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Background
We examined the association between metabolic dysregulation and cancer mortality in a prospective cohort of Black and White adults. MethodsA total of 25,038 Black and White adults were included in the analysis. Metabolic dysregulation was defined in two ways: 1) using the joint harmonized criteria for metabolic syndrome (MetS) and 2) bas...
Contexts in source publication
Context 1
... 30,239 REGARDS participants, 5201 were excluded due to missing data for exposure (components of metabolic syndrome) or follow-up time, resulting in 25,038 participants remaining for the main analysis (Fig. 1). The most common cancer deaths were lung (27.5%), gastro-intestinal (20.6%), and hematological (10.6%) (Additional file 1). As shown in Table 1, Black participants were younger (63.8 vs. 65.3 years), less likely to be male (37.9% vs. 49.9%), had lower education (19.0% vs. 7.1% with less than high school education), and lower income (25.6% vs. 11.8% with less than $20,000 house- hold income) compared with White participants (p values <0.01). Compared with White participants, Black partici- pants had higher total body weight (87.7 vs. 82.4 kg), WC were at an increased risk of cancer mortality. Among White participants, those with reduced HDL-cholesterol (AHR: 1.27, 95% CI: 1.03-1.55) were at an increased risk of cancer mortality. The associations between MetS and cancer mor- tality attenuated in models excluding baseline chronic med- ical conditions (Additional file ...
Context 2
... performed factor analysis and identified six distinct fac- tors associated with metabolic dysregulation among 19,963 participants with complete data on 15 metabolism-related Fig. 2 Kaplan-Meier plot for time to cancer death by number of metabolic syndrome components variables ( Fig. 1 and Additional file 3, previously introduced in methods). The distribution of each metabolic dysregula- tion factor by demographic and socioeconomic characteris- tics of REGARDS participants are provided in Additional file 4. Among all participants (Table 3 and Additional file 5), those in the highest quartile of the glucose (4th quartile AHR: 1.35; 95% CI: 1.08-1.61) were at an increased risk of cancer mortality, while participants in the highest quartiles for obesity (4th quartile AHR: 0.68; 95% CI: 0.49-0.94) and cholesterol (3rd vs. 1st quartile AHR: 0.81; 95% CI: 0.65- .99) factors had reduced risk of cancer mortality compared with those in the first quartile. Black and White participants within higher quartiles of the obesity factor had a reduced risk of cancer mortality compared with those in the lowest quartile, however Blacks in the highest quartile of the glu- cose factor experienced increased risk (AHR: 1.57; 95% CI: 1.10-2.23) for cancer mortality compared with those in the first quartile. White participants with one (AHR: 1.60, 95% CI: 1.16-2.19) or two (AHR: 1.52, 95% CI: 1.08-2.14) of any factor in the highest quartile were at an increased risk of cancer mortality. The associations between derived factors for metabolic dysregulation and cancer mortality were simi- lar in models excluding baseline chronic medical conditions (Additional file ...
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Aims:
The purpose of this study was to analyse the association of leisure-time physical activity of different intensities at baseline, and cardiovascular disease incidence, cardiovascular disease mortality and all-cause mortality in a population-based sample of 60-year-old men and women with and without established metabolic syndrome, for more tha...
Citations
... ≥ 94 cm in men, ≥ 80 cm in women). Previous evidence on associations between individual MetS components and mortality is inconsistent, with potential reported differences by sex [43], age [48] and ethnicity [49]. A recent meta-analysis of 13 observational cohort studies demonstrated a strong positive association between MetS, but not its individual components, and all-cause mortality [50], whereas an earlier meta-analysis of 20 cohort studies of elderly adults also reported positive all-cause mortality risk associations for higher blood glucose and lower HDL cholesterol, in addition to a positive association for MetS itself [48]. ...
Background
Non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome (MetS) are implicated in the aetiology of non-communicable diseases. Our study aimed to evaluate associations between NAFLD and MetS with overall and cause-specific mortality.
Methods
We used dietary, lifestyle, anthropometric and metabolic biomarker data from a random subsample of 15,784 EPIC cohort participants. NAFLD was assessed using the fatty liver index (FLI) and MetS using the revised definition. Indices for metabolic dysfunction–associated fatty liver disease (MAFLD) were calculated. The individual associations of these indices with overall and cause-specific mortality were assessed using multivariable Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (95%CIs). As a subobjective, risk associations with adaptations of new classifications of metabolic dysfunction–associated steatotic liver disease (MASLD) and metabolic and alcohol-related liver disease (MetALD) were also assessed.
Results
Among the 15,784 sub-cohort participants, a total of 1997 deaths occurred (835 due to cancer, 520 to CVD, 642 to other causes) over a median 15.6 (IQR, 12.3–17.1) years of follow-up. Compared to an FLI < 30, FLI ≥ 60 was associated with increased risks of overall mortality (HR = 1.44, 95%CI = 1.27–1.63), and deaths from cancer (HR = 1.32, 95%CI = 1.09–1.60), CVD (HR = 2.06, 95% CI = 1.61–2.63) or other causes (HR = 1.21, 95%CI = 0.97–1.51). Mortality risk associations were also elevated for individuals with MAFLD compared to those without. Individuals with MetS were at increased risk of all mortality endpoints, except cancer-specific mortality. MASLD and MetALD were associated with higher risk of overall mortality.
Conclusions
Our findings based on a prospective cohort suggest that individuals with hepatic steatosis or metabolic dysfunction have a higher overall and cause-specific mortality risk.
... It has been shown to increase the risk of cancer-related death and CVMDs. [18][19][20] Accumulating evidence suggests a link between cancer and CVMDs, in addition to shared risk factors such as smoking, obesity, age, and inflammation. [21,22] Cancer and related therapeutics may increase the risk of thrombosis and adverse cardiovascular events in this population. ...
Background and Objectives
An increased risk of cardiovascular and metabolic diseases (CVMDs) among patients with cancer suggests a potential link between CVMD and cancer. The impact of CVMD on the survival time of patients with esophageal and gastric cancer remains unknown. We aimed to determine the incidence of CVMD and its impact on the longterm outcomes in esophageal and gastric cancer patients.
Methods
A total of 2074 cancer patients were enrolled from January 1, 2007 to December 31, 2017 in two hospitals, including 1205 cases of esophageal cancer and 869 cases of gastric cancer, who were followed up for a median of 79.8 and 79.3 months, respectively. Survival time was analyzed using the Kaplan–Meier method before and after propensity score matching.
Results
The incidence of CVMD in patients with esophageal and gastric cancer was 34.1% (411/1205) and 34.3% (298/869), respectively. The effects of hypertension, diabetes, and stroke on the long-term survival of esophageal and gastric cancer patients were not significant (all P > 0.05). The survival time was significantly longer in esophageal cancer patients without ischemic heart disease than in patients with ischemic heart disease, both before matching (36.5 vs. 29.1 months, P = 0.027) and after matching (37.4 vs. 27.9 months, P = 0.011). The survival time in gastric cancer patients without ischemic heart disease was significantly longer than in patients with ischemic heart disease, both before (28.4 vs.17.5 months, P = 0.032) and after matching (29.5 vs.17.5 months, P = 0.02).
Conclusion
The survival time of esophageal and gastric cancer patients with ischemic heart disease was significantly reduced compared to that of esophageal and gastric cancer patients without ischemic heart disease.
... Metabolic syndrome (MetS) represents a multicomponent risk factor for cardiovascular disease (CVD) and type 2 diabetes, including abdominal (visceral) obesity, high blood pressure, high fasting plasma glucose levels, elevated triglyceride (TG) levels, and low high-density lipoprotein cholesterol (HDL-C) levels [1]. However, several studies have shown that MetS is associated with the risk of cancer, depression, and all-cause mortality, in addition to CVD [2][3][4]. Therefore, effective public health strategies to control and treat MetS are necessary. 15:26 Several lifestyle factors, including unhealthy dietary habits, low physical activity, and smoking, have been associated with the development of MetS [1]. ...
Background
This longitudinal study aimed to investigate the effects of nonrestorative sleep on developing metabolic syndrome (MetS) and related diseases in a general Japanese middle-aged population.
Methods
Overall, 83,224 adults without MetS (mean age: 51.5 ± 3.5 years) from the Health Insurance Association in Japan were followed up for a maximum of 8 years between 2011 and 2019. The Cox proportional hazard method was used to determine whether nonrestorative sleep, assessed using a single-item question, was significantly associated with the respective development of MetS, obesity, hypertension, diabetes, and dyslipidemia. The MetS criteria were adopted by the Examination Committee for Criteria of Metabolic Syndrome in Japan.
