The prevalence of metabolic syndrome and its association with body fat distribution in middle-aged individuals from Indonesia and the Netherlands: a cross-sectional analysis of two population-based studies

Abstract

Background: The prevalence of metabolic syndrome varies among populations with different ethnicities. Asian populations develop metabolic complications at lower amounts of adiposity than western populations. The role of abdominal obesity in the metabolic differences between the two populations is poorly understood.

Objectives: Our objectives were to estimate the prevalence of metabolic syndrome and the relative contribution of its components in the Indonesian and the Dutch population, as well as to examine the associations of overall and abdominal obesity with metabolic syndrome.

Methods: In this cross-sectional study of middle-aged adults in the Netherlands Epidemiology of Obesity Study (n = 6602) and the Indonesian National Health Surveillance (n = 10,575), metabolic syndrome was defined by the unified IDF and AHA/NHLBI criteria. We performed logistic and linear regressions to examine associations of BMI and waist circumference with the metabolic syndrome, mutually adjusted for waist circumference and BMI.

Results: The prevalence of metabolic syndrome was 28% and 46% in Indonesian men and women, and 36% and 24% in Dutch men and women. The most prominent components were hypertension (61%) and hyperglycemia (51%) in the Indonesian, and hypertension (62%) and abdominal obesity (40%) in the Dutch population. Per SD in BMI and waist circumference, odds ratios (ORs, 95% CI) of metabolic syndrome were 1.5 (1.3-1.8) and 2.3 (1.9-2.7) in Indonesian men and 1.7 (1.2-2.5) and 2.9 (2.1-4.1) in Dutch men. The ORs of metabolic syndrome were 1.4 (1.2-1.6) and 2.3 (2.0-2.7) in Indonesian women and 1.0 (0.8-1.3) and 4.2 (3.2-5.4) in Dutch women.

Conclusion: More Indonesian women than men have metabolic syndrome, whereas the opposite is true for the Dutch population. In both the Indonesian and the Dutch populations, hypertension is the primary contributor to the prevalence of metabolic syndrome. In both populations, abdominal adiposity was more strongly associated with metabolic syndrome than overall adiposity.

Keywords: Abdominal obesity; BMI; Metabolic syndrome; Waist circumference.

Fig. 1

The contributions of metabolic syndrome components in the Indonesian and Dutch population. a The contributions of components in the Indonesian population. b The contributions of components in the Dutch population. The colorful area within the inner bold black line represents the proportions (%) of the population with metabolic syndrome (having concomitantly 3, 4, or 5 components). A blank area represents proportions of ≤ 0.4%. The number outside the colorful area represents the proportion of the population with no abnormalities

Fig. 2

The Associations of Overall and Abdominal Adiposity with metabolic syndrome and its components. The forest plot showed the adjusted Odds Ratios of Metabolic Syndrome and its components per 1 SD of BMI (4.4 kg/m²) and per 1 SD of waist circumference (11.6 cm in the Indonesian, 13.4 cm in the Dutch population). Data were presented in OR (95% CI). BMI and waist circumference were mutually adjusted. See Table 4. a The associations in the Indonesian population. Models were adjusted for age, education, smoking behavior, physical activity, pre-existing CVD, Stroke, and Diabetes, urban/rural, and socioeconomic status. b The associations in the Dutch population. Models were adjusted for age, education, smoking behavior, physical activity, pre-existing CVD, Stroke, and Diabetes, and alcohol consumption. In women: plus menopausal status and sex hormone use