The Prevalence of Metabolic Syndrome in an Apparently Healthy, Normotensive and Non-Diabetic Population in Saudi Arabia by Two Definitions: Implications for Local Practice


Objectives: We aimed to 1) investigate the prevalence of MS in apparently healthy, non-hypertensive non-diabetic individuals living in Jeddah using the IDF and the NCEP-ATP III criteria to test for agreement in classification, and to determine the characteristics of subjects identified by either definition, and 2) examine the significance of family medical history and life style habits. Methods: 557 apparently healthy individuals aged 18 - 50 y were randomly approached in Jeddah health centres. 412 agreed to participate, while 55 were excluded because they were found to be frankly hypertensive and/or diabetic. Finally, 357 apparently healthy subjects with no hypertension or diabetes were fully studied. Anthropometric and demographic information were collected. Insulin, glucose, and lipid profile were obtained in fasting blood samples. Individuals were identified using the two definitions of metabolic syndrome, and their characteristics were compared statistically to the rest of the population. Results: Of the 233 subjects fulfilling the inclusion criteria, 44 and 39 (18.9% and 16.7%) were identified as having MS by the IDF or ATPIII definitions, respectively. The most common characteristic was central obesity using the IDF definition, and low HDL-cholesterol using the NCEP-ATP III definition. As expected from our exclusion criteria, the least common feature was high blood pressure in both cases. There was no significant difference between subgroups with and without MS with regard to smoking, exercise, and family history of disease. Regression analysis indicated the strongest predictors of MS were: blood glucose, LDL-C/HDL-C ratio and plasma insulin using the NCEP-ATPIII definition, and blood glucose, Waist /Hip ratio and plasma atherogenic index (PAI) using the IDF definition. Conclusions: In the absence of local cut-off thresholds for waist circumference, subjects might escape diagnosis using the IDF definition. The use of waist/Hip ratio, LDL-C: HDL-C, PAI and circulating insulin help with the diagnosis.

Share and Cite:

