Incidence and Risk Factors for Metabolic Syndrome in Korean Male Workers, Ages 30 to 39

doi:10.1016/j.annepidem.2006.10.001

Annals of Epidemiology

Volume 17, Issue 4, April 2007, Pages 245-252

https://doi.org/10.1016/j.annepidem.2006.10.001 Get rights and content

Purpose

There are few prospective data on the incidence of metabolic syndrome. The goals of this study were to define the incidence of and specific risk factors for metabolic syndrome (MetS) in Korean male workers 30 to 39 years of age.

Methods

A prospective cohort study was undertaken involving 4,779 male workers, 30 to 39 years of age, who did not take medication for dyslipidemia or have a history of any malignancy at study entry. Subjects were reexamined annually at a university hospital in Seoul, Korea, over a 3-year period between 2002 to August 2005. A modified National Cholesterol Education Program definition of MetS with body mass index was used instead of waist circumference. Cox proportional hazards models were used to calculate adjusted hazard ratios in separate models for MetS.

Results

At the end of the 3-year follow-up period, MetS developed in 708 individuals. The unadjusted incidence density of MetS was 70.5 (95% CI, 65.3∼75.37), and the age-adjusted incidence density of MetS was 76.9 per 1,000 person-years (95% CI, 67.8∼86.1). Among a variety of candidate risk factors, uric acid, weight change, γ-glutamyltranspeptidase, and alanine aminotransferase were independent risk predictors for MetS.

Conclusions

The high-incidence density of this MetS in Korea may be an indicator of future increases in diabetes and cardiovascular disease.

Introduction

Metabolic syndrome (MetS), which is a clustering of disturbed glucose and insulin metabolism, overweight and abdominal fat distribution, hypertension, and dyslipidemia 1, 2, 3, has become a major public health issue worldwide. MetS is associated with an increased risk of diabetes and cardiovascular disease 4, 5.

Over the past two decades, a striking increase in the number of people with MetS worldwide has taken place. It has been suggested that the prevalence of MetS has increased in the U.S. population because of the increasing number of individuals with obesity and/or type 2 diabetes 6, 7. In Korea, the prevalence of MetS was markedly increased over the 1998 to 2001 period (23.6% in the 1998 Korean National Health and Nutrition Examination Surveys [KNHANES] and 28.0% in the 2001 survey) (8). However, despite abundant epidemiologic research that has been published on MetS, there are few prospective data on the incidence of MetS. The purposes of this study were 1) to estimate the incidence of MetS in Korean male workers who ages 30 to 39 years and 2) to define specific risk factors for MetS.

Section snippets

Subjects

To examine the incidence of MetS and its risk factors in Korean male workers ages 30 to 39, a prospective cohort study was conducted. The study population was composed of Korean male workers at one of the biggest semiconductor manufacturing companies in Korea. All workers were required by the Industrial Safety and Health Law in Korea to participate in annual or biennial health examinations, depending on their job title. A total of 6,967 male workers, ages 30 to 39 years, participated in health

Results

At baseline, the 6,436 subjects had a mean age of 33.5 (SD, 2.5) years, and the overall prevalence of MetS was 15.0% (95% CI, 14.1, 15.9). Of the 965 subjects with MetS at baseline, 801 successfully participated in health examinations over 3 successive years until August of 2005. Four hundred forty-three (55.3%) subjects remained with MetS and 358 (44.7%) were reclassified as free of MetS after the 3-year follow-up.

Of the 4,779 subjects included in the analytic cohort, the mean age was 33.2

Discussion

The main results of this study carried out in Korean male workers ages 30 to 39 were 1) the age-adjusted incidence density of MetS was 76.9 per 1,000 person-years (95% CI, 67.8∼86.1); and 2) among a variety of candidate risk predictors, uric acid, weight change, GGT, and ALT were independent risk predictors for MetS.

