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221
METABOLIC SYNDROME AND RELATED DISORDERS
Volume 7, Number 3, 2009
© Mary Ann Liebert, Inc.
Pp. 221–230
DOI: 10.1089/met.2008.0077
1Department of Medical Statistics and Epidemiology, Hamad Medical Corporation, Doha, Qatar.
2Department of Evidence for Population Health Unit, School of Epidemiology and Health Sciences, University of Manchester,
Manchester, United Kingdom.
3Department of Endocrinology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
4Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Jordan.
5Qatar Diabetic Associations and Qatar Foundation, Doha, Qatar.
Prevalence of Metabolic Syndrome According to Adult
Treatment Panel III and International Diabetes Federation
Criteria: A Population-Based Study
Abdulbari Bener, Ph.D., F.R.S.S., F.F.P.H.,1, 2 Mahmoud Zirie, M.D., F.A.C.E.,3 Manal Musallam, M.P.H.,3
Yousef S. Khader, B.D.S., M.Sc., M.S.P.H., Sc.D.,4 and Abdulla O.A.A. Al-Hamaq, M.P.H., Ph.D.5
Abstract
Objective: The objective of the study was to examine the prevalence of metabolic syndrome among adult Qatari
population according to the revised criteria of the National Cholesterol Education Program Adult Treatment Panel
III (NCEP ATP III) and the International Diabetes Federation (IDF), assess which component contributed to the in-
creased risk of the metabolic syndrome, and identify the characteristics of the subjects with metabolic syndrome.
Design: This was a cross-sectional study.
Setting: The survey was carried out in urban and semiurban primary health-care centers.
Subjects and Methods: The survey was conducted from January, 2007, to July, 2008, among Qatari nationals
above 20 years of age. Of the 1496 subjects who were approached to participate in the study, 1204 (80.5%) gave
their consent. Face-to-face interviews were conducted using a structured questionnaire followed by laboratory
tests. Metabolic syndrome was de ned using the NCEP ATP III as well as IDF criteria.
Results: The overall prevalence of metabolic syndrome in studied subjects was 26.5% and 33.7% according to ATP
III and IDF criteria (P < 0.001). The prevalence of metabolic syndrome by ATP III and IDF increased with age and
body mass index (BMI), whereas it decreased with higher education and physical activity. Also, the prevalence
of metabolic syndrome was more common in women. Among the components of metabolic syndrome, central
obesity was signi cantly higher in the studied subjects. The IDF de nition of metabolic syndrome gave a higher
prevalence in all age groups. The overall prevalence of metabolic syndrome and its components according to IDF
criteria was higher in the studied subjects than the estimates given by the ATP III. Multivariate logistics regres-
sion analysis (ATP III and IDF) showed that age and BMI were signi cant contributors for metabolic syndrome.
Both de nitions strongly supported age and obesity as associated factors for metabolic syndrome.
Conclusions: The current study found a high prevalence of metabolic syndrome among Qataris. There was a
steady increase in the prevalence of metabolic syndrome through the decades, independent of the de nition.
Age and BMI were important signi cant predictors for metabolic syndrome.
Introduction
The metabolic syndrome is a combination of several clin-
ical features, including central obesity, high blood pressure,
elevated concentrations of fasting glucose and triglycerides,
low concentration of high-density lipoprotein cholesterol
(HDL-C), and insulin resistance.1 The clustering of these
features has been speculated to increase the risk of cardio-
vascular disease (CVD) because each component is associ-
ated with the disease. The metabolic syndrome is associated
with increasing risk of cardiovascular morbidity and mor-
tality, with risk estimates ranging from 1.4 to 4.5.2 Metabolic
s yn dr om e i s h e lpf u l i n p re d ic ti n g t he oc cu r re nc e o f i m pa ir ed
met.2008.0077.indd 221 5/13/2006 11:01:55 PM
BENER ET AL.222
fasting glucose.3 The cluster of metabolic and hemodynamic
disturbances known as metabolic syndrome is increasingly
attracting the attention of International research institutions
and scienti c societies as a major modi able determinant of
CVD and impaired fasting glucose.
In recent years, metabolic syndrome has evolved into
an internationally recognized clinical entity, assuming ep-
idemic proportions.4 More than 47 million individuals in
the United States meet the criteria for the metabolic syn-
drome.5 The prevalence of metabolic syndrome increases
with age, affecting less than 10% of people in their 20s and
40% of people in their 60s.6 The prevalence of the metabolic
syndrome has varied markedly between different popula-
tions, most likely because of the lack of accepted criteria
for the de nition of the syndrome.7 No de nite agreement
has been reached on the de nition of metabolic syndrome.
The proposed de nition has agreed on the syndrome core
components, namely central obesity, insulin resistance, dys-
lipidemia, and high blood pressure. Insulin resistance and
central obesity have been acknowledged as important caus-
ative factors for metabolic syndrome, but the exact mecha-
nism of metabolic syndrome has not been clari ed.
The most widely accepted criteria have been proposed by
the World Health Organization (WHO),8 the European group
for the study Insulin Resistance (EGIR),9 and the National
Cholesterol Education Program Adult Treatment Panel III
(NCEP ATP III).10 The International Diabetes Federation
(IDF)11 and American Heart Association (AHA)/National
Heart, Lung and Blood Institute (NHLB1)12 recently pro-
posed a new worldwide de nition of metabolic syndrome
intended to facilitate its clinical diagnosis and simplify the
comparison among data from different countries. In our
study sample, we have used ATP III and IDF de nitions to
examine how prevalence estimates might differ according
to the de nition used and compare the degree to which par-
ticipants were being similar or differently classi ed by the
two de nitions.
The 2005 IDF de nition of the metabolic syndrome was
designed to be useful worldwide, but to date few prevalence
studies have used this de nition. The IDF emphasizes cen-
tral obesity as an essential criterion for the metabolic syn-
drome due to the evidence linking ethnicity-speci c waist
circumference to the other components of the metabolic syn-
drome. Because central obesity is regarded as a likely early
step in the development of full metabolic syndrome, this
de nition puts a very large number of individuals belonging
to one of the longest living and healthiest populations in the
world at increased risk for CVD and type 2 diabetes mellitus
(T2DM).13
People with metabolic syndrome are at increased risk
for impaired fasting glucose and CVD, and these risk fac-
tors are strongly increased in the populations that have
adopted the western life style. The state of Qatar is a rap-
idly developing country with change that has in uenced
the lifestyle of the people toward urbanization, particu-
larly over the recent decades. Furthermore, few previous
studies have reported the high prevalence of hypertension
and T2DM in a Qatari population.14,15 Hence, this study was
undertaken to examine the prevalence of metabolic syn-
drome in the sample of adult Qatari population according
to the revised criteria of NCEP ATP III and IDF and assess
which component contributed to the increased risk of the
metabolic syndrome.
Subjects and Methods
This was a cross-sectional study conducted among the
adult Qatari population above 20 years of age from January,
2007, to July, 2008. The study was approved by the Hamad
Medical Corporation prior to commencing data collection.
Each participant was provided with brief information about
the study and was assured of strict con dentiality. Of the
1496 subjects who were approached to participate in the
study, 1204 (80.5%) gave their consent. Only participants
who agreed to participate and signed the consent form were
included in the study.
Sampling procedure
A multistage strati ed cluster sampling design was de-
veloped using the administrative divisions of the primary
health centers in Qatar that had approximately equal num-
bers of inhabitants. To secure a representative sample of the
study population, sampling was strati ed with a view to
obtaining proportional representation from urban and semi-
urban areas. The sample size was determined on the a priori
presumption that the prevalence rate of impaired fasting
glucose in Qatar would be more or less similar to rates found
for several other countries in the eastern Mediterranean,
where the reported prevalence of impaired fasting glucose
is reported to be 17%, with a 99% con dence interval (CI) for
an error of 2.5% at the level of signi cance; thus, a sample
size of 1496 subjects would be required for this study. Of the
total of 22 primary health-care centers available, 10 were se-
lected at random. Of these 8 were located in urban and 2
in semiurban areas of Qatar. Finally, subjects were selected
systematically 1-in-2 using a sampling procedure. During
the study period, 1496 subjects were approached, of whom
1204 responded to the questionnaire, for a response rate of
80.5%.
Questionnaire
A well-designed and pilot-tested questionnaire was
used to collect data. The designed questionnaire was tested
among 50 subjects as a pilot study for the validity of the
questionnaire. The investigators had made the necessary
corrections and modi cations after considering the minor
differences and discrepancies that had been found during
the pilot study. The rst part included information about
socio-demographic and anthropometric characteristics in-
cluding age, sex, marital status, education level, occupation,
height, weight, and parental consanguinity. The second
part collected information about complications such as cen-
tral obesity, hypertension, triglyceride, HDL-C, and family
history of diabetes and hypertension. Lifestyle habits like
physical activity, sleeping hours, and smoking habits were
collected.
Diagnostic criteria
National Cholesterol Education Program T hird Adult Treatme nt
Panel III.10 According to ATP III criteria, a participant has the
metabolic syndrome if she/he has three or more of the fol-
lowing criteria: (1) fasting plasma glucose (FPG) ≥100 mg/
dL (5.6 mmol/L); (2) blood pressure ≥130/85 mm Hg; (3)
triglycerides ≥150 mg/dL (1.7 mmol/L); (4) HDL-C, men <40
met.2008.0077.indd 222 5/13/2006 11:01:55 PM
PREVALENCE OF METABOLIC SYNDROME AND ITS COMPONENTS 223
Hypertension was taken according to the de nition of
ATP III and IDF, which is systolic blood pressure (SBP) ≥130
mm Hg or diastolic blood pressure (DBP) ≥85 mm Hg or
using antihypertensive medication. Two readings of the SBP
and DBP were taken from the subject’s left arm while seated
and his/her arm at heart level, using a standard zero mer-
cury sphygmomanometer after at least 10–15 minutes of rest.
Then the average of the two readings was obtained.
Waist circumference was measured in centimeters with
subjects wearing light clothes at midway level between
lower rib margin and iliac crest using a nonstretchable mea-
suring tape. Waist circumference was measured according
to the de nition of ATP III and IDF and considered as risk
factor for metabolic syndrome.
Laboratory measurements
Fasting blood venous samples were collected from all
participants for determination of impaired fasting glucose,
low HDL-C, and triglycerides. The criteria for impaired fast-
ing glucose, low HDL-C, and triglycerides were according to
the de nition of ATP III and IDF as classi ed above.
Statistical analysis
Data were analyzed using the Statistical Package for
Social Sciences (SPSS, version 15.0) software. Age speci c
prevalence rates of metabolic syndrome and its components
were determined. The Student t-test was used to ascertain
mg/dL (1.03 mmol/L), women, <50 mg/dL (1.29 mmol/L; (5)
men with waist circumference >102 cm and women with
waist circumference >88 cm.
International Diabetes Federation.11 According to IDF criteria,
a participant has the metabolic syndrome if she/he has a high
waist circumference (≥94 cm in men and ≥80 cm in women)
plus any two of the following conditions: (1) FPG ≥100 mg/
dL (5.6 mmol/L) or previously diagnosed impaired fasting
glucose; (2) blood pressure ≥130/85 mm Hg or treatment for
hypertension; (3) triglycerides ≥150 mg/dL (1.7 mmol/L); (4)
HDL-C, men <40 mg/dL (1.03 mmol/L); women, <50 mg/dL
(1.29 mmol/L) or treatment for low HDL.
Physical examination and measurements
Physical examination and measurements were performed
by a trained nurse. Height was measured in centimeters
using a height scale (SECA, Germany) while the subject was
standing in bare feet and with normal straight posture. Male
subjects were requested to remove their head cover (Igaal
and Guttra). Weight was measured in kilograms using a
weight scale (SECA, Germany). The subjects were asked to
remove any objects from their pockets and to stand on the
weight scale in bare feet with light clothing. BMI was calcu-
lated as the ratio of weight (kilogram) to the square of height
(meters). Obesity and overweight were classi ed according
to WHO criteria.16 A person was considered obese if the BMI
value was ≥30 kg/m
2, overweight if BMI ≥25 kg/m
2 and
<30 kg/m 2.
T 1. S-D C P A G (n = 1204)
Var i a bles
Males (n = 594) Females (n = 610)
Count (%) Count (%) P value
Age (Mean ± SD) 41.2 ± 8.95 39.6 ± 10.7 0.0 04
Age group <30 72 (12.1) 131 (21.5)
30–39 185 (31.1) 179 (29.3)
40–49 220 (37.0) 193 (31.6) <0.001
50 –59 110 (18.5) 77 (12.6)
≥60 7 (1.2) 30 (4.9)
Marital status Married 351 (59.1) 500 (82.0)
Not married 211 (35.5) 99 (16.2) <0.001
Divorced/widow 32 (5.4) 11 (1.8)
Educational status Illiterate 8 (1.3) 186 (30.5)
Primary 124 (20.9) 233 (38.2)
Secondary 133 (22.4) 78 (12.8) <0.001
High School 183 (30.8) 75 (12.3)
University 146 (24.6) 38 (6.2)
Occupation Retired/not working 78 (13.1) 54 (8.9)
Clerical job 130 (21.9) 93 (15.2)
Professional (doctor,
engineer, lawyer)
183 (30.8) 119 (19.5) <0.001
Manual worker 116 (19.5) 12 (2.0)
Student 17 (2.9) 24 (3.9)
Housewife 0 (0) 308 (50.5)
Army/police 70 (11.8) 0 (0)
Consanguinity Yes 233 (39.2) 201 (33.0) 0.023
No 361 (60.8) 409 (67.0)
Abbreviation: SD, standard deviation.
met.2008.0077.indd 223 5/13/2006 11:01:55 PM
BENER ET AL.224
respectively, P = 0.004). There was a signi cant difference
between men and women in terms of age group, marital sta-
tus, educational status, and occupation (P < 0.001).
Table 2 shows the prevalence of metabolic syndrome in
studied subjects de ned by ATP III and IDF criteria accord-
ing to important characteristics of the subjects. The preva-
lence of metabolic syndrome was 26.5% according to ATP
III and 33.7% according to IDF (P < 0.001). The prevalence
of metabolic syndrome by ATP III and IDF increased with
age and BMI, whereas decreased with higher education and
physical activity. Also, the prevalence of metabolic syndrome
was more common in women according to ATP (61.4%) and
IDF (56.7%).
Table 3 reveals the age-speci c prevalence of metabolic
syndrome and the different components of metabolic syn-
drome in studied subjects by ATPIII and IDF criteria. The
IDF de nition of metabolic syndrome and its components
gave a higher prevalence in subjects, compared to the
the signi cance of differences between two means of a con-
tinuous variable and con rmed by nonparametric Mann–
Whitney test. The chi-squares test was performed to test for
differences in proportions of categorical variables between
two or more groups. In 2 × 2 tables, the Fisher exact test
(two-tailed) replaced the chi-squared test if the assump-
tions underlying chi-squared were violated, namely in case
of small sample size and where the expected frequency is
less than 5 in any of the cells. Multiple logistic regressions
analysis was used to determine factors associated with met-
abolic syndrome. A P value of less than 0.05 was considered
statistically signi cant.
Results
Table 1 shows the socio-demographic characteristics of
the participants according to gender. The mean ± SD age
of studied men and women was (41.2 ± 8.9 and 39.6 ± 10.7
T 2. P M S S S A ATP III IDF D
O I C S W M S (n = 1204)
Tot a l
(n =120 4)
Metabolic syndrome
(ATP III)
(n = 319)
26.5% P value
Metabolic syndrome (IDF)
(n = 406)
33.7% P value
Count (%) Count (%)a Count (%)a
Age group <30 203 (16.9 15 (4.7) 16 (3.9)
30–39 364 (30.2) 87 (27.3) 126 (31.0)
40–49 413 (34.3) 109 (34.2 <0.001 134 (33.0) <0.001
50–59 187 (15.5) 89 (27.9) 104 (25.6)
≥60 37 (3.1) 19 (6.0) 26 (6.4)
Gender M 594 (49.3) 123 (38.6) <0.001 176 (43.3) 0.003
F 610 (50.7) 196 (61.4) 230 (56.7)
Educational status Illiterate 194 (16.1) 82 (25.7 105 (25.9)
Pr i mary 357 (29.7 111 (34.8) 141 (34.7)
Seco ndary 211 (17.5) 47 (14.7) <0.001 59 (14.5) <0.001
High School 258 (21.4) 42 (13.2) 55 (13.5)
Universit y 184 (15.3 37 (11.6) 46 (11.3)
Body mass index <25 265 (22.0) 28 (8.8) 41 (10.1)
25–30 379 (31.5) 81 (25.4) <0.001 105 (25.9) <0.001
>30 560 (46.5) 210 (65.8) 260 (64.0)
Consanguinity Yes 434 (36.0) 117 (36.7) 0.784 139 (34.2) 0.351
No 770 (64.0 202 (63.3) 267 (65.8)
Family history
of diabetes
Yes 281 (23.3) 95 (29.8) 0.02 105 (25.9) 0.140
No 923 (76.7) 224 (70.2) 301 (74.1)
Family history of
hypertension
Yes 415 (3 4. 5 116 (36.4) 0.406 161 (39.7) 0.007
No 789 (65.5) 203 (63.6) 245 (60.3)
Do you exercise? Yes 337 (28.0) 69 (21.6) 0.003 93 (22.9) 0.005
No 867 (72.0) 250 (78.4) 313 (77.1)
Sleeping ≤7 hours 585 (48.6) 176 (55.2) 0.006 186 (45.8) 0.169
>7 hours 619 (51.4) 143 (44.8) 220 (54.2)
Smoker Yes 78 (6.5) 27 (8.5) 0.092 37 (9.1) 0.008
No 1123 (93.5) 291 (91.5) 368 (90.9)
aPercent of subjects with metabolic syndrome in that age group out of all subjects with metabolic syndrome.
