Study on Dynamic Progression and Risk Assessment of Metabolic Syndrome Based on Multi-State Markov Model

Abstract

Aim

Metabolic syndrome (MetS) coexists with the occurrence and even death of cardiovascular disease and diabetes mellitus. It is essential to study the factors in the dynamic progression of MetS in the interest of prevention and control.

Purpose

The aim of this study was to analyze the dynamic progression of Mets and explore the potential factors influencing the progression or reversal of MetS.

Patients and Methods

This study involved 5581 individuals from two waves of the China Health and Retirement Longitudinal Study: 2011 and 2015. A multistate Markov model containing 4 states (free of metabolic disorder (FMD), mild metabolic disorder (MMD), severe metabolic disorder (SMD) and MetS) was adopted to study the dynamic progression of MetS and its influencing factors.

Results

After follow-up, a total of 2862 cases (50.28% of the total number) had disease state transition. The intensity of transition from MetS to SMD is the same as that from SMD to MMD, and is greater than that from MMD to Mets (0.06 vs 0.05). For the MetS state, a mean of 1/0.08=12.5 years was spent in the MetS state before recovery. The exercise, smoke, drink, BMI level, hyperuricemia had statistically significant effects on progression of MetS status (P<0.05). The obesity or overweight, little exercise, smoke, drink and hyperuricemia increased the risk of forward progression of MetS disease status. There were significant nonmodifiable (age, gender) and modifiable factors (exercise, drink, BMI level, or high HbA1c) associated with reversion of MetS state.

Conclusion

The likelihood of progression from MMD to MetS is less likely than that of reversion from MetS to SMD and SMD to MMD. Old females were more resistant to recover from worse states than males. Prevention and intervention measures should be adopted early when MMD or SMD onset occurs.

Keywords:

• metabolic syndrome
• multi-state Markov model
• forward progression
• backward reversal

Abbreviations

CHARLS, China Health and Retirement Longitudinal Study; MetS, Metabolic syndrome; FMD, free of metabolic disorder; MMD, mild metabolic disorder; SMD, severe metabolic disorder; BMI, body Mass Index; Low HDL-C, low high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; ADL, ability of daily living; CES-D10, Center for Epidemiological Studies Depression Scale-10; TC, total cholesterol; HbA1c, glycated hemoglobin; CRP, C-reactive protein; HbA1c, glycated hemoglobin; CI, confidence interval; HR, Hazard Ratios.

Data Sharing Statement

The datasets generated and analysed during the current study are available in the CHARLS repository [http://charls.pku.edu.cn/].

Ethics Approval

The CHARLS survey was approved by the Institutional Review Board of Peking University, China (IRB00001052-11014 and IRB00001052-11015). This study was approved by the Ethics Committee of the Xinjiang Medical University, China (XJYKDXR20220302045).

Consent for Publication

Consent for publication was obtained from all the authors.

Acknowledgments

We appreciate all the individuals who took part in CHARLS and all the researchers, clinicians, administrative staff and coordinators at the data sites who have enabled this survey to be carried out.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no conflicts of interest in relation to this work.

Additional information

Funding

This study was supported by the National Natural Science Foundation of China (project no. 71663053).