Results
The mean follow-up duration was 6.0 years. The incidence rate of MetS was 50.1 person-years/1,000 during the study period. Data suggested that nonrestorative sleep was associated with MetS (hazard ratio [HR]: 1.12, 95% confidence interval [CI]: 1.08–1.16) and other disorders, such as obesity (HR: 1.07, 95% CI: 1.02–1.12), hypertension (HR: 1.07, 95% CI: 1.04–1.11), and diabetes (HR: 1.07, 95% CI: 1.01–1.12) but not with dyslipidemia (HR: 1.00, 95% CI: 0.97–1.03).
Conclusions
Nonrestorative sleep is associated with the development of MetS and many of its core components in the middle-aged Japanese population. Therefore, assessing nonrestorative sleep may help identify individuals at a risk of MetS development.
... The burden of certain types of CVD such as hypertension, heart failure, and ischemic stroke, and specific cancers such as prostate and breast cancer, as well as cancer-related mortality, is significantly higher in African Americans (AAs) compared to Caucasians (11,12). At the same time, modifiable shared risk factors exhibit a racial skewing, with a higher proportion of AAs affected by obesity and obesity-associated diseases such as metabolic syndrome (7,13,14). Much of this risk can be explained by adverse social determinants of health (SDOH), often abbreviated as socio-economic disparities, that disproportionately afflict AAs, including poor quality diet, lack of safe places to exercise, insufficient access to health care, etc. (15)(16)(17)(18). ...
Cardiovascular disease (CVD) and cancer often occur in the same individuals, in part due to the shared risk factors such as obesity. Obesity promotes adipose inflammation, which is pathogenically linked to both cardiovascular disease and cancer. Compared with Caucasians, the prevalence of obesity is significantly higher in African Americans (AA), who exhibit more pronounced inflammation and, in turn, suffer from a higher burden of CVD and cancer-related mortality. The mechanisms that underlie this association among obesity, inflammation, and the bidirectional risk of CVD and cancer, particularly in AA, remain to be determined. Socio-economic disparities such as lack of access to healthy and affordable food may promote obesity and exacerbate hypertension and other CVD risk factors in AA. In turn, the resulting pro-inflammatory milieu contributes to the higher burden of CVD and cancer in AA. Additionally, biological factors that regulate systemic inflammation may be contributory. Mutations in atypical chemokine receptor 1 (ACKR1), otherwise known as the Duffy antigen receptor for chemokines (DARC), confer protection against malaria. Many AAs carry a mutation in the gene encoding this receptor, resulting in loss of its expression. ACKR1 functions as a decoy chemokine receptor, thus dampening chemokine receptor activation and inflammation. Published and preliminary data in humans and mice genetically deficient in ACKR1 suggest that this common gene mutation may contribute to ethnic susceptibility to obesity-related disease, CVD, and cancer. In this narrative review, we present the evidence regarding obesity-related disparities in the bidirectional risk of CVD and cancer and also discuss the potential association of gene polymorphisms in AAs with emphasis on ACKR1.
... Among this age group, 70% of obese men and 30% of normal weight men will develop metabolic dysfunction 2 . The consumption of a high-fat diet (HFD) is recognized as a leading cause of obesity, metabolic dysfunction, elevated chronic inflammation 3 , and cancer mortality 4 . Major indicators of metabolic dysfunction include elevated glucose levels, insulin resistance, and the expansion of mesenteric and omental adipose tissues 5 . ...
A high fat diet and obesity have been linked to the development of metabolic dysfunction and the promotion of multiple cancers. The causative cellular signals are multifactorial and not yet completely understood. In this report, we show that Inositol Polyphosphate-4-Phosphatase Type II B (INPP4B) signaling protects mice from diet-induced metabolic dysfunction. INPP4B suppresses AKT and PKC signaling in the liver thereby improving insulin sensitivity. INPP4B loss results in the proteolytic cleavage and activation of a key regulator in de novo lipogenesis and lipid storage, SREBP1. In mice fed with the high fat diet, SREBP1 increases expression and activity of PPARG and other lipogenic pathways, leading to obesity and non-alcoholic fatty liver disease (NAFLD). Inpp4b −/− male mice have reduced energy expenditure and respiratory exchange ratio leading to increased adiposity and insulin resistance. When treated with high fat diet, Inpp4b −/− males develop type II diabetes and inflammation of adipose tissue and prostate. In turn, inflammation drives the development of high-grade prostatic intraepithelial neoplasia (PIN). Thus, INPP4B plays a crucial role in maintenance of overall metabolic health and protects from prostate neoplasms associated with metabolic dysfunction.
