Association Between Metabolic Syndrome and Mortality: Prospective Cohort Study

Abstract

Background: Metabolic syndrome (MetS) is a common metabolic disorder that results from the increasing prevalence of obesity, which has been an increasing concern in recent years. Previous evidence indicated that MetS was associated with mortality; however, different definitions of MetS were used. In 2005, the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III updated the definition of MetS, which has since been widely adopted. Therefore, it is necessary to conduct a novel study among other populations and countries with a larger sample size using the updated definition of MetS and death code to examine the association of MetS with all-cause and cause-specific mortality.

Objective: We aimed to examine the associations of MetS with all-cause and cause-specific mortality.

Methods: A total of 36,414 adults were included in this study, using data from the National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and the continuous NHANES (1999-2014) in the United States. Death outcomes were ascertained by linkage to National Death Index records through December 31, 2015. MetS was defined by the NCEP ATP III-2005 criterion. Complex survey design factors including sample weights, clustering, and stratification were considered for all analyses with instructions for using NHANES data. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for mortality from all causes, heart disease, diabetes, and cancer.

Results: We observed 8494 deaths during the 16.71 years of follow-up. Compared with those without MetS, individuals with MetS were associated with a significantly elevated multiadjusted HR of 1.24 (95% CI 1.16-1.33), 1.44 (95% CI 1.25-1.66), and 5.15 (95% CI 3.15-8.43) for all cause, heart diseases, and diabetes mellitus, respectively, whereas no significant association was found for cancer mortality (HR 1.17, 95% CI 0.95-1.43).

Conclusions: Our study provides additional evidence that MetS and its components are significantly associated with all-cause, heart disease, and diabetes mortality, but not with cancer mortality. Health care professionals should pay more attention to MetS and its individual component.

Keywords: cancer; diabetes mellitus; heart disease; metabolic syndrome; mortality.

Figure 1

Unadjusted Kaplan-Meier hazard curves: (A) metabolic syndrome (MetS) and heart disease; (B) MetS and diabetes mellitus; (C) MetS and all causes; (D) the number of MetS components and heart disease; (E) the number of MetS components and diabetes mellitus; and (F) the number of MetS components and all causes.