Three definitions of metabolic syndrome applied to a sample of young obese men and their relation with plasma testosterone

Figures & data

Table I.  The various definitions of metabolic syndrome.

Definition of metabolic syndrome
	NCEP (1) At least 2 of	WHO (2) At least 2 of	IDF (3)
Waist circumference (cm)	>102	≥94	≥94
Waist hip ratio		>0.90	>0.90
BMI		≥0.30	≥30
			And at least 2 of
Triglycerides (mg/dl)	≥150	≥150	≥150
HDL-cholesterol (mg/dl)	< 40	< 35	< 35
Blood pressure (mm Hg)	≥130/85 or medication	≥140/90 or medication	≥140/90 or medication
		AND
Fasting glucose (mg/dl)	≥110	≥110
Fasting insulin		Upper quartile of non-diabetic	Insulin resistance

(1) National Cholestrerol Education Program, JAMA 2001; 285: 2486–2497.

(2) World Health Organization, Diabetes Med 1999; 16: 442–3.

(3) International Diabetes, J Urol 2005; 174: 827–34.

triglycerides (mg/dL) ≥150 ( ≥1.7 mmol/L).

HDL-cholesterol (mg/dL) <40 (<1.7 mmol/L).

Fasting glucose (mg/dL) ≥110 ( ≥6.1 mmol/L).

Table II.  Characteristics of the patients (median [10–90% range]).

Age	31 (20–39)
BMI (kg/m^2)	32.6 (27.4–35.2)
Waist circumference (WC) (cm)	111 (96–118)
Hip circumference (HC) (cm)	113 (104–117.5)
WC/HC	0.97 (0.9–1.1)
L4 (cm^2) Visc. adip. tissue	201 (123–338)
L4 (cm^2) Subcut. adip. tissue	368 (254–354)
Triglycerides (mmol/L)	1.8 (1.0–4.4)
LDL-chol. (mmol/L)	3.2 (2.4–4.9)
HDL-chol. (mmol/L)	1.1 (0.8–1.6)
Cholesterol (mmol/L)	5.3 (4.2–7.0)
Glucose (mmol/L)	5.5 (4.7–6.5)
Testosterone (nmol/L)	12.2 (6.9–23.4)
Free T (calculated) pmol/L	267 (134–430)
SHBG (nmol/L)	29 (11–63)
Insulin (µME/ml)	10.9 (3.2–39.6)
Leptin (ng/ml)	20.8 (1.9–43.0)
DHEA-sulphates (µmol/L)	3.3 (1.6–5.6)
HOMA	2.8 (0.75–3.9)
Systolic BP (mm Hg)	130 (110–140)
Diastolic BP (mm Hg)	90 (80–100)

L4 (cm²), cross-sectional area visceral and subcutaneous adipose tissue; LDL/HDL, low/high-density lipoprotein; SHBG, sex hormone binding globulin; HOMO, the homeostatic model assessment.

Table III.  Overlap and differences of identifying men as having metabolic syndrome using three definitions of metabolic syndrome.

	NCEP+	NCEP−	WHO+	WHO−	IDF+	IDF−
NCEP+	34		19	15	24	10
WHO+	19	4	23	–	17	6
IDF+	24	3	17	10	27	–

Table IV.  Relationship between a positive identification of metabolic syndrome and plasma T, SHBG and calculated free T.

Metabolic syndrome (MetS)
	NCEP+	NCEP−	WHO+	WHO−	IDF+	IDF−
Total T (nmol/L)	11.2 ± 4.0*	16.3 ± 6.8	10.9 ± 4.4*	15.0 ± 6.3	11.2 ± 4.6*	15.3 ± 63
SHBG (nmol/L)	29.7 ± 21.5**	45.2 ± 32.0	33.9 ± 27.2	37.4 ± 28.0	31.4 ± 223**	40.4 ± 30.7
Calc f T (pmol/L)	249 ± 94***	294 ± 129	230 ± 95***	295 ± 120	236 ± 85***	296 ± 125

MetS+ versus MetS−*p < 0.05.

MetS+ versus MetS−**p < 0.05.

MetS+ versus MetS−***p < 0.05.

Table V.  Number of men (%) with low testosterone levels (<11.5 mol/L) with and without metabolic syndrome (MetS) according to three definitions of metabolic syndrome.

Hormones	NCEP		WHO		IDF
	MetS	Obesity	MetS	Obesity	MetS	Obesity
Total T	50	31	52	30	59	30
calc. fT	44	35	42	27	41	36