... We did not find an association between obesity and cancer mortality. It is possible that obesity-related metabolic dysregulations rather than merely obesity are required to show an association with cancer mortality [27,28]. For example, in an analysis using data collected in the REasons for Geographic and Racial Differences in Stroke (REGA RDS) study, obesity was shown to be associated with a reduced risk for cancer mortality whereas glucose dysregulation and metabolic syndrome were associated with an increased risk for cancer mortality [28]. ...
... It is possible that obesity-related metabolic dysregulations rather than merely obesity are required to show an association with cancer mortality [27,28]. For example, in an analysis using data collected in the REasons for Geographic and Racial Differences in Stroke (REGA RDS) study, obesity was shown to be associated with a reduced risk for cancer mortality whereas glucose dysregulation and metabolic syndrome were associated with an increased risk for cancer mortality [28]. ...
Background
Overall mortality has been reported to be lower among individuals classified as overweight/obese when compared with their normal weight counterparts (“obesity paradox”) when obesity classification is based on the body mass index (BMI). One possible reason for this apparent paradox is that BMI is not a reliable measure of obesity-related risk as it does not differentiate fat mass from lean muscle mass or fat mass phenotypes. Waist circumference (WC), as a measure of central adiposity, may be a better indicator of obesity-related risk. We examined the association of overall mortality with BMI and with WC measures, including WC, waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR).
Methods
Data from 3976 African American participants (551 deaths) in the Jackson Heart Study (JHS) were analyzed. Cox regression models were used to perform survival analysis. Obesity measures were analyzed as dichotomous (obese/non-obese) and continuous variables. Baseline covariates included age, sex and smoking status.
Results
Comparing obese to non-obese participants, adjusted hazard ratios (95% CI) for overall mortality were 1.14 (0.96, 1.35), 1.30 (1.07, 1.59), 1.02 (0.73, 1.41) and 1.45 (1.18, 1.79) when using BMI, WC, WHtR and WHR, respectively. For BMI, WC and WHtR, a J-shaped relationship was observed with overall mortality. For WHR, a monotonic increasing relationship was observed with overall mortality.
Conclusions
In the JHS, we found that obesity as defined by WC and WHR was associated with an increased risk of overall and CVD mortality, while obesity defined by BMI was associated only with an increased risk of CVD mortality. WHR was the only obesity measure that showed a monotonic increasing relationship with overall and CVD mortality.
... 5,6 In cohort studies including women, metabolic syndrome has been statistically significantly associated with a risk of endometrial, pancreatic, gastric, colorectal, ovarian, and postmenopausal breast cancers and non-Hodgkin lymphoma. [7][8][9][10] To our knowledge, only 2 other large cohort studies have shown a significant relationship between indicators of cardiometabolic health and mortality across several cancer sites together 11,12 ; however, no other group has comprehensively evaluated the relationship between cardiometabolic abnormalities determined before the cancer diagnosis and specific causes of death among postmenopausal women. ...
Background
Cardiometabolic abnormalities are a leading cause of death among women, including women with cancer.
Methods
This study examined the association between prediagnosis cardiovascular health and total and cause‐specific mortality among 12,076 postmenopausal women who developed local‐ or regional‐stage invasive cancer in the Women's Health Initiative (WHI). Cardiovascular risk factors included waist circumference, hypertension, high cholesterol, and type 2 diabetes. Obesity‐related cancers included breast cancer, colorectal cancer, endometrial cancer, kidney cancer, pancreatic cancer, ovarian cancer, stomach cancer, liver cancer, and non‐Hodgkin lymphoma. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for important predictors of survival.