S. M. Bahijri, R. M. Al Raddadi, H. Jambi, M. A. Alaama and G. Ferns, "The Prevalence of Metabolic Syndrome in an Apparently Healthy, Normotensive and Non-Diabetic Population in Saudi Arabia by Two Definitions: Implications for Local Practice," Open Journal of Endocrine and Metabolic Diseases, Vol. 3 No. 1, 2013, pp. 18-24. doi: 10.4236/ojemd.2013.31003.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] B. Isomaa, “A Major Health Hazards: The Metabolic Syndrome,” Life Science, Vol. 73, No., 2003, pp. 2395-2411.
[2] C. L. Scott, “Diagnosis, Prevention and Intervention for the Metabolic Syndrome,” The American Journal of Cardiology, Vol. 92, Suppl. 1, 2003, pp. 35i-42i.
[3] “The Idf Consensus Worldwide Definition of the Metabolic Syndrome,” 2006.
[4] Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, “Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III),” The Journal of the American Medical Association, Vol. 285, No. 19, 2001, pp. 2486-2497. doi:10.1001/jama.285.19.2486
[5] J. Tuomilehto, J. Lindstr?m and J. G. Eriksson, “Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle among Subjects with Impaired Glucose Tolerance,” The New England Journal of Medicine, Vol. 344, No. 18, 2001, pp. 1343-1350.
[6] J. Lindstrom, A. Louheranta, M. Mannelin, M. Rastas, V. Salminen and J. Eriksoon, “The Finnish Diabetes Prevention Study (DPS): Lifestyle Intervention and 3-Year Results on Diet and Physical Activity,” Diabetes Care, Vol. 26, No. 12, 2003, pp. 3230-3236.
[7] M. Al-Nozha, M. Al-Maatouq, Y. Al-Mazrou, S. Al-Harthi, M. Arafah and M. Khalil, “Diabetes Mellitus in Saudi Arabia,” Saudi Medical Journal, Vol. 25, No. 11, 2004, pp. 1603-1610.
[8] D. A. Al-Qahtani and M. L. Imtiaz, “Prevalence of Metabolic Syndrome in Saudi Adult Soldiers,” Saudi Medical Journal, Vol. 26, No. 9, 2005, pp. 1360-1366.
[9] D. Al-Qahtani, M. Imtiaz, O. Saad and N. Hussein, “A Comparison of the Prevalence of Metabolic Syndrome in Saudi Adult Females Using Two Definitions,” Metabolic Syndrom and Related Disorders, Vol. 4, No. 3, 2006, pp. 204-214. doi:10.1089/met.2006.4.204
[10] D. H. Akbar, “Metabolic Syndrome Is Common in Saudi Type 2 Diabetic Patients,” Diabetes International, Vol. 12, No. 2, 2002, pp. 47-49.
[11] M. Al-Nozha, A. Al-Khadra, M. R. Arafah, M. A. Al-Maatouq, M. Z. Khalil, N. B. Khan, Y. Y. Al-Mazrou, et al., “Metabolic Syndrome in Saudi Arabia,” Saudi Medical Journal, Vol. 26, No. 12, 2005, pp. 1918-1925.
[12] I. E. Barrimah, A. Mohaimeed, F. Midhat and H. A. Al-Shobiliet, “Prevalence of Metabolic Syndrome among Qassim University Personnel in Saudi Arabia,” International Journal of Health Sciences, Vol. 3, No. 2, 2009, pp. 133-142.
[13] N. M. Al-Daghri, O. S. Al-Attas, M. S. Alokail, K. M. Alkharfy, S. L. B. Sabico and G. P. Chrousos, “Decreasing Prevalence of the Full Metabolic Syndrome but a Persistently High Prevalence of Dyslipidemia among Adult Arabs,” Plos One, Vol. 5, No. 8, 2010, p. e12159. doi:10.1371/journal.pone.0012159
[14] E. S. Ford, “Prevalence of the Metabolic Syndrome Defined by the International Diabetes Federation among Adults in the U.S.,” Diabetes Care, Vol. 28, No. 11, 2005, pp. 2745-2749.
[15] Decode Study Group, “Prevalence of the Metabolic Syndrome in Populations of Asian Origin. Comparison of the Idf Definition with the Ncep Definition,” Diabetes Research and Clinical Practice, Vol. 76, No. 1, 2005, pp. 57-67.
[16] Decode Study Group, “Comparison of Different Definitions of the Metabolic Syndrome in Relation to Cardiovascular Mortality in European Men and Women,” Diabetologia, Vol. 49, No. 12, 2006, pp. 2837-2846.
[17] G. Assmann, R. Guerra, G. Fox, P. Cullen, H. Schulte, D. W. Willett and S. M. Grundy, “Harmonizing the Definition of Metabolic Syndrome: Comparison of the Criteria of the Adult Treatment Panel III and the International Diabetes Federation in U.S. American and European Populations,” American Journal of Cardiology, Vol. 99, No. 4, 2007, pp. 541-548.
[18] B. Cheung, K. Ong, Y. Man, L. Wong, C. Lau and K. Lam, “Prevalence of the Metabolic Syndrome in the United States National Health and Nutrition Examination Survey 1999-2002 According to Different Defining Criteria,” The Journal of Clinical Hypertension, Vol. 8, No. 8, 2006, pp. 562-570.
[19] A. C. Santos and H. Barros, “Impact of Metabolic Syndrome Definitions on Prevalence Estimates: A Study in a Portuguese Community,” Diabetes and Vascular Disease Research, Vol. 4, No. 4, 2007, pp. 320-327.
[20] Y. Yoon, E. Lee, C. Park, S. Lee and S. Oh, “The New Definition of Metabolic Syndrome by the International Diabetes Federation Is Less Likely to Identify Metabolically Abnormal but Non-Obese Individuals than the Definition by the Revised National Cholesterol Education Program: The Korea Nhanes Study,” International Journal of Obesity, Vol. 31, No. 3, 2007, pp. 528-534.
[21] A. Gemalmaz, S. Aydin, O. Bafiak, G. Discigil and A. Karul, “Prevalence of the Metabolic Syndrome in a Rural Turkish Population: Comparison and Concordance of Two Diagnostic Criteria,” Turkish Journal of Medical Sciences, Vol. 38, No. 2, 2008, pp. 159-165.
[22] Y. W. Park, S. Zhu, L. Palaniappan, S. Heshka, M. R. Carnetho and S. B. Heymsfield, “Prevalence and Associated Risk Factor Findings in the Us Population from the Third National Health and Nutrition Examination Survey, 1988-1994,” Archives of Internal Medicine, Vol. 163, No. 4, 2003, pp. 427-436.
[23] D. E. Laaksonen, L. Niskanen, H. M. Lakka, T. A. Lakka and M. Uusitupa, “Epidemiology and Treatment of the Metabolic Syndrome,” Annals of Medicine, Vol. 36, No. 5, 2004, pp. 332-346.
[24] R. H. Eckel, S. M. Grundy and P. Z. Zimmet, “The Metabolic Syndrome,” Lancet, Vol. 365, No. 9468, 2005, pp. 1415-1428.
[25] L. Zhang, Q. Qiao, J. Tuomilehto, E. D. Janus, T. H. Lam, A. Ramachandran, V. Mohan, et al., “Distinct Ethnic Differences in Lipid Profiles across Glucose Categories,” The Journal of Clinical Endocrinology & Metabolism, Vol. 95, No. 4, 2010, pp. 1793-1801.
[26] K. F. Petersen, S. Dufour, D. Befroy, R. Garcia and G. I. Shulman, “Impaired Mitochondrial Activity in the Insulin-Resistant Offspring of Patients with Type 2 Diabetes,” The New England Journal of Medicine, Vol. 350, No. 7, 2004, pp. 664-671.
[27] A. Laws, H. M. Hoen, J. V. Selby, M. F. Saad, S. M. Haffner and B. V. Howard, “Differences in Insulin Suppression of Free Fatty Acid Levels by Gender and Glucose Tolerance Status: Relation to Plasma Triglyceride and Apolipoprotein B Concentrations: Insulin Resistance Atherosclerosis Study (Iras) Investigators,” Arteriosclerosis, Thrombosis, and Vascular Biology, Vol. 17, No. 1, 1997, pp. 64-71.
[28] X. L. Wang, L. Zhang, K. Youker, M. Zhang, J. Wang, S. A. LeMaire, J. S. Coselli, et al., “Free Fatty Acids Inhibit Insulin Signaling-Stimulated Endothelial Nitric Oxide Synthase Activation through Upregulating PTEN or Inhibiting Akt Kinase,” Diabetes, Vol. 55, No. 8, 2006, pp. 2301-2310.
[29] S. M. Bahijri, E. M. Alissa, D. H. Akbar and T. M. Ghabrah, “Estimation of Insulin Resistance in Non-Diabetic Normotensive Saudi Adults by Quicki, Homa-Ir and Modified Quicki: A Comparative Study,” Annals of Saudi Medicine, Vol. 30, No. 4, 2010, pp. 257-264. doi:10.4103/0256-4947.65252

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.