| Objectives1.To explore the association between metabolic syndrome(MS)of 2005 NCEP-ATP Ⅲ resivised criterion(A criterion),2009 IDF,AHA and NHLBI criterion(B criterion),2016 JCDCG criterion(C criterion)with risk of type 2 diabetes mellitus(T2DM)and its cause.2.To compare the predictive power of A criterion,B criterion,and C criterion of MS for T2 DM incidence,and determine the most optimal MS criterion for screening of high-risk populations of T2 DM with its cuase.MethodsParticipants aged ≥ 18 years old were selected using cluster sampling method in Cijian and Tiemen towns of Xin’an County,Henan Province,China.The questionnaire interview,physical examination,fasting plasma glucose,and lipid profile measurements for the study participants were done during July to August of 2007 and July to August of 2008.The same study methods were implemented for the follow-up examination during July to August of 2013 and July to October of 2014.We analyzed the association of MS of three criteria with T2 DM incidence and its cause using Cox proportional hazard regression model and Spiegelman,and compared prediction power of three MS criteria and its cause using ROC curse among eligibled 12252 participants(male: 4650;female: 7602).Results1.During a mean of 5.92 years follow-up for 12252 non-T2 DM participants,776 cases(296 males and 480 females)occurred and T2 DM incidences were 10.71,10.61,and 10.77/1000 person-years for overall,male,and female participants,respectively.2.T2 DM incidence(/1000 person-years)was higher in MS group than non-MS group regardress of MS definitions(P<0.0001),and C criterion was the highest and B criterion was the lowest(A: 20.87 [19.14-22.60] and 4.98 [4.34-5.62];B: 20.60 [18.91-22.28] and 4.78 [4.15-5.42];C: 25.91 [23.37-28.45] and 6.74 [6.07-7.41]).Similar results were observed in males and females.3.After adjustment for gender,age,tobacco and alcohol comsumption,family history of DM,physical activity,and resting heart rate,compared with normal MS group,HR [95% CI] of T2 DM incidence was significantly increased in MS group(P<0.0001),and C criterion was the lowest(A,5.11 [4.24-6.16];B,5.07 [4.20-6.12];C,4.16 [3.53-4.91]);population attributable risk(PAR [95% CI])of T2 DM was also the lowest for C criterion(A,0.61 [0.55-0.66];B,0.62 [0.56-0.67];C,0.42 [0.36-0.48]).Similar results were observed in males and females.4.Abnormal WC,BP,TG,HDL-C,and FPG groups were higher for T2 DM incidence(/1000 person-years)among three criteria compred with normal group(WC: A,16.54 [15.14-17.93] and 6.07 [5.31-6.82];B,16.10 [14.80-17.39] and 5.32 [4.57-6.07];C,19.33 [17.55-21.10] and 6.66 [5.94-7.38];BP: A/B/C,15.43 [14.03-16.82] and 7.39 [6.58-8.21];TG: A/B/C,17.64 [15.97-19.31] and 7.32 [6.57-8.08];HDL-C: A/B,12.42 [11.36-13.49] and 8.42 [7.41-9.44];C,13.37 [11.89-14.84] and 9.45 [8.60-10.31];FPG: A/B,25.25 [23.10-27.40] and 4.98 [4.37-5.58];C,50.60 [45.20-56.00] and 6.90 [6.27-7.53];P<0.0001).Similar results were observed in males and females.5.After adjustment for gender,age,tobacco and alcohol comsumption,family history of DM,physical activity,and resting heart rate,HR [95% CI] and PAR [95% CI] of T2 DM incidence were not completely consistented among different MS components.With normal WC group as reference,HR [95% CI] of T2 DM incidence was significantly increased in abnormal WC group,and B criterion was the highest and C criterion was the lowest(A,3.20 [2.65-3.85];B,3.26 [2.69-3.96];C,3.13 [2.64-3.70];P<0.0001);PAR [95% CI] of T2 DM was the lowest for B criterion(A,0.49 [0.41-0.56];B,0.54 [0.46-0.61];C,0.41 [0.35-0.48]);similar results were observed in males and females.With normal group as reference,HR [95% CI] of T2 DM incidence for overall,male and female participants was significantly increased in abnormal BP and TG groups(BP: 1.93 [1.63-2.30],1.68 [1.28-2.21],and 2.06 [1.65-2.59];TG: 2.63 [2.23-3.09],2.26 [1.73-2.94],and 2.80 [2.26-3.46];P<0.0001);PAR(95% CI)of T2 DM incidence for overall,male,and female participants was 0.30(0.23-0.36),0.36(0.29-0.42),and 0.23(0.11-0.33)in abnormal BP group;and 0.28(0.19-0.38),0.34(0.27-0.40),and 0.40(0.32-0.47)in abnormal TG group,respectively.With normal HDL-C group as reference,HR [95% CI] of T2 DM incidence was significantly increased in abnormal HDL-C group(A/B,1.56 [1.30-1.86];C,1.46 [1.23-1.72];P<0.0001);PAR(95% CI)of T2 DM incidence for A/B and C criteria was 0.24(0.15-0.33)and 0.13(0.07-0.18);similar results were observed in males and females.With normal FPG group as reference,HR [95% CI] of T2 DM incidence was significantly increased in abnormal FPG group(P<0.0001),and A/B criterion was higher than C criterion(6.41 [5.36-7.66] vs.8.81 [7.42-10.47]);A/B criterion was higher than C criterion for PAR(95% CI)of T2 DM incidence(0.63 [0.57-0.68] vs.0.44 [0.38-0.50]);similar results were observed in males and females.6.Area under the curve(AUC)of MS was not significant difference between A criterion and B criterion(P>0.05),but they were significantly higher than C criterion(P<0.05): overall(A,0.678 [0.670-0.686];B,0.680 [0.672-0.688];C,0.654 [0.645-0.662]),males(A,0.654 [0.640-0.667];B,0.659 [0.645-0.673];C,0.647 [0.633-0.661]),and females(A/B,0.693 [0.683-0.704];C,0.658 [0.647-0.669]).Sensitivity and negative predictive value were the highest for MS of B criterion among three criteria(P<0.05).7.AUC,sensitivity,and negative predictive value were the highest for abnormal WC of B criteria among different criterion(P<0.05).There were low AUC,sensitivity,and negative predictive value for abnormal BP,TG,and HDL-C of different criteria.AUC,sensitivity,and negative predictive value were higher for abnormal FPG of A/B criterion than C criterion(P<0.05).Conclusions1.MS of three criteria and its components increased risk of T2 DM incidence.2.T2 DM risk and PAR was the lowest for MS of 2016 JCDCG criterion and it might be attributed to difference of abnormal WC or FPG among different criteria.3.Prediction powers were better for MS of 2005 NCEP ATP Ⅲ criterion and 2009 IDF,AHA and NHLBI criterion than 2016 JCDCG criterion,and it might be attributed to difference of abnormal FPG among different criteria.4.MS of 2009 IDF,AHA and NHLBI criterion was the most optimal to screen high-risk populations of T2 DM. |