The incidence density of MetS that we report in this study is much higher than that reported in Japan. Longitudinal studies of Japanese men ages 35 to 59 reported that the incidence

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Cited by (77)

Individual and combined relationship of serum uric acid and alanine aminotransferase on metabolic syndrome in adults in Qingdao, China
2022, Nutrition, Metabolism and Cardiovascular Diseases
Associations of alanine aminotransferase (ALT) and serum uric acid (SUA) with metabolic syndrome (MetS) remain controversial. We aimed to explore individual and combined effects of ALT and SUA on MetS in community residents.
A population-based cross-sectional survey involving randomly selected Chinese adults aged 35–74 years was conducted in 2009 in Qingdao, China, and 4642 participants were included in the current study. Based on a combination of SUA and ALT levels in the tertile, subjects were grouped into Group 1-9. The individual and combined relations of SUA and ALT to MetS were analyzed by logistic regression models. The prevalence of MetS was 28.50% in males and 22.30% in females. ALT and SUA were independently associated with MetS and ORs (95% CIs) were 1.55 (1.42–1.70) and 1.92 (1.72–2.14), respectively, after adjusting for potential confounders. With the elevation of ALT and SUA levels, the risk of developing MetS increased. Compared to Group 1, ORs (95% CIs) of combined ALT and SUA for MetS were 2.21 (1.70–2.88), 4.02 (3.10–5.21), 2.19 (1.62–2.97), 2.53 (1.91–3.34), 4.69 (3.60–6.12), 1.76 (1.17–2.64), 3.65 (2.63–5.06) and 7.15 (5.41–9.46) in Group 2–9, respectively.
ALT and SUA were both related to MetS independently. Combined elevation of ALT and SUA levels could increase the risk of MetS and its components than an elevation in SUA and ALT alone. Therefore, measures should be taken to lower SUA and ALT levels to reduce the risk of having MetS.
Low serum uric acid concentration augments insulin effects on the prevalence of metabolic syndrome
2018, Diabetes and Metabolic Syndrome: Clinical Research and Reviews
Insulin and uric acid were shown affect the prevalence of Metabolic Syndrome (MetS), but no studies examine their interaction. Therefore, we conducted this study to determine their biological interaction in subjects from central Mexico.
433 subjects were enrolled for a cross-sectional study. MetS was defined according to the Harmonizing Definition. Hyperuricemia was defined as ≥7.0 mg/dL in males and ≥5.8 mg/dL in females. Hyperinsulinemia was defined as ≥11.0 μU/mL. Pearson correlation coefficient (r) was calculated to determine the association between uric acid or insulin and MetS. Logistic regression was used to determine the risk (odds ratio) of developing MetS. Biological interactions were determined by the PROCESS Macro and Anderson’s method.
Insulin and uric acid levels were elevated in MetS positive group (p < .05) and correlated with the number of MetS components (r = 0.276 and r = 0.166, p < .001, respectively). The interaction between uric acid and insulin was associated with the number of MetS components (PROCESS Model 1, interaction coefficient = −0.009, 95%CI: −0.017 to −0.001, p = .036). Johnson-Neyman analysis suggests the interaction is lost when uric acid concentration increased >7.0 mg/dL. When the cohort was separated by hyperinsulinemia and hyperuricemia, there was a significant risk of developing MetS for subjects with hyperuricemia (odds ratio = 2.3; 95%CI: 1.1–4.8, p < .05), hyperinsulinemia (odds ratio = 3.1; 95%CI: 1.9–4.9, p < .05), or both (odds ratio = 7.4; 95%CI: 3.2–17.2, p < .05); however, there was no multiplicative or additive interaction.
Here, we show that uric acid and insulin augments the prevalence of MetS; however, no biological interaction was determined for hyperuricemia and hyperinsulinemia.
Serum uric acid: A strong and independent predictor of metabolic syndrome after adjusting for body composition
2016, Metabolism: Clinical and Experimental
Some observational studies have suggested that serum uric acid (SUA) levels are one of the determinants of the metabolic syndrome (MetS). However, previous studies reported combined results for men and women after adjusting for sex and few studies take body composition into consideration. Therefore, we performed this sex-specific longitudinal study to investigate how baseline SUA levels influence incident MetS, including body composition as an adjusting factor in a large number of subjects.
A total of 14,442 participants (8715 men and 5727 women) participating in a medical health check-up program without diagnosed MetS at baseline were enrolled. Separate analyses were performed for men and women including body composition as a confounding factor. Cox proportional hazards models were used to quantify independent associations between SUA levels and incident MetS.
During 63,940 person-years of follow-up, there were 4215 (2974 men, 1241 women) incident cases of MetS between 2006 and 2012. After adjustments for age, systolic BP, diastolic BP, BMI, eGFR, smoking status, TG, LDL-C, HDL-C, fasting glucose, and proportion of fat-free mass (100-fat mass, %), the hazard ratios (HR) [95% confidence interval (CI)] for incident MetS comparing the second, the third, and the fourth quartiles to the first quartile of SUA levels were 0.862 (0.770–0.965), 1.102 (0.991–1.225), and 1.246 (1.121–1.385) in men (p for trend < 0.001), and 1.045 (0.862–1.266), 1.251 (1.050–1.490), and 1.321 (1.109–1.574) in women (p for trend < 0.001), respectively. As a continuous variable, in fully-adjusted models, the HRs (95% CI) for incident MetS associated with each increase of 1 mg/dl of SUA levels were 1.094 (1.060–1.130) in men (p < 0.001) and 1.148 (1.072–1.228) in women (p < 0.001), respectively.
We demonstrated that SUA levels are strong and independent predictors of MetS. This relationship remained significant after full adjustments for multiple associated confounders including body composition in both men and women.
High serum uric acid levels increase the risk of metabolic syndrome in elderly women: The PRO.V.A study
2016, Nutrition, Metabolism and Cardiovascular Diseases
Citation Excerpt :
Large cross-sectional studies have established associations between increased SUA levels and individual components of MetS [4–9]. Longitudinal studies in adults have also suggested a causal relationship between high SUA levels and MetS [10–21]. The latter studies have some limitations, however: they did not extensively investigate use of medications; they only concerned subjects who were healthy at the baseline and they did not specifically include elderly participants, who have a higher prevalence of hyperuricemia and MetS than middle-aged adults [9].
Serum uric acid (SUA) is the end-product of purine metabolism in humans, and its levels often increase in subjects with metabolic syndrome (MetS). Despite several studies demonstrating a relationship between increased SUA levels and the prevalence of MetS, prospective data on SUA as a predictor of the incidence of MetS in the elderly are limited. Our aim was to conduct a prospective study on the association between SUA concentrations and the onset of MetS in an elderly Italian cohort.
This is a cohort study (Progetto Veneto Anziani; Pro.V.A.) involving community-dwelling subjects aged ≥65 years and followed up for a mean 4.4 years. We included 1128 participants (aged 74.7 ± 7.1 years) without MetS at the baseline. Gender-specific SUA groups according to the standard deviation (SD) from the mean were considered, taking the incidence of MetS as the main outcome.
The mean SUA level was significantly higher in men than in women (5.4 ± 1.2 vs. 4.5 ± 1.2 mg/dl; p < 0.0001). Over the 4.4-year follow-up, 496 individuals developed MetS. After adjusting for potential confounders, Cox's regression analysis revealed no relationship between higher baseline SUA concentrations and the incidence of MetS in men or in the sample as whole, while women with SUA levels more than 1 SD above the mean (≥5.7 mg/dl) carried a 58% higher risk (95%CI: 1.03–2.40; p = 0.03) of being newly diagnosed with MetS during the follow-up.
High SUA levels significantly and independently predicted MetS in older women, but not in men, over a 4.4-year follow-up.
Association of Metabolic Syndrome With Serum Uric Acid Level in Male Workers
2024, Journal of Endocrinology and Metabolism
Hyperuricemia: An Intriguing Connection to Metabolic Syndrome, Diabetes, Kidney Disease, and Hypertension
2024, Current Hypertension Reports