Abbreviations: ATP III, Adult Treatment Panel III; IDF, International Diabetes Federation.
met.2008.0077.indd 224 5/13/2006 11:01:56 PM
PREVALENCE OF METABOLIC SYNDROME AND ITS COMPONENTS 225
according to ATP III and IDF criteria. According to multivar-
iate logistic regression analysis (ATP III and IDF), age and
BMI were important signi cant predictors for metabolic syn-
drome (P < 0.001). Both de nitions strongly supported age
and obesity as associated factors for metabolic syndrome.
Figure 1 shows the age-speci c prevalence of metabolic
syndrome in the men studied according to IDF and ATP III.
The prevalence of metabolic syndrome in men by the IDF
was higher than by ATP III criteria in all age groups. There
was a big difference in the prevalence of metabolic sy ndrome
in men above 60 years old according to IDF, when compared
estimates by the ATP III criteria: metabolic syndrome (33.7%
vs. 26.5%; P < 0.001), central obesity (83.5% vs. 65.3%; P <
0.001), hypertension (37.3% vs. 36.5%; P = 0.673), impaired
fasting glucose (22.7% vs. 21.8%; P = 0.589), low HDL (30.4%
vs. 26.3%; P = 0.267), except for triglyceride (23.8% vs. 24%;
P = 0.962). Out of all the metabolic syndrome components,
only central obesity was signi cantly different among the
two metabolic syndrome groups classi ed according to ATP
III and IDF criteria.
Tables 4 and 5 show the multivariate logistic regression
analysis of factors associated with metabolic syndrome
T 3. A-S P M S D C M
S S S ATP III IDF C (n = 1204)
Metabolic syndrome and
its components Age group
Number. of
subjectsa
ATP III IDF
n(%)bP valuecn(%)bP valuec
Metabolic syndrome <30 203 15 (7.4) 16 (7.9)
30–39 364 87 (23.9) 126 (34.6)
40–49 413 109 (26.4) <0.0001 134 (32.4) <0.0001
Tota l
50–59 187 89 (47.6) 104 (55.6)
60+ 37 19 (51.4) 26 (70.3)
1204 319 (26.5) 406 (33.7)
Central obesity <30 203 82 (40.4) 131 (64.5)
30–39 364 206 (56.6) 294 (80.8)
40–49 413 324 (78.5) <0.0001 373 (90.3) <0.0001
Tota l
50–59 187 141 (75.4) 170 (90.9)
60+ 37 33 (89.2) 37 (100.0)
1204 786 (65.3) 1005 (83.5)
Hypertension <30 203 34 (16.7) 33 16.3)
30–39 364 120 (33.0) 124 (34.1)
40–49 413 152 (36.8) <0.0001 158 (38.3) <0.0001
Tota l
50–59 187 101 (54.0) 102 (54.5)
60+ 37 32(86.5) 32(86.5)
1204 439 (36.5) 449 (37.3)
Impaired fasting
glucose
<30 203 8 (3.9) 13 (6.4)
30–39 364 77 (21.2) 76 (20.9)
40–49 413 88 (21.3) <0.0001 86 (20.8) <0.0001
Tota l
50–59 187 69 (36.9) 77 (41.2)
60+ 37 20 (54.1) 21 (56.8)
1204 262 (21.8) 273 (22.7)
Low high-density
lipoprotein
<30 203 43(21.2) 43(21.2)
30–39 364 81 (22.3) 91 (25.0)
40–49 413 107 (25.9) 123 (29.8)
Tota l
50–59 187 79 (42.2) <0.0001 92 (49.2) <0.0001
60+ 37 7 (18.9) 17 (45.9)
1204 317 (26.3) 366 (30.4)
High triglyceride <30 203 30(14.8) 30(14.8)
30–39 364 99 (27.2) 99 (27.2)
40–49 413 92 (22.3) <0.0001 90 (21.8) <0.0001
50–59 187 60 (32.1) 60 (32.1)
60+ 37 8 (21.6) 8 (21.6)
Tota l 1204 289 (24.0) 287 (23.8)
aNumber of studied participants in the respective age group.
