In the sub-Saharan group, waist circumference was lower, and the lipid profile showed higher HDL and lower triglycerides levels. This ensued a lower prevalence of categorical MetS in this population in male subjects. Diagnosis of T2DM occurred earlier in this sub-Saharan population, and while le='font-style: italic'>β × le='font-style: italic'>S was higher in those subjects compared with Caucasians, the demographics suggest that lifetime insulin secretion decreases faster in these otherwise less insulin-resistant subjects.
In male sub-Saharan African subjects with T2DM, the MetS prevalence is lower than in sub-Saharan females, and lower than that recorded in Belgian diabetic subjects. This difference resulted from lower girth circumference and less atherogenic lipid profile. However, this sub-Saharan population had earlier onset diabetes with concurrent insulin resistance and earlier loss of insulin secretion.
A cross-sectional study of randomly selected 75-year-olds from a general population was performed (191 women and 194 men). The MetS was defined according to the National Cholesterol Education Program criteria. Heart rate was measured as beats per minute immediately after exercise and at 4 minutes into recovery.
Heart rate recovery (median and interquartile range, beat/min) was 48 (37-58) for women and 49 (38-58) for men. Thirty-seven percent of the women and 25%of the men had the MetS. Heart rate recovery was 52 (42-61) for women with the MetS and 42 (31-49) for those without. The corresponding values for men was 50 (39-61) and 47 (35-54); the difference between individuals with and without the MetS was significant for women (le='font-style: italic'>P < .001) but not for men (le='font-style: italic'>P = .084). The following significant correlation coefficients between HRR and MetS components were found: for women, waist circumference (−0.43, le='font-style: italic'>P < .001), high-density lipoprotein cholesterol (0.37, le='font-style: italic'>P < .001), insulin sensitivity (−0.37, le='font-style: italic'>P < .001), fasting plasma glucose (−0.30, le='font-style: italic'>P < .001), and triglycerides (−0.24, le='font-style: italic'>P = .001); for men, triglycerides (−0.20, le='font-style: italic'>P = .005). The sex disparity in the strength of correlation reached statistical significance for insulin sensitivity (le='font-style: italic'>P < .001) and waist circumference (le='font-style: italic'>P = .042).
Among 75-year-olds, the MetS and related components are more strongly correlated to HRR in women than in men.
This study was designed to identify the clinical and laboratory parameters of metabolic syndrome and cardiovascular risk factors in a population of 2045 male military personnel based in the Paris region. The initial 1-year cross-sectional study will be followed by a 10-year follow-up and patient care.
The 2045 subjects included 185 (9%) presented at least 3 of the 5 NCEP ATP III criteria defining metabolic syndrome. They were significantly older (42.2 ± 8.5 yrs) than the other subjects (37.3 ± 8.7 yrs, P < 0.001), had a higher BMI (29.5 ± 3.4 le='font-style: italic'>vs 24.8 ± 2.9 kg/m2, P < 0.001) and a greater body weight at age 20 (75.4 ± 11 le='font-style: italic'>vs 70.4 ± 8.5 kg, P < 0.01). Smoking, little physical activity and family histories of diabetes and arterial hypertension were more frequent in these men. While levels of the cholesterol and CRP us were higher, Lp(a) and homocysteine concentrations were normal. Plasma insulin and BMI (r = 0.456 P < 0.0001) and plasma insulin and waist circumference (r = 0.446 P < 0.0001) were well correlated. Lastly, plasma insulin, free fatty acids and cardiovascular risk increased steadily with the increase in the number of metabolic syndrome criteria.
These results in a large and particularly uniform population of men show the prevalence of metabolic syndrome in adult men, and demonstrate its link with insulin resistance. Men with several risk factors require specific care, particularly for hypertension and dyslipidemia; the effectiveness of this care will be evaluated during the follow-up period.
L'importance du syndrome métabolique en terme de santé publique est soulignée par tous mais peu d'études épidémiologiques françaises permettent d'approcher la réalité du terrain. EPIMIL est une étude épidémiologique prospective qui a débuté le 1er Février 2003.
Cette étude vise à rechercher les paramètres cliniques et biologiques du syndrome métabolique et des facteurs de risque cardiovasculaire dans une population ciblée de 2045 militaires de sexe masculin de la région parisienne. La période d'inclusion qui a duré 1 an sera suivie d'une période de 10 ans de surveillance et d'intervention.
Parmi ces 2045 sujets, 185 (9%) présentent au moins 3 des 5 critères du NCEP ATP III et répondent à la définition du syndrome métabolique. Ces derniers sont significativement plus âgés (42,2 ± 8,5 le='font-style: italic'>vs 37,3 ± 8,7 ans, P < 0,001), leur IMC est plus élevé (29,5 ± 3,4 le='font-style: italic'>vs 24,8 ± 2,9 kg/m2, P < 0,001) ainsi que leur poids à 20 ans (75,4 ± 11 le='font-style: italic'>vs 70,4 ± 8,5 kg, P < 0,01). L'exposition au tabac, un faible niveau d'activité physique et des antécédents familiaux de diabète et d'HTA sont plus souvent observés chez ces malades. Si les taux du cholestérol et de la CRP ultrasensible sont plus élevés, on n'observe en revanche aucune différence des taux de Lp(a) et d'homocystéine. Il existe une excellente corrélation entre l'insulinémie et l'IMC (r = 0,456, P < 0,0001) et l'insulinémie et le tour de taille (r = 04446, P < 0.0001). Enfin, l'insulinémie, le taux des acides gras libres, les différents marqueurs de risque et le risque cardiovasculaire absolu croissent régulièrement avec le nombre de critères du syndrome métabolique.
Ces résultats confirment la forte prévalence du syndrome métabolique dans une population d'adultes de sexe masculin particulièrement homogène et montrent la réalité de son lien avec l'insulinorésistance. Ces sujets qui concentrent ainsi de nombreux facteurs de risque nécessitent une prise en charge particulière notamment de l'HTA et des dyslipidémies, dont l'efficacité sera évaluée par l'étude de suivi.
Metabolic Syndrome and the Mismeasure of Risk