Original Paper Received: April 12, 2013 Accepted after revision: September 10, 2013 Published online: February 1, 2014
Ann Nutr Metab 2013;63:298–304 DOI: 10.1159/000355575
Prevalence of Metabolic Syndrome and Its Relationship with Physical Activity in Suburban Beijing, China Wei-Hong Zhang a Peng Xue c Meng-Ying Yao b Hai-Min Chang d Yan Wu e Lei Zhang f, g
a
Department of Basic Medicine, Nursing College, and b Department of Severe Respiratory Diseases, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, c Key Laboratory of Molecular and Cellular Immunology, Henan University, Kaifeng, d Department of Forensic Clinical Medicine, Xinxiang Medical University, Xinxiang, and e National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, f Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Epidemiology, Peking University Cancer Hospital, Beijing Cancer Hospital and Institute, and g Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
Key Words Metabolic syndrome · Physical activity · Relationship
Abstract Background: The present study aimed to estimate the upto-date prevalence of metabolic syndrome and its relationship with physical activity among suburban adults in Beijing, China. Methods: A cross-sectional survey in a representative sample of 19,003 suburban adults aged 18–76 years was carried out in 2007–2008. Data was collected via questionnaires and blood pressure, anthropometric, and laboratory measurements. Results: Of the residents aged 18–76 years in suburban Beijing, 25.9% (27.3% in men and 25.1% in women), 21.3% (19.4% in men and 22.9% in women), and 25.3% (24.2% in men and 26.1% in women) had 1 component, 2 components, and 3 or more components of metabolic syndrome, respectively. The age-standardized prevalence of metabolic syndrome and its components, including abdominal obesity, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure, and elevated fasting plasma glucose, decreased across categories with
© 2014 S. Karger AG, Basel 0250–6807/14/0634–0298$39.50/0 E-Mail [email protected] www.karger.com/anm
increasing physical activity. After adjusting for age, sex, education level, smoking, and alcohol consumption, residents were more likely to have metabolic syndrome across categories with decreasing physical activity; a similar relationship also applied to components of metabolic syndrome. Conclusion: A high prevalence of metabolic syndrome and its components is commonly present in suburban Beijing. Increasing physical activity can reduce the relative risk of metabolic syndrome and it components. © 2014 S. Karger AG, Basel
Introduction
Metabolic syndrome (MetS) is an important risk factor for cardiovascular disease and type 2 diabetes [1], as well as mortality from cardiovascular disease and other causes [2, 3]. The prevalence of MetS and its components has been steadily increasing over the past two decades, and it
Wei-Hong Zhang and Peng Xue contributed equally to this work.
Lei Zhang Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education) Department of Epidemiology Peking University Cancer Hospital and Institute, Beijing 100142 (China) E-Mail zlei @ hsc.pku.edu.cn
is now estimated to affect at least a quarter of the Chinese population [4–6]. Previous studies have suggested an inverse relationship between physical activity and MetS [7– 10]. Accordingly, leading health organizations now promote the use of physical activity as a therapeutic strategy for the management of MetS [11, 12]; however, the intensity at which physical activity may be of benefit in reducing the risk for MetS remains unclear. This gap in the literature is particularly evident for Chinese populations where the prevalence of obesity, which is the most prevalent manifestation of MetS, and physical inactivity has increased with economic development and rapid urbanization [13]. Beijing, for instance, has emerged as one Chinese city that has undergone considerable economic growth and rapid urbanization, and has had concomitant increases in the prevalence of metabolic abnormalities [6]. To date, we are aware of several studies documenting the prevalence of MetS among adults in Beijing [6, 14]. In addition, to the best of our knowledge, there are few published reports that have evaluated the relationship between MetS and physical activity in Beijing. This study aimed to quantify the up-to-date prevalence of MetS and to examine its relationship with physical activity among suburban adults in Beijing, in order to evaluate the efficacy of physical activity in preventing MetS, and provide a context for policy planners and health education programs in these similar areas. Methods Study Population A cross-sectional population survey of cardiovascular disease was carried out among suburban adults in Beijing in 2007–2008. In brief, a 3-stage stratified sampling method was used to select a representative sample of the general population. In stage one, 5 towns were randomly selected. In the second stage of sampling, 30 villages/street districts were randomly selected from a total of 76 villages/street districts. In the final stage, individuals were randomly chosen from the selected townships/street districts. A total of 20,655 people aged 18–76 years were randomly selected from 30 primary sampling units (villages or street districts) and invited to participate in the study. Of these, 968 declined to participate, 514 did not complete the study, and 180 had incomplete information; therefore, 19,003 people (7,148 men and 11,855 women) completed the survey and examinations and were eligible for analysis. The overall response rate was 92.0%. Institutional review boards or ethics committees at all participating institutes approved the study protocol. Written informed consent was obtained from each participant before data collection. Participants with untreated conditions identified during the examination were referred to a primary health care provider.
MetS and Physical Activity
Data Collection Well-trained interviewers conducted face-to-face interviews with participants via a structured questionnaire to collect information on social-demographic factors, health status, and nutrition and lifestyle practices (including dietary factors, smoking status, and physical activity). Educational attainment was categorized as primary, secondary, or tertiary. According to the respondents’ self-reports, the smoking status of participants was classified as nonsmoker, ex-smoker, or current smoker, and alcohol consumption was categorized as not a current drinker or current drinker. Blood Pressure and Anthropometric Measurements Three consecutively measurements of blood pressure (BP) were taken on the right arm using a calibrated mercury sphygmomanometer after the participant had been resting in a seated position for at least 5 min. Constant room temperature (22 ° C) was kept to avoid the influence of temperature and weather. Participants were advised to avoid cigarette smoking, alcohol, caffeinated beverages, and exercise for at least 30 min before the measurement. The average of 3 measurements was used in the analysis. Body weight, height, and waist circumference were measured twice with the participant in light indoor clothing without shoes during the interview. Weight was measured on an electronic scale placed on a firm, level surface to the nearest 0.1 kg. Height was measured by a wall-mounted stadiometer to the nearest 0.1 cm. Waist circumference was measured to the nearest 0.1 cm using constant tension tapes at the end of a normal expiration, with arms relaxed at the sides, at the midpoint between the lower part of the lowest rib and the highest point of the hip on the midaxillary line.
Laboratory Measurements Overnight fasting blood specimens were obtained by venipuncture for measurement of serum lipids and plasma glucose. Participants who did not meet overnight fasting were asked to visit centers later when their fasting time was more than 10 h. Blood specimens were centrifuged and plasma was stored at –70 ° C until laboratory assay. Plasma glucose and lipid levels were measured using a modified hexokinase enzymatic method (HITACHI automatic clinical analyzer, model 7060; Japan). Concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) were analyzed enzymatically with commercially available reagents [15]. Lipid measurements were standardized according to the criteria of the Centers for Disease Control and Prevention-National Heart, Lung, and Blood Institute Lipid Standardization Program [16].
Clinical Criteria for Data Interpretation MetS was defined according to the joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention, the National Heart, Lung, and Blood Institute, the American Heart Association, the World Heart Federation, the International Atherosclerosis Society, and the International Association for the Study of Obesity in 2009 as follows: abdominal obesity should not be a prerequisite for diagnosis but it is 1 of 5 criteria, so the presence of 3 or more of the risk factors shown below constitutes a diagnosis of MetS [17]: abdominal obesity (waist circumference ≥85 cm for males and ≥80 cm for females) [18], elevated TG level (≥1.7 mmol/l), reduced HDL-C (
Ann Nutr Metab 2013;63:298–304 DOI: 10.1159/000355575
Prevalence of Metabolic Syndrome and Its Relationship with Physical Activity in Suburban Beijing, China Wei-Hong Zhang a Peng Xue c Meng-Ying Yao b Hai-Min Chang d Yan Wu e Lei Zhang f, g
a
Department of Basic Medicine, Nursing College, and b Department of Severe Respiratory Diseases, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, c Key Laboratory of Molecular and Cellular Immunology, Henan University, Kaifeng, d Department of Forensic Clinical Medicine, Xinxiang Medical University, Xinxiang, and e National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, f Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Epidemiology, Peking University Cancer Hospital, Beijing Cancer Hospital and Institute, and g Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
Key Words Metabolic syndrome · Physical activity · Relationship
Abstract Background: The present study aimed to estimate the upto-date prevalence of metabolic syndrome and its relationship with physical activity among suburban adults in Beijing, China. Methods: A cross-sectional survey in a representative sample of 19,003 suburban adults aged 18–76 years was carried out in 2007–2008. Data was collected via questionnaires and blood pressure, anthropometric, and laboratory measurements. Results: Of the residents aged 18–76 years in suburban Beijing, 25.9% (27.3% in men and 25.1% in women), 21.3% (19.4% in men and 22.9% in women), and 25.3% (24.2% in men and 26.1% in women) had 1 component, 2 components, and 3 or more components of metabolic syndrome, respectively. The age-standardized prevalence of metabolic syndrome and its components, including abdominal obesity, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure, and elevated fasting plasma glucose, decreased across categories with
© 2014 S. Karger AG, Basel 0250–6807/14/0634–0298$39.50/0 E-Mail [email protected] www.karger.com/anm
increasing physical activity. After adjusting for age, sex, education level, smoking, and alcohol consumption, residents were more likely to have metabolic syndrome across categories with decreasing physical activity; a similar relationship also applied to components of metabolic syndrome. Conclusion: A high prevalence of metabolic syndrome and its components is commonly present in suburban Beijing. Increasing physical activity can reduce the relative risk of metabolic syndrome and it components. © 2014 S. Karger AG, Basel
Introduction
Metabolic syndrome (MetS) is an important risk factor for cardiovascular disease and type 2 diabetes [1], as well as mortality from cardiovascular disease and other causes [2, 3]. The prevalence of MetS and its components has been steadily increasing over the past two decades, and it
Wei-Hong Zhang and Peng Xue contributed equally to this work.
