The dynamic behaviour of metabolic syndrome and its components in an eight-year population-based cohort from the Mediterranean

PLoS One. 2017 May 18;12(5):e0176665. doi: 10.1371/journal.pone.0176665. eCollection 2017.

Abstract

Background: The significant rise in the prevalence of obesity coincides with the considerable increase in the prevalence of metabolic syndrome (MS) currently being observed worldwide. The components of MS are not static and their dynamics, such as the order of their occurrence, or the time of exposure to them are, as yet, unknown but could well be clinically relevant. Our objective was to study the dynamic behaviour of MS and its components in a large population-based cohort from a Mediterranean region.

Methods and findings: Our study employed a retrospective cohort (between January 1, 2005 and December 31, 2012) made up of individuals from the general population in a region in the northeast of Catalonia, Spain. Given that most of the explicative variables of the risk of having MS were time dependent and, therefore, the risk was not proportional, we used the Andersen-Gill (AG) model to perform a multivariate survival analysis and inferences were performed using a Bayesian framework. Thirty-nine percent of the participants developed MS; 44.6% of them with a single limited episode. Triglycerides and low HDL cholesterol, together with obesity, are components associated with the first occurrence of MS. Components related to the metabolism of glucose are associated with a medium risk of having a first episode of MS, and those related to blood pressure are associated with a lower risk. When the components related to blood pressure and the metabolism of glucose appear first, they determine the appearance of the first episode of MS. The variables concerning the persistence of MS are those that correspond to clinical conditions that do not have well-established drug treatment criteria.

Conclusions: Our results suggest that the components related to the metabolism of glucose and to high blood pressure appear early on and act as biomarkers for predicting MS, while the components related to obesity and dyslipidaemia, although essential for the development of MS, appear later. Making lifestyle changes reduces the conditions associated with the persistence of MS.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Mediterranean Region / epidemiology
  • Metabolic Syndrome / epidemiology*
  • Middle Aged
  • Retrospective Studies

Grants and funding

This paper was developed within the scope of the project ‘Compositional and Spatial Analysis’ (COSDA), AGAUR, ‘Generalitat de Catalunya’, 2014SGR551. It was partly funded through Project FIS 15/0040 from the Health Research Fund (Fondo de Investigación Sanitaria), Instituto de Salud Carlos III, Ministry of Economy and Competitiveness, Government of Spain, through the ‘A way to making Europe’, European Regional Development Fund (FEDER), European Union, by the CIBER of Epidemiology and Public Health (CIBERESP) through the strategic subprogram ‘Crisis and Health’, and through the Research Grant to Improve the Scientific Productivity of the Research Groups of the University of Girona 2016-2018 (MPCUdG2016/69). The work did not obtain additional funding for its development.