Statistical frameworks for setting cutoff points of metabolic syndrome criteria

ABSTRACT

We propose three statistical frameworks for determining the cutoff points of metabolic syndrome (MetS) criteria, consisting of six components that are the same as in widely used MetS definitions, e.g., the 2004 updated NCEP-ATPIII criteria. Several international organizations have proposed MetS definitions; no literature indicates that any of these definitions is based on statistical frameworks. For all the three frameworks, the cutoff points are set to maximize the observed prevalence rate of stroke and DM. The three frameworks differ in assumptions on the joint distribution of the six components. Using the cohort data from a regional hospital in Taiwan, we illustrate applications of the three frameworks and compare them with the updated NCEP-ATPIII definition and the 2009 consensus definition of IDF and AHA/NHLBI. The performance measure is the odds ratio, the odds of getting stroke or DM within subjects with MetS divided by the analogous odds for subjects without MetS. Our numerical results show that the odds ratios of the three frameworks are higher than those of the updated-NCEP and consensus definitions, showing that the proposed frameworks seem to provide a better association of MetS with stroke and DM.

KEYWORDS:

• Cut-off point
• Diabetes mellitus
• Metabolic syndrome
• Stroke

MATHEMATICS SUBJECT CLASSIFICATION:

• 62P10
• 62H30

Acknowledgments

We thank Taiwan Landseed Hospital for providing LIONS data. We also thank referees for comments that improved the presentation of this article. This research was supported by Landseed Hospital under Contract LH-2013-09. The second author is partially supported by Taiwan Ministry of Science and Technology under Contract NSC 102-410-H-033-035.