Lei Zhang Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education) Department of Epidemiology Peking University Cancer Hospital and Institute, Beijing 100142 (China) E-Mail zlei @ hsc.pku.edu.cn
is now estimated to affect at least a quarter of the Chinese population [4–6]. Previous studies have suggested an inverse relationship between physical activity and MetS [7– 10]. Accordingly, leading health organizations now promote the use of physical activity as a therapeutic strategy for the management of MetS [11, 12]; however, the intensity at which physical activity may be of benefit in reducing the risk for MetS remains unclear. This gap in the literature is particularly evident for Chinese populations where the prevalence of obesity, which is the most prevalent manifestation of MetS, and physical inactivity has increased with economic development and rapid urbanization [13]. Beijing, for instance, has emerged as one Chinese city that has undergone considerable economic growth and rapid urbanization, and has had concomitant increases in the prevalence of metabolic abnormalities [6]. To date, we are aware of several studies documenting the prevalence of MetS among adults in Beijing [6, 14]. In addition, to the best of our knowledge, there are few published reports that have evaluated the relationship between MetS and physical activity in Beijing. This study aimed to quantify the up-to-date prevalence of MetS and to examine its relationship with physical activity among suburban adults in Beijing, in order to evaluate the efficacy of physical activity in preventing MetS, and provide a context for policy planners and health education programs in these similar areas. Methods Study Population A cross-sectional population survey of cardiovascular disease was carried out among suburban adults in Beijing in 2007–2008. In brief, a 3-stage stratified sampling method was used to select a representative sample of the general population. In stage one, 5 towns were randomly selected. In the second stage of sampling, 30 villages/street districts were randomly selected from a total of 76 villages/street districts. In the final stage, individuals were randomly chosen from the selected townships/street districts. A total of 20,655 people aged 18–76 years were randomly selected from 30 primary sampling units (villages or street districts) and invited to participate in the study. Of these, 968 declined to participate, 514 did not complete the study, and 180 had incomplete information; therefore, 19,003 people (7,148 men and 11,855 women) completed the survey and examinations and were eligible for analysis. The overall response rate was 92.0%. Institutional review boards or ethics committees at all participating institutes approved the study protocol. Written informed consent was obtained from each participant before data collection. Participants with untreated conditions identified during the examination were referred to a primary health care provider.
MetS and Physical Activity
Data Collection Well-trained interviewers conducted face-to-face interviews with participants via a structured questionnaire to collect information on social-demographic factors, health status, and nutrition and lifestyle practices (including dietary factors, smoking status, and physical activity). Educational attainment was categorized as primary, secondary, or tertiary. According to the respondents’ self-reports, the smoking status of participants was classified as nonsmoker, ex-smoker, or current smoker, and alcohol consumption was categorized as not a current drinker or current drinker. Blood Pressure and Anthropometric Measurements Three consecutively measurements of blood pressure (BP) were taken on the right arm using a calibrated mercury sphygmomanometer after the participant had been resting in a seated position for at least 5 min. Constant room temperature (22 ° C) was kept to avoid the influence of temperature and weather. Participants were advised to avoid cigarette smoking, alcohol, caffeinated beverages, and exercise for at least 30 min before the measurement. The average of 3 measurements was used in the analysis. Body weight, height, and waist circumference were measured twice with the participant in light indoor clothing without shoes during the interview. Weight was measured on an electronic scale placed on a firm, level surface to the nearest 0.1 kg. Height was measured by a wall-mounted stadiometer to the nearest 0.1 cm. Waist circumference was measured to the nearest 0.1 cm using constant tension tapes at the end of a normal expiration, with arms relaxed at the sides, at the midpoint between the lower part of the lowest rib and the highest point of the hip on the midaxillary line.
Laboratory Measurements Overnight fasting blood specimens were obtained by venipuncture for measurement of serum lipids and plasma glucose. Participants who did not meet overnight fasting were asked to visit centers later when their fasting time was more than 10 h. Blood specimens were centrifuged and plasma was stored at –70 ° C until laboratory assay. Plasma glucose and lipid levels were measured using a modified hexokinase enzymatic method (HITACHI automatic clinical analyzer, model 7060; Japan). Concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) were analyzed enzymatically with commercially available reagents [15]. Lipid measurements were standardized according to the criteria of the Centers for Disease Control and Prevention-National Heart, Lung, and Blood Institute Lipid Standardization Program [16].
Clinical Criteria for Data Interpretation MetS was defined according to the joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention, the National Heart, Lung, and Blood Institute, the American Heart Association, the World Heart Federation, the International Atherosclerosis Society, and the International Association for the Study of Obesity in 2009 as follows: abdominal obesity should not be a prerequisite for diagnosis but it is 1 of 5 criteria, so the presence of 3 or more of the risk factors shown below constitutes a diagnosis of MetS [17]: abdominal obesity (waist circumference ≥85 cm for males and ≥80 cm for females) [18], elevated TG level (≥1.7 mmol/l), reduced HDL-C (
