| Summary: | 博士 === 國立陽明大學 === 公共衛生研究所 === 93 === Introduction
Diabetes Mellitus (DM) is a growing public health issue in Taiwan. Although four papers have been published on metabolic syndrome in Taiwan, none have discussed the relationship between metabolic syndrome and mortality. The four aforementioned papers were written on: the association between hematologic and metabolic syndrome components in a Chinese population by Wang, metabolic syndrome and its contribution to coronary artery disease in non-diabetic subjects by Lin, the prevalence of metabolic syndrome in Kinmen by Chuang and components of insulin resistance syndrome in a community-based population by Chien.
Methods
This study was conducted by Yang-Ming Crusade in Kinmen, 1991-1993, 12,490 eligible subjects aged 30 and above were enrolled in screening. A total of 9,117 individuals with complete information were used for analysis. This was performed through computer matching of death certificates from Department of Health and matching with OPD and admission information from National Health Insurance in 1997. Using all-causes of deaths or cardiovascular and diabetes mellitus deaths as the dependent variables with different risk factor cut-off points referencing from 14 papers as independent variables, the largest C statistic of logistic regression analysis was chosen as the first-priority components of metabolic syndrome. By comparing results with those published in international papers, we also analyzed data with ATP Ⅲ definition of metabolic syndrome.
The definition of first-priority metabolic syndrome is blood pressure (SBP/DBP ≧140/90 mmHg or treatment), blood glucose (diabetes mellitus or impaired glucose tolerance), high density lipoprotein cholesterol (< 35 mg/dL), triglyceride (≧110 mg/dL) and waist circumference (≧100 cm for male, ≧97 cm for female) Metabolic syndrome is defined by the presence of three or more of the aforementioned factors.
Result
Prevalence of first-priority metabolic syndrome is 8.8% in males and 10.5% in females, however under the ATP III definition of metabolic syndrome, prevalence rates are 18.5% in males and 27.4% in females. The multivariate adjusted hazard ratio was 1.4 for cancer deaths, 1.6 for all-causes of death, 1.7 for deaths from cardiovascular diseases, 2.1 for deaths from cardiovascular diseases and DM, and 2.7 for deaths from coronary heart diseases. Using zero components of first-priority definitions of metabolic syndrome as referenc, the multivariate adjusted odds ratio are 1.3, 1.6, 2.0, 3.1 for 1, 2, 3, ≧4 components. The odds ratio of DM and hypertension in 1997 increased just as the increase in abnormal components of metabolic syndrome in 1991-1993. The odds ratio of DM and hypertension increased from 3.4 to 22.0 and 3.5 to 11.6 respectively for one and four abnormal components of first-priority metabolic syndrome.
For females over 50 years of age, logistic regression analysis showed that hypertension (OR=2.1), hyperglycemia (OR=1.7), high waist circumference (OR=1.6), hypertriglyceride (OR=1.6) were statistically significant factors for total mortality of first-priority metabolic syndrome. The C statistic for both hypertension and waist circumference were 64.3, there were only 66.7 for additional variable of blood glucose or triglyceride. It may be beneficial to educate females over 50 years old about the importance of prevention through at-home measuring for hypertension and waist circumference. Individuals with blood pressure over 140/90 mmHg or waists measuring greater than 100cm for male and 97 cm for female risk premature death and should be screened for blood glucose and triglyceride levels. By implementing glucose and triglyceride screening only after initial at-home blood pressure or waist size screening has detected abnormalities, such preventive health strategies may help public health authorities save nearly 63% in fees for wide-scale community screening.
|
|---|
