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Open Access Original investigation

Central obesity is important but not essential component of the metabolic syndrome for predicting diabetes mellitus in a hypertensive family-based cohort. Results from the Stanford Asia-pacific program for hypertension and insulin resistance (SAPPHIRe) Taiwan follow-up study

I-Te Lee123, Yen-Feng Chiu4, Chii-Min Hwu35, Chih-Tsueng He6, Fu-Tien Chiang7, Yu-Chun Lin4, Themistocles Assimes8, J David Curb9 and Wayne H-H Sheu13*

Author Affiliations

1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 407, Taiwan

2 Institute of Medicine, Chung Shan Medical University, Taichung, 402, Taiwan

3 School of Medicine, National Yang-Ming University, Taipei, 112, Taiwan

4 Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, 350, Taiwan

5 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, 112, Taiwan

6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, 114, Taiwan

7 Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan

8 Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA

9 John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, 96813, USA

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Cardiovascular Diabetology 2012, 11:43  doi:10.1186/1475-2840-11-43

Published: 26 April 2012

Abstract

Background

Metabolic abnormalities have a cumulative effect on development of diabetes, but only central obesity has been defined as the essential criterion of metabolic syndrome (MetS) by the International Diabetes Federation. We hypothesized that central obesity contributes to a higher risk of new-onset diabetes than other metabolic abnormalities in the hypertensive families.

Methods

Non-diabetic Chinese were enrolled and MetS components were assessed to establish baseline data in a hypertensive family-based cohort study. Based on medical records and glucose tolerance test (OGTT), the cumulative incidence of diabetes was analyzed in this five-year study by Cox regression models. Contribution of central obesity to development of new-onset diabetes was assessed in subjects with the same number of positive MetS components.

Results

Among the total of 595 subjects who completed the assessment, 125 (21.0%) developed diabetes. Incidence of diabetes increased in direct proportion to the number of positive MetS components (P ≪ 0.001). Although subjects with central obesity had a higher incidence of diabetes than those without (55.7 vs. 30.0 events/1000 person-years, P ≪ 0.001), the difference became non-significant after adjusting of the number of positive MetS components (hazard ratio = 0.72, 95%CI: 0.45-1.13). Furthermore, in all participants with three positive MetS components, there was no difference in the incidence of diabetes between subjects with and without central obesity (hazard ratio = 1.04, 95%CI: 0.50-2.16).

Conclusion

In Chinese hypertensive families, the incidence of diabetes in subjects without central obesity was similar to that in subjects with central obesity when they also had the same number of positive MetS components. We suggest that central obesity is very important, but not the essential component of the metabolic syndrome for predicting of new-onset diabetes. (Trial registration: NCT00260910, ClinicalTrials.gov).

Keywords:
Metabolic syndrome; Incidence; New-onset diabetes; Obesity