Elsevier

The Lancet

Volume 365, Issue 9468, 16–22 April 2005, Pages 1398-1405
The Lancet

Articles
Prevalence of the metabolic syndrome and overweight among adults in China

https://doi.org/10.1016/S0140-6736(05)66375-1Get rights and content

Summary

Background

The metabolic syndrome and obesity are major risk factors for cardiovascular disease. Little information exists on the prevalence of the metabolic syndrome in China. We aimed to provide up-to-date estimates of the prevalence of the metabolic syndrome and overweight in the general adult population in China.

Methods

We did a cross-sectional survey in a nationally representative sample of 15 540 Chinese adults aged 35–74 years in 2000–01. Metabolic syndrome was defined according to guidelines from the US National Cholesterol Education Program. Overweight was defined as body-mass index of 25·0 kg/m2 or greater.

Findings

The age-standardised prevalence of metabolic syndrome was 9·8% (95% CI 9·0–10·6) in men and 17·8% (16·6–19·0) in women. The age-standardised prevalence of overweight was 26·9% (25·7–28·1) in men and 31·1% (29·7–32·5) in women. The prevalence of the metabolic syndrome and overweight was higher in northern than in southern China, and higher in urban than rural residents.

Interpretation

Our results indicate that a large proportion of Chinese adults have the metabolic syndrome and that overweight has become an important public health problem in China. These findings emphasise the urgent need to develop national strategies for the prevention, detection, and treatment of overweight and the metabolic syndrome, to reduce the societal burden of cardiovascular disease in China.

Introduction

Cardiovascular disease is the leading cause of mortality worldwide.1 China and other economically developing countries have experienced a cardiovascular disease epidemic in recent decades, while mortality from cardiovascular disease has fallen in economically developed countries.1, 2 Furthermore, during the next 20 years, cardiovascular disease morbidity and mortality are predicted to increase in China.3, 4 As a result of economic growth and associated sociodemographic changes, the burden from infectious diseases has diminished in China and other economically developing countries, but changes in lifestyle and diet have led to an increase in life expectancy and an increased burden of cardiovascular disease and other chronic diseases.4, 5, 6

Obesity is an important modifiable risk factor for cardiovascular disease, including type 2 diabetes, hypertension, hypercholesterolaemia, coronary heart disease, and stroke.7 Excess bodyweight is also associated with an increased risk for development of other adverse health consequences, such as osteoarthritis, gall bladder disease, and some cancers.8, 9 The metabolic syndrome is characterised by a clustering of cardiovascular risk factors, including abdominal obesity, raised blood pressure and glucose concentration, and dyslipidaemia. The syndrome is associated with the development of diabetes, cardiovascular, and kidney disease,10, 11, 12, 13 and an increased risk for mortality from cardiovascular disease and all causes.14

The metabolic syndrome and overweight are becoming increasingly common in economically developed countries, as shown by emerging prevalence data.15, 16 Some evidence suggests that overweight is also increasing in economically developing countries.17 However, few data exist on the metabolic syndrome in economically developing countries. We aimed to estimate the prevalence of the metabolic syndrome and overweight in the general adult population in China and to examine distributions of these problems by geographic region and urbanisation.

Section snippets

Study population

The International Collaborative Study of Cardiovascular Disease in ASIA (InterASIA) was a cross-sectional study of cardiovascular disease risk factors in nationally representative samples of the general adult population in China. A four-stage stratified sampling method was used. In stage one, 31 provinces (and municipalities) were stratified into northern and southern China, as divided by the Yangtze River. In addition to the municipalities of Beijing in northern China and Shanghai in southern

Results

Characteristics of the study participants are shown in table 1. Men and women residents of northern China had higher systolic and diastolic blood pressure, bodyweight, body-mass index, waist circumference, total and LDL-cholesterol, and fasting plasma glucose than their counterparts in southern China (p<0·0001 for all comparisons). Bodyweight, body-mass index, waist circumference, total and LDL-cholesterol, triglycerides, and fasting plasma glucose were significantly higher in urban than in

Discussion

The InterASIA results indicate that 64million (or 13·7%) adults aged 35–74 years in China have the metabolic syndrome as defined by ATP III. Additionally, nearly 38% of men and 33% of women have one component of the metabolic syndrome. When we modified the ATP III criteria on the basis of recommendations for Asian populations, the number of adults aged 35–74 years in China with the metabolic syndrome increased to 71million (or 15·1%). The results from this study also show that an estimated

References (52)

  • CJ Murray et al.

    Mortality by cause for eight regions of the world: Global Burden of Disease Study

    Lancet

    (1997)
  • AD Lopez

    Assessing the burden of mortality from cardiovascular diseases

    World Health Stat Q

    (1993)
  • Z Wu et al.

    Sino-MONICA project: a collaborative study on trends and determinants in cardiovascular diseases in China, Part i: morbidity and mortality monitoring

    Circulation

    (2001)
  • C Yao et al.

    The changing pattern of cardiovascular diseases in China

    World Health Stat Q

    (1993)
  • BM Popkin et al.

    Trends in diet, nutritional status, and diet-related noncommunicable diseases in China and India: the economic costs of the nutrition transition

    Nutr Rev

    (2001)
  • S Yusuf et al.

    Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization

    Circulation

    (2001)
  • RM Krauss et al.

    Obesity: impact on cardiovascular disease

    Circulation

    (1998)
  • Report of a WHO consultation

    World Health Organ Tech Rep Ser

    (2000)
  • National Task Force on the Prevention and Treatment of Obesity

    Arch Intern Med

    (2000)
  • Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III)

    JAMA

    (2001)
  • B Isomaa et al.

    Cardiovascular morbidity and mortality associated with the metabolic syndrome

    Diabetes Care

    (2001)
  • SM Haffner et al.

    Prospective analysis of the insulin-resistance syndrome (syndrome X)

    Diabetes

    (1992)
  • J Chen et al.

    The metabolic syndrome and chronic kidney disease in U.S. adults

    Ann Intern Med

    (2004)
  • M Trevisan et al.

    Syndrome X and mortality: a population-based study. Risk factor and life expectancy research group

    Am J Epidemiol

    (1998)
  • KM Flegal et al.

    Overweight and obesity in the United States: prevalence and trends, 1960–1994

    Int J Obes Relat Metab Disord

    (1998)
  • ES Ford et al.

    Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey

    JAMA

    (2002)
  • SM Saw

    The epidemiology of obesity: a review

    Ann Acad Med Singapore

    (1997)
  • D Perloff et al.

    Human blood pressure determination by sphygmomanometry

    Circulation

    (1993)
  • CC Allain et al.

    Enzymatic determination of total serum cholesterol

    Clin Chem

    (1974)
  • WT Friedewald et al.

    Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge

    Clin Chem

    (1972)
  • GL Myers et al.

    The Centers for Disease Control-National Heart, Lung and Blood Institute Lipid Standardization Program. An approach to accurate and precise lipid measurements

    Clin Lab Med

    (1989)
  • The Asia-Pacific perspective: redefining obesity and its treatment

    (2000)
  • J He et al.

    Serum total and lipoprotein cholesterol levels and awareness, treatment, and control of hypercholesterolemia in China

    Circulation

    (2004)
  • National Institutes of Health

    Obes Res

    (1998)
  • Series 1: programs and collection procedures

    Vital Health Stat 1

    (1994)
  • D Gu et al.

    Prevalence, awareness, treatment, and control of hypertension in china

    Hypertension

    (2002)
  • Cited by (838)

    • Association of the age of onset of metabolic syndrome with the risk of all cancer types

      2023, Diabetes and Metabolic Syndrome: Clinical Research and Reviews
    View all citing articles on Scopus

    Members listed at end of paper

    View full text