or more MS components, and there was strong linear relationship between CRP levels and the risk of MS components accumulation.