[Predictive capacity of the diagnostic criteria of metabolic syndrome on the insulin-resistance and the coronary risk]. / Capacidad predictiva de los criterios diagnósticos del síndrome metabólico sobre la resistencia a la insulina y el riesgo coronario.

BACKGROUND AND OBJECTIVE: Since at present several diagnostic criteria of the metabolic syndrome (MS) exist, the objective of the study is to verify the utility of the criteria of the International Diabetes Federation (IDF) to diagnose the MS, their agreement with other previous definitions and the insulin resistance (IR). It also studies its relation with the coronary risk (CR). SUBJECTS AND METHOD: Design of a cross-sectional descriptive study in the scope of the primary care of Yecla (Murcia). We studied 317 selected people from a stratified random sampling (age and sex) of 424 from a population of 18,059 with sanitary card and aged > or = 30 years. Socio-demographic, anthropometric and analytical (lipids, microalbuminuria, hemoglobin A1c and insulinemia) variables were registered. Criteria from the World Health Organization (WHO), Third Report of National Cholesterol Education Program (NCEP-III), European Group for the Study of Insuline Resistance (EGIR) and IDF were used to diagnose the MS. We defined IR when index HOMA > or = 3.8. The agreement between definitions of MS was determined by the kappa statistic. The CR was quantified according to Anderson (1991) method. RESULTS: The prevalence of the MS was: WHO, 35.3% (95% confidence interval [CI], 29.8-40.8); NCEP, 20.2% (95% CI, 15.6-24.8); EGIR, 24% (95% CI, 19.1-28.9), and IDF, 28.9% (95% CI, 23.8-34). The prevalence of IR was 27.7% (95% CI, 22.6-32.8). The agreement between the most clinical criteria (NCEP, IDF) and the biochemists (WHO, EGIR, HOMA) was lower (kappa < 0.50). A 58.2% (WHO), 66.1% (NCEP), 50% (EGIR) and 57% (IDF) of subjects with MS presented a CR greater than 20%. CONCLUSIONS: A high prevalence of the MS in Yecla exists, with a good agreement between the most clinical definitions of the syndrome (NCEP and IDF), that are associated with greater CR.

Capacidad predictiva de los criterios diagnósticos del síndrome metabólico sobre la resistencia a la insulina y el riesgo coronario / Predictive capacity of the diagnostic criteria of metabolic syndrome on the insulin-resistance and the coronary risk

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[Prevalence of metabolic syndrome in the adult population of Yecla (Murcia). Degree of agreement between three definitions of it]. / Prevalencia del síndrome metabólico en la población adulta de Yecla (Murcia). Grado de acuerdo entre tres definiciones.

OBJECTIVES: To determine the prevalence of metabolic syndrome (MS), its components and insulin resistance (IR) in the adult population of Yecla. To study the variability between 3 definitions of the syndrome and IR. To identify the variables that predict the presence of IR and to verify the diagnostic validity of several strategies for predicting it. DESIGN: Descriptive, cross-sectional study. SETTING: Primary care, Yecla (Murcia), Spain. PARTICIPANTS: We studied 317 persons (292 with analysis) out of 424 selected by stratified (age and sex) random sampling from 18,059 people > or = 30 years old and possessing a health card. MAIN MEASUREMENTS: We used WHO-98, NCEP III, and EGIR criteria for diagnosing MS, and WHO-99 for defining DM2, impaired basal glucose and impaired glucose tolerance. The following variables were collected: social, demographic and personal details, plasma lipid, glycosylated haemoglobin, microalbuminuria, and insulin levels. IR was defined by the HOMA method at > or = 3.8 or as the highest quartile of basal insulinemia in normoglycaemic persons. RESULTS: MS prevalence was NCEP 20.2% (95% CI, 15.6-24.8), WHO 35.3% (95% CI, 29.8-40.8), EGIR 24% (95% CI, 19.1-28.9), and IR was 27.7% (95% CI, 22.6-32.8). The sensitivity and specificity of NCEP, WHO, and EGIR criteria for detecting IR were (46% and 90%), (78% and 81%), and (73% and 95%), respectively. Insulin resistance was associated significantly with age, basal glycaemia, triglycerides, and waist circumference. CONCLUSIONS: Metabolic syndrome is common in Yecla (more so in men). There is disagreement between several diagnostic criteria for the syndrome, with NCEP criteria less sensitive in determining IR. A generally accepted definition is needed.