bPercent of subjects in that age group out of studied subjects in the same age group.
cP values are for prevalence of the metabolic syndrome component across age groups.
Abbreviations: ATP III, Adult Treatment Panel III; IDF, International Diabetes Federation.
met.2008.0077.indd 225 5/13/2006 11:01:57 PM
BENER ET AL.226
T 4. M L R A
F A W M S
A ATP III C
Odds ratio 95% CI P value
Age 1.750 1.52–2.01 <0.001
Female gender 1.637 1.23–2.18 0.001
Body mass index (≥30 kg/m 2)1.9361.58–2.37<0.001
Sleeping <7 hrs per day 1.450 1.10–1.91 0.009
Family history of DM 1.507 1.10–2.07 0.011
Abbreviations: ATP III, Adult Treatment Panel III; CI,
con dence interval; DM, diabetes mellitus.
T 5. M L R A
F A W M S
A IDF C
Odds ratio 95% CI P value
Age 1.719 1.50–1.96 <0.001
Low education level 1.230 1.11–1.37 <0.001
Body mass index (≥30 kg/m 2)1.918 1.60–2.30 <0.001
Abbreviations: IDF, International Diabetes Federation; CI,
con dence interval.
100
90
80
70
60
50
%
40
30
20
10
0
< 30 30–39
56
69
27
36.4
16.8
23.6
26.4
37.3
42.9
100.0
40–49
Age Group
50–59
ATPIII
IDF
60+
FIG. 1. Age-speci c prevalence of metabolic syndrome in
studied men according to IDF and ATPIII
to ATP III. This might be due to the high prevalence of cen-
tral obesity in that age group.
Figure 2 shows the age-speci c prevalence of metabolic
syndrome in studied women according to IDF and ATP III.
The IDF de nition of metabolic syndrome gave a higher
prevalence in all age groups of women than by ATP III, ex-
cept in those below 30 years old. Metabolic syndrome was
more prevalent in women in the 50–59 years old using both
criteria (ATP III and IDF).
Table 6 shows the prevalence of the metabolic syndrome
in different countries.
Discussion
The metabolic syndrome presents a high prevalence in
the world.17 Also, in our study sample, the prevalence of
metabolic syndrome was high among Qataris and varied
according to the de nition used. The prevalence of meta-
bolic syndrome was lower with the NCEP ATP III de nition
(26.5%) and higher when using the IDF de nition (33.7%).
The metabolic syndrome prevalence varies depending on
the diagnosis criteria; most are higher with IDF than ATP
III criteria, as seen in our study. Because the two de nitions
are based on much of the same components, the difference
in prevalence was mainly related to different waist circum-
ference and to the focus on central obesity as an obligatory
component in the IDF de nition in contrast to being one out
of ve equally weighted components in the 2005 ATP III
de nition.
Similar to our results, in a Portuguese community,18 the
prevalence of metabolic syndrome varied according to def-
inition used. The prevalence of the metabolic syndrome
was lower with the NCEP ATP III criteria (24.0%) and con-
siderably higher when using the IDF criteria (41.9%). The
Qatar metabolic syndrome prevalence according to ATP III
(26.5%) and IDF (33.7%) is comparable to the rate in United
Kingdom
19 that the overall prevalence of the metabolic syn-
drome was 22.0% considering the ATP III criteria and 31.8%
when the IDF de nition was applied. But in Portuguese com-
munity, a big gap in prevalence was noted between ATP III
and IDF criteria, but not in the United Kingdom and Qatar.