View all citing articles on Scopus

: Drs. Ryu and Song contributed equally to this work.

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Incidence and Risk Factors for Metabolic Syndrome in Korean Male Workers, Ages 30 to 39

Purpose

Methods

Results

Conclusions

Introduction

Section snippets

Subjects

Results

Discussion

J Am Diet Assoc

Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications: Report of a WHO Consultation. Part 1: Diagnosis and Classification of Diabetes Mellitus

Comment on the provisional report from the WHO consultation: European Group for the Study of Insulin Resistance (EGIR)

Diabet Med

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NECP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)

JAMA

The metabolic syndrome as predictor of type 2 diabetes: the San Antonio heart study

Diabetes Care

The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men

JAMA

Central adiposity determines prevalence differences of the metabolic syndrome

Obes Res

Increasing prevalence of the metabolic syndrome among US adults

Diabetes Care

Korean National Health and Nutrition Examination Surveys. Changes in the characteristics of metabolic syndrome in Korea over the period 1998–2001 as determined by Korean National Health and Nutrition Examination Surveys

Diabetes Care

The Asia-Pacific Perspective: Redefining Obesity and Its Treatment

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. 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

Serum gamma-glutamyltransferase and risk of metabolic syndrome and type 2 diabetes in middle-aged Japanese men

Diabetes Care

Annual Report on the Vital Statistics in Seoul, Korea

Metabolic syndrome: pathophysiology and implications for management of cardiovascular disease

Circulation