Results
After a median follow‐up of 10.0 years from the date of the cancer diagnosis, there were 3607 total deaths, with 1546 (43%) due to cancer. Most participants (62.9%) had 1 or 2 cardiometabolic risk factors, and 8.1% had 3 or 4. In adjusted models, women with 3 to 4 risk factors (vs none) had a higher risk of all‐cause mortality (HR, 1.99; 95% CI, 1.73‐2.30), death due to cardiovascular disease (CVD) (HR, 4.01; 95% CI, 2.88‐5.57), cancer‐specific mortality (HR, 1.37; 95% CI, 1.1‐1.72), and other‐cause mortality (HR, 2.14; 95% CI, 1.70‐2.69). A higher waist circumference was associated with greater all‐cause mortality (HR, 1.17; 95% CI, 1.06‐1.30) and cancer‐specific mortality (HR, 1.22; 95% CI, 1.04‐1.42).
Conclusions
Among postmenopausal women diagnosed with cancer in the WHI, cardiometabolic risk factors before the cancer diagnosis were associated with greater all‐cause, CVD, cancer‐specific, and other‐cause mortality. These results raise hypotheses regarding potential clinical intervention strategies targeting cardiometabolic abnormalities that require future prospective studies for confirmation.
Lay Summary
This study uses information from the Women's Health Initiative (WHI) to find out whether cardiac risk factors are related to a greater risk of dying among older women with cancer. The WHI is the largest study of medical problems faced by older women in this country.
The results show that women who have 3 or 4 risk factors are more likely to die of any cause, heart disease, or cancer in comparison with women with no risk factors.
It is concluded that interventions to help to lower the burden of cardiac risk factors can have an important impact on survivorship among women with cancer.
... In addition, the metabolic phenotype of an individual can be indicative of an abnormal biochemical or physiological state (Burgdorf et al., 2010;Reed et al., 2014;Colombo et al., 2018;Gar et al., 2018). Metabolic dysregulation is a major cause of various diseases, including diabetes, cardiovascular diseases, neuronal diseases, and cancers (Akinyemiju et al., 2017;Chong et al., 2017;Herholz et al., 2018). A pathological state can significantly alter metabolic pathways, resulting in aberrant levels of intermediates or end-products that can be viewed as potential diagnostic biomarkers or even therapeutic targets. ...
The relationship between aberrant metabolism and the initiation and progression of diseases has gained considerable attention in recent years. To gain insights into the global relationship between diseases and metabolites, here we constructed a human diseases-metabolites network (HDMN). Through analyses based on network biology, the metabolites associated with the same disorder tend to participate in the same metabolic pathway or cascade. In addition, the shortest distance between disease-related metabolites was shorter than that of all metabolites in the Kyoto Encyclopedia of Genes and Genomes (KEGG) metabolic network. Both disease and metabolite nodes in the HDMN displayed slight clustering phenomenon, resulting in functional modules. Furthermore, a significant positive correlation was observed between the degree of metabolites and the proportion of disease-related metabolites in the KEGG metabolic network. We also found that the average degree of disease metabolites is larger than that of all metabolites. Depicting a comprehensive characteristic of HDMN could provide great insights into understanding the global relationship between disease and metabolites.
... In a Korean population-based study (36) and in another study combining seven cohorts from three European countries (37), researchers found elevated BP was significantly associated with increased total cancer death. Specifying racial groups, one study found a null association of hypertension and total cancer mortality in whites and a marginal significant association in blacks (38). Another one found a significantly higher risk of breast cancer death in black women than in white women (26). ...
... We also found in whites, compared to individuals with normal fasting glucose level, those with impaired level had a 45% higher risk of total cancer death while in blacks, the association did not reach to statistical significance. Even though mortality specifically due to diabetes has been reported higher in blacks than in whites (38), few studies have examined whether the impaired fasting glucose level causes discrepancies in overall cancer death between blacks and white. One study evaluating a group of individuals 45 years of age and older found impaired fasting glucose significantly increased risk for cancer death in blacks but not in whites (38) while two breast cancer studies found diabetes was associated with a significantly increased hazard for breast cancer-specific death in white patients only (27,28). ...
... Even though mortality specifically due to diabetes has been reported higher in blacks than in whites (38), few studies have examined whether the impaired fasting glucose level causes discrepancies in overall cancer death between blacks and white. One study evaluating a group of individuals 45 years of age and older found impaired fasting glucose significantly increased risk for cancer death in blacks but not in whites (38) while two breast cancer studies found diabetes was associated with a significantly increased hazard for breast cancer-specific death in white patients only (27,28). Researchers also found diabetes was associated with a later state of cancer diagnosis and more aggressive tumor grade for white women only, which in part, may account for the survival reduction in white women (28). ...
Background: Previous data showed that metabolic syndrome (MS) and its components are associated with
cancer mortality. However, whether the association varies by race is unclear. To examine the association
between metabolic risk factors and cancer death in non-Hispanic whites (whites) and non-Hispanic blacks
(blacks) in the US.
Methods: We used data from National Health and Nutrition Examination Survey III (NHANES III)
[1988–1994], a nationwide survey conducted by the National Center for Health Statistics of the Centers
for Disease Control and Prevention in the US. We included a total of 18,001 participants aged ≥20 years
in the study. We ascertained cancer death from NHANES III mortality follow-up study, which linked
with the National Death Index and provides follow-up from the date of baseline NHANES III [1988–
1994] through December 2006. MS was defined as the presence of at least three of five risk factors [i.e.,
elevated triglycerides (TG) (≥150 mg/dL), impaired fasting blood glucose (≥100 mg/dL), increased waist
circumference (≥88 cm for women and ≥102 cm for men), elevated blood pressure (BP) (≥130 mmHg systolic
BP or ≥85 mmHg diastolic BP) and, reduced high density lipoprotein (HDL) cholesterol (<50 mg/dL)].
The interaction between race and MS and its components against total cancer mortality was first tested.
Cox proportional hazards regression was then used to estimate the hazard ratios (HR) and 95% confidence
intervals (CI) for total cancer mortality in relation to each MS individual component, and a MS composite
score in whites and blacks, separately.
Results: We found a statistically significant interaction between MS and race as well as MS components
and race in their effect on cancer death. In adjusted models, elevated BP was significantly associated with a
41% increased risk of total cancer death in blacks (HR 1.41; 95% CI, 1.10–1.80) while in whites, the risk of
cancer death increased 29% with central obesity (HR 1.29; 95% CI, 1.05–1.59), 26% with low HDL (HR
1.26; 95% CI, 1.04–1.52), and 45% with impaired fasting glucose (HR 1.45; 95% CI, 1.19–1.76).
Conclusions: The relationship between metabolic risk factors and total cancer mortality differed by race
in the US. In blacks, high BP was associated with an increased risk for cancer death while in whites, central
obesity, low HDL, and especially impaired fasting glucose were positively associated with cancer death.
Keywords: Metabolic risk factors; cancer death; racial disparities
This review aimed to systematically quantify the differences in Metabolic Syndrome (MetS) prevalence across various ethnic groups in high-income countries by sex, and to evaluate the overall prevalence trends from 1996 to 2022. We conducted a systematic literature review using MEDLINE, Web of Science Core Collection, CINAHL, and the Cochrane Library, focusing on studies about MetS prevalence among ethnic groups in high-income countries. We pooled 23 studies that used NCEP-ATP III criteria and included 147,756 healthy participants aged 18 and above. We calculated pooled prevalence estimates and 95% confidence intervals (CI) using both fixed-effect and random-effect intercept logistic regression models. Data were analysed for 3 periods: 1996–2005, 2006–2009, and 2010–2021. The pooled prevalence of MetS in high-income countries, based on the NCEP-ATP III criteria, was 27.4% over the studied period, showing an increase from 24.2% in 1996–2005 to 31.9% in 2010–2021, with men and women having similar rates. When stratified by ethnicity and sex, ethnic minority women experienced the highest prevalence at 31.7%, while ethnic majority women had the lowest at 22.7%. Notably, MetS was more prevalent in ethnic minority women than men. Among ethnic minorities, women had a higher prevalence of MetS than men, and the difference was highest in Asians (about 15 percentage points). Among women, the prevalence of MetS was highest in Asians (41.2%) and lowest in Blacks/Africans (26.7%). Among men, it was highest in indigenous minority groups (34.3%) and lowest among in Blacks/Africans (19.8%). MetS is increasing at an alarming rate in high-income countries, particularly among ethnic minority women. The burden of MetS could be effectively reduced by tailoring interventions according to ethnic variations and risk profiles.
