Metabolic Syndrome in Jordan

Metabolic syndrome (MeS) has received increased attention in the past few years. It is a constellation of interrelated risk factors of metabolic origin that directly promote the development of atherosclerotic cardiovascular diseases (CVD).

Written by Yousef Khader

Introduction

Metabolic syndrome (MeS) has received increased attention in the past few years. It is a constellation of interrelated risk factors of metabolic origin that directly promote the development of atherosclerotic cardiovascular diseases (CVD) 1. MeS more strongly predicts CVD and total mortality than its individual components 2. It has been estimated that MeS soon will overtake cigarette smoking as the primary risk factor for cardiovascular disease in U.S. population 3. The prevalence of MeS varies by definition used and population studied 4. The MeS is common among Arab populations in Mediterranean countries 5,6 and among Arab Americans 7.


Metabolic Syndrome among Jordanian adults

In a cross sectional study of 1121 Jordanians aged 25 years and above, the age-adjusted prevalence of MeS, using the Adult Treatment Panel III (ATP III) criteria, was 36.3% (95% CI: 33.6–39.0%) 8. The prevalence was 28.7% among men and 40.9% among women. The age-specific prevalence rates are shown in Figure 1. The prevalence increased significantly with age in men and women. Low HDL cholesterol was the most common abnormality in men (62.7%), and abdominal obesity was the most common abnormality in women (69.1%).

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Figure 1. Age-specific prevalence of the metabolic syndrome among Jordanian adults

 

Metabolic syndrome among Jordanian children and adolescents

Data pertaining to MeS in children are scarce and most studies were conducted in developed countries with very little is known about this syndrome in children in the Middle East and Arab countries including Jordan.  In a national population-based household sample in Jordan, 1046 children and adolescents aged 18 years or less were included in the analysis to estimate the prevalence of MeS 9. MeS was defined using the International Diabetes Federation (IDF) consensus definition. The prevalence of MeS according to IDF criteria was 1.4% in subjects aged between 10 and 15.9 years (1.1% for boys and 1.9% for girls, p-value = 0.556) and 3.6% in subjects aged between 16 and 18 years (3.8% for boys and 3.5% for girls, p-value = 0.906) (Figure 2).

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Figure 2. The prevalence of metabolic syndrome among boys and girls aged between 7 and 18 years using the International Diabetes Federation (IDF) consensus worldwide definition.

 

When categorized according to body mass index (BMI), the prevalence of the MeS was 15.1% in obese subjects (BMI ≥ 95th percentile), compared to 0.3% in subjects with normal BMI (BMI < 85th percentile) and 3.0% in overweight subjects (85th percentile ≤ BMI < 95th percentile) (Figure 3).

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Figure 3. The prevalence of clustering of metabolic abnormalities among Jordanian children and adolescent aged between 7 and 18 years according to BMI.

 

Metabolic syndrome among patients undergoing cardiac catheterization in Jordan

A cross-sectional study was conducted among patients underwent cardiac catheterization at King Abdullah University Hospital (KAUH) in north Jordan 10. All consecutive patients who underwent cardiac catheterization over a period of five months were included in this analysis. MeS was defined using National Cholesterol Education Program (ATP III) and International Diabetes Federation (IDF) criteria.  The prevalence of MeS among patients undergoing cardiac catheterization in north Jordan was 64.7 % according to ATP III criteria and 76.7 % according to and IDF criteria (Figure 4). About 96.7 % of the participants had at least one metabolic abnormality. The prevalence was significantly higher among women. Gender, body mass index, and family history of cardiovascular diseases were the only variables significantly associated with MeS.

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Figure 4. Prevalence of metabolic syndrome using Adult Treatment Panel (ATP III) and International Diabetes Federation (IDF) criteria according to age

  

The association between metabolic syndrome and coronary artery disease in Jordan

A case-control study of 269 patients diagnosed with coronary artery disease (CAD) and 1026 subjects without CAD was conducted in Jordan 11. Patients were diagnosed with MeS based on the criteria of the National Cholesterol Education Program (NCEP) adult treatment panel (ATP) III. MeS was present in 65.1% of patients with CAD and in 44.0% of those with no CAD (p<0.0005). After adjusting for the important variables in the multivariate analysis, those with MeS were twice more likely to have CAD (OR = 1.94, 95% CI: 1.29, 2.93, p = 0.002) compared to those without MeS. The number of metabolic abnormalities was significantly associated with CAD, when it substituted MeS in the regression model, with a higher number of MeS components led to greater odds for CAD.

References

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