The IDF de nition results in a higher prevalence, probably
re ecting the IDF criteria for de ning the central obesity.
The study ndings showed a signi cant relationship
between metabolic syndrome (ATP III and IDF) and age,
gender, and educational status. Regardless of the de nitions
used, the age-speci c prevalence of metabolic syndrome
increased progressively with increasing age. Applying the
IDF de nition in a large Qatari population aged above 20
years, the prevalence was highly age dependent. This was
evident in Qataris, with a nine-fold increase in age-speci c
prevalence in the age group 20–30 years (7.9%) to the age
group above 60 years (70.3%). A study conducted by Laaka
et al. reported that there is generally a strong age and gender
dependence in the prevalence of the metabolic syndrome,
but a wide geographical variation in its frequency.20 Several
population studies have reported an increase in the prev-
alence of the metabolics syndrome with age regardless of
FIG. 2. Age-speci c prevalence of metabolic syndrome in
studied women according to IDF and ATPIII
Age Group
ATPIII
IDF
< 30 30–39
0
10
24
84
20.7
30.7
37.3
42.5
77.9
81.9
63.3
53.3
20
30
40
%50
60
70
80
90
40–49 50–59 60+
met.2008.0077.indd 226 5/13/2006 11:01:58 PM
PREVALENCE OF METABOLIC SYNDROME AND ITS COMPONENTS 227
de nition, although some have reported a peak in the sev-
enth decade,21 which is in consistent with our study with a
peak in the sixth decade. Also, our results showed that lower
educational levels were signi cantly associated with meta-
bolic syndrome, which is consistent with other studies from
different population.22
Among Qatari population, the prevalence of metabolic
syndrome was signi cantly higher in women by ATP III
(61.4% vs. 38.6%, P < 0.001) and IDF (56.7% vs. 43.3%, P <
0.001). Also, in the United Kingdom, the metabolic syndrome
was signi cantly more frequent in females (24.9% vs. 17.4%,
P < 0.001).19 In Slovakia, the prevalence of metabolic
syndrome was signi cantly higher in females (23.9%) when
compared to males (15.9%, P < 0.0001).23 As for Iranians in
the Tehran study, a prevalence of 42% in women and 24% in
men was found.24 Nevertheless, there are many populations
where there is higher prevalence in men. In a Dutch popu-
lation,25 the prevalence of metabolic syndrome was higher
in men 36.8% than women (31.0%) (P = 0.01) according to
IDF criteria; by ATP III criteria, the prevalence was 26.7% in
males and 22.8% in females (P = 0.02).
Among the different components of metabolic syndrome
in the study sample, central obesity was signi cantly high in
subjects according to ATP III (65.3%) and IDF (83.5%) criteria.
T 6. T P M S D C
Country Age group Year Sample size Criteria Prevalence rate (%) Prevalence type
Arab American 28 20–75 2003 542 ATP III 23.0 Age standardized
South Korea 29 20–82 2001 40,698 ATP III 6.8 Age standardized
Saudi Arabia 30 20–60 2004 2,250 ATP III 20.8 Age standardized
Oman
21 >20 2001 1,419 ATP III 21.0 Age standardized
Chennai, India 31 20–75 2003 475 ATP III 41.0 Crude
China
32 20–94 1998–2000 2,776 ATP III 10.2 Crude
Italy 33 65–97 2006 981 ATP III 27.2 Crude
United States 34 >20 1999–2002 3,601 ATP III
IDF
34
39.0
Crude
Hungary 35 >20 2006 13,383 ATP III
IDF
8.3
11.5
Age standardized
Greece 35 >20 2005 9,669 ATP III
IDF
24.5
43.4
Age standardized
Tai wan 36 20–80 2002 5,936 ATP IIIa
IDFa
15.7
16.4
Age standardized
Iran
37 ≥20 10,368 ATP III 33.7 Age standardized
South Australia 38 ≥18 20 05 4,0 60 ATP
IDF
15.3
22.8
Crude
Spain 39 ≥20 2005 7,256 ATP III 5.8 Crude
Palestine 40 30–65 1996–1998 992 WHO 17.0 Crude
The Netherlands 41 ≥20 2008 3,000 ATPIII
IDF
23
37
Crude
Crude
Slovakia 42 ≥20 2008 1,517 ATP III
IDF
20.1
38.1
Crude
Crude
Urban Indians 43 25–70 2008 267 ATP III 35.2 Crude
Peru 44 ≥30 2008 271 ATP III 18.8% Crude
Tu rk ey 45 ≥20 2008 4,809 ATP III 26.9% Crude
Portuga l 18 18–92 2007 1,433 ATP III
IDF
24.0
41.9
Crude
Crude
Brazil 46 25–64 2007 1,663 ATP III 29.8 Crude
Japan 47 ≥20 2006 4,941 IDF 9.1% Crude
Thailand
48 15–87 2007 636 ATP III
IDF
20.0%
18.7%
Crude
Crude
North Jordan 49 ≥25 2007 1,121 ATP III 36.3% Age standardized
Sweden 50 45–69 2008 1,007 ATP III 15.0% Crude
Mexico 41 35–65 1998 325 IDF 41.2% Crude
United Arab Emirates 42 ≥20 2008 4,097 ATP III
IDF
39.6
40.5
Age standardized
Qatar (current study) ≥20 2008 1,204 ATP III
IDF
ATP III
IDF
26.5
33.7
26.8
34.4
Crude
Age standardized
aModi ed criteria.
Abbreviations: ATP III, Adult Treatment Panel III; IDF, International Diabetes Federation; WHO, World Health Organization.
met.2008.0077.indd 227 5/13/2006 11:01:58 PM
BENER ET AL.228
The prevalence of IDF-de ned central obesity was quite high
compared to ATP III because the IDF criteria emphasize
central obesity as an essential component for the metabolic
syndrome rather than as an optional component as in ATP
III. Yoon et al.26 reported that in Asian populations, central
obesity seems to have greater impact on the overall preva-
lence of the syndrome, challenging the appropriateness of
IDF criteria. Also, hypertension was higher in subjects by
both de nitions (37%) compared to other components. This
is comparable to the prevalence in other populations, like
Slovak population, which tends to have increased BP 44%
compared to the United States (33%) and Greek (38.1%) pop-
ulations.23 High blood pressure was considered the most
controversial feature of metabolic syndrome. In the study
sample, the frequency of high fasting glucose was relatively
low, especially when compared to the prevalence of central
obesity or high BP. It was described in a group of subjects
who developed metabolic syndrome with little or no inher-
ent insulin resistance, but with abdominal obesity.27 This
supports the idea that excess body fat plays a major role for
metabolic syndrome. Even multivariate logistic regression
analysis revealed that age and BMI were signi cant contrib-
utors to metabolic syndrome.
To the best of our knowledge, this is the rst report show-
ing the age-speci c prevalence of metabolic syndrome and
its components through the decades and assessed obesity
component contributed to the increased risk of the meta-
bolic syndrome. Metabolic syndrome constitutes a major
public burden as de ned by its prevalence risk. With the
obesity epidemic, the impact of metabolic syndrome is likely
to increase.
Conclusion
The current study observed a signi cant increase in the
risk of metabolic syndrome among Qataris. The prevalence
of metabolic syndrome among Qataris is comparable to other
studies in different populations. Although good agreement
was found between two de nitions for metabolic syndrome,
the prevalence of this syndrome and its components was
higher with the IDF criteria. There was a steady increase in
the prevalence of the syndrome through the decades, inde-
pendent of the de nition. The youngest and more educated
par ticipants presented the lowest frequency of i ndividual fea-
tures of metabolic syndrome. Women presented a tendency to
show a higher prevalence compared with men. Multivariate
analysis by both de nitions strongly supported age and BMI
as important signi cant predictors for metabolic syndrome.
Acknowledgments
The project was supported and funded by the Diabetic
Association, and the Qatar Foundation provided generous sup-
port and help while this project was conducted. We also would
like to thank Hamad Medical Corporation for their approval of
this study (HMC Research Protocol No. 275 and No. 325).
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Address reprint requests to:
Prof. Abdulbari Bener
Advisor to WHO
Department of Medical Statistics and Epidemiology
Hamad Medical Corporation
Weill Cornell Medical College
PO Box 3050
Doha
Qatar
E-mail: abener@hmc.org.qa;
abb2007@qatar-med.cornell.edu;
abaribener@hotmail.com
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