Prevalencia del síndrome metabólico en la población adulta de Yecla (Murcia). Grado de acuerdo entre tres definiciones / Prevalence of metabolic syndrome in the adult population of Yecla (Murcia). Degree of agreement between three definitions of it

Objetivos. Detectar la prevalencia del síndrome metabólico (SM), sus componentes y la resistencia a la insulina (RI) en la población adulta de Yecla. Estudiar la concordancia de 3 definiciones del SM entre sí y con la RI. Identificar variables que puedan predecir la presencia de RI y comprobar la validez diagnóstica de varias estrategias para predecirla. Diseño. Estudio descriptivo, transversal. Emplazamiento. Población de Yecla (Murcia). Ámbito de atención primaria. Participantes. Estudiamos a 317 personas (292 aportaron analítica) de 424 seleccionadas mediante muestreo aleatorio estratificado (edad y sexo) de 18.059 con tarjeta sanitaria y edad é 30 años. Mediciones principales. Utilizamos los criterios NCEP III, OMS-98 y EGIR (Grupo Europeo de Estudio de la Resistencia a la Insulina) para diagnosticar el SM y OMS-99 para definir la diabetes mellitus no insulinodependiente, la glucemia basal alterada y la tolerancia alterada a la glucosa. Recogimos variables sociodemográficas y antropométricas, y determinamos la presencia de lípidos, microalbuminuria, HbA1c e insulinemia; definimos RI si el índice HOMA é 3,8 o como cuartil más alto de insulinemia basal en normoglucémicos. Resultados. La prevalencia del SM fue, según los criterios NCEP, del 20,2% (intervalo de confianza [IC] del 95%, 15,6-24,8), OMS del 35,3% (IC del 95%, 29,8-40,8), EGIR del 24% (IC del 95%, 19,1-28,9) y RI del 27,7% (IC del 95%, 22,6-32,8). La sensibilidad y la especificidad de NCEP, OMS y EGIR para detectar RI fueron del 46 y el 90%, del 78 y el 81% y del 73 y el 95%, respectivamente. La edad, la glucemia basal, los triglicéridos y el perímetro de la cintura se asocian significativamente con RI. Conclusiones. Hay una alta prevalencia de SM en el área (mayor en los varones). Hay diferencias entre los diferentes criterios diagnósticos del síndrome, y los de NCEP son menos sensible para determinar la RI. Es necesario establecer una definición universalmente aceptada del SM

Objectives. To determine the prevalence of metabolic syndrome (MS), its components and insulin resistance (IR) in the adult population of Yecla. To study the variability between 3 definitions of the syndrome and IR. To identify the variables that predict the presence of IR and to verify the diagnostic validity of several strategies for predicting it. Design. Descriptive, cross-sectional study. Setting. Primary care, Yecla (Murcia), Spain. Participants. We studied 317 persons (292 with analysis) out of 424 selected by stratified (age and sex) random sampling from 18 059 people >=30 years old and possessing a health card. Main measurements. We used WHO-98, NCEP III, and EGIR criteria for diagnosing MS, and WHO-99 for defining DM2, impaired basal glucose and impaired glucose tolerance. The following variables were collected: social, demographic and personal details, plasma lipid, glycosylated haemoglobin, microalbuminuria, and insulin levels. IR was defined by the HOMA method at >=3.8 or as the highest quartile of basal insulinemia in normoglycaemic persons. Results. MS prevalence was NCEP 20.2% (95% CI, 15.6-24.8), WHO 35.3% (95% CI, 29.8-40.8), EGIR 24% (95% CI, 19.1-28.9), and IR was 27.7% (95% CI, 22.6-32.8). The sensitivity and specificity of NCEP, WHO, and EGIR criteria for detecting IR were (46% and 90%), (78% and 81%), and (73% and 95%), respectively. Insulin resistance was associated significantly with age, basal glycaemia, triglycerides, and waist circumference. Conclusions. Metabolic syndrome is common in Yecla (more so in men). There is disagreement between several diagnostic criteria for the syndrome, with NCEP criteria less sensitive in determining IR. A generally accepted definition is needed