Metabolic Syndrome and Development of Diabetes Mellitus: Application and Validation of Recently Suggested Definitions of the Metabolic Syndrome in a Prospective Cohort Study

TLDR

WHO and NCEP recently proposed definitions for metabolic syndrome, but their validity remains largely unknown. The study evaluated the sensitivity and specificity of these definitions for detecting prevalent and incident diabetes in a Finnish cohort of 1,005 middle‑aged men over four years. Four WHO and NCEP‑based definitions were compared using data from the cohort. All definitions identified high‑risk individuals; the WHO definition had the highest sensitivity but lower specificity, while the NCEP definition was more specific but less sensitive, indicating the WHO definition is more valid for predicting diabetes.

Abstract

The World Health Organization (WHO) and the National Cholesterol Education Program (NCEP) recently proposed definitions for the metabolic syndrome. Little is known of their validity, however. The authors assessed the sensitivity and specificity of the definitions of the metabolic syndrome for prevalent and incident diabetes mellitus in a Finnish population-based cohort of middle-aged men (n = 1,005) followed for 4 years since the late 1980s. Four definitions based on the WHO and NCEP recommendations were compared. All definitions identified persons at high risk for developing diabetes during the 4-year follow-up (odds ratios = 5.0–8.8). The WHO definition including waist-hip ratio > 0.90 or body mass index ≥ 30 kg/m2 was the most sensitive (0.83 and 0.67) and least specific (0.78 and 0.80) in detecting the 47 prevalent and 51 incident cases of diabetes. The NCEP definition in which adiposity was defined as waist girth > 102 cm detected only 61% of prevalent and 41% of incident diabetes, although it was the most specific (0.89 and 0.90). The WHO definition seems valid as judged by its relatively high sensitivity and specificity in predicting diabetes. The NCEP definition including waist > 102 cm also identifies persons at high risk for diabetes, but it is relatively insensitive in predicting diabetes.