Clinical utility of metabolic syndrome severity scores: considerations for practitioners

Figures & data

Table 1 Equations for sex- and race/ethnicity-specific metabolic syndrome severity Z-score

Adults aged 20–64 years

Males

Non-Hispanic White = −5.4473+0.0125 × waist circumference − 0.0251 × HDL + 0.0047 × SBP + 0.8244 × ln(Tri) + 0.0106 × Glu

Non-Hispanic Black = −6.3780+0.0232 × waist circumference − 0.0175 × HDL + 0.0040 × SBP + 0.5400 × ln(Tri) + 0.0203 × Glu

Hispanic = −5.5459+0.0135 × waist circumference − 0.0278 × HDL + 0.0054 × SBP + 0.8340 × ln(Tri) + 0.0105 × Glu

Females

Non-Hispanic White = −7.2536+0.0254 × waist circumference − 0.0120 × HDL + 0.0075 × SBP + 0.5800 × ln(Tri) + 0.0203 × Glu

Non-Hispanic Black = −7.1895+0.0304 × waist circumference − 0.0095 × HDL + 0.0054 × SBP + 0.4455 × ln(Tri) + 0.0225 × Glu

Hispanic = −7.7516+0.0162 × waist circumference − 0.0157 × HDL + 0.0084 × SBP + 0.8872 × ln(Tri) + 0.0206 × Glu

Adolescents age 12–19 years

Males

Non-Hispanic White = −4.9310+0.2804 × BMI z-score − 0.0257 × HDL + 0.0189 × SBP + 0.6240 × ln(Tri) + 0.0140 × Glu

Non-Hispanic Black = −4.7544+0.2401 × BMI z-score − 0.0284 × HDL + 0.0134 × SBP + 0.6773 × ln(Tri) + 0.0179 × Glu

Hispanic = −3.2971+0.2930 × BMI Z-score − 0.0315 × HDL + 0.0109 × SBP + 0.6137 × ln(Tri) + 0.0095 × Glu

Females

Non-Hispanic White = −4.3757+0.4849 × BMI z-score − 0.0176 × HDL+0.0257 × SBP+0.3172 × ln(Tri) + 0.0083 × Glu

Non-Hispanic Black = −3.7145+0.5136 × BMI z-score − 0.0190 × HDL+0.0131 × SBP+0.4442 × ln(Tri) + 0.0108 × Glu

Hispanic = −4.7637+0.3520 × BMI z-score − 0.0263 × HDL + 0.0152 × SBP + 0.6910 × ln(Tri) + 0.0133 × Glu

Notes: For each given sex and racial/ethnic subgroups, MetS severity Z-scores are generated from inserting an individual’s clinically measured values for waist circumference (in centimeters), HDL (in milligrams per deciliter), SBP (in millimeters of mercury), natural-log of fasting triglycerides (in milligrams per deciliter), and fasting glucose (in milligrams per deciliter).

Abbreviations: BMI, body mass index; MetS, metabolic syndrome HDL, high-density lipoprotein; SBP, systolic blood pressure; Glu, glucose.

Figure 1 Correlations between MetS severity score and risk factors associated with the pathophysiology of MetS.

Notes: MetS severity scores and concurrent measures of (A) homeostasis model of insulin resistance (HOMA), (B) high-sensitivity C-reactive protein, and (C) uric acid (all assessed among participants aged 20–64 years of the National Health and Nutrition Survey 1999–2008), and (D) adiponectin (assessed among members of the Princeton Lipid Research cohort). R² values varied by race, with HOMA 0.44 for Whites and 0.36 for Blacks and Hispanics; ln(hsCRP) 0.17 for Whites and Blacks and 0.09 for Hispanics; uric acid 0.16 for Whites, 0.06 for Blacks and 0.03 for Hispanics; and adiponectin 0.22 for Whites and Blacks combined. Reprinted from Metabolism. 63(2). Gurka MJ, Lilly CL, Norman OM, DeBoer MD. An examination of sex and racial/ethnic differences in the metabolic syndrome among adults: a confirmatory factor analysis and a resulting continuous severity score. 218–225; Copyright 2014, with permission from Elsevier,⁶¹ and DeBoer MD, Gurka MJ, Morrison JA, Woo JG. Inter-relationships between the severity of metabolic syndrome, insulin and adiponectin and their relationship to future type 2 diabetes and cardiovascular disease. Int J Obes (Lond). Epub 2016 May 24,⁷¹ with permission.
Abbreviations: hsCRP, high-sensitivity C-reactive protein; MetS, metabolic syndrome; HOMA, homeostatic model assessment.

Figure 2 Odds ratios of future T2DM and CVD for every 1-point increase in MetS severity score.

Notes: Among members of the Princeton Lipid Research Clinic cohort, MetS severity scores were measured at childhood (mean age 13 years) and mid-adulthood (mean age 38 years), and adult outcomes were determined in mid-adulthood and later adulthood (mean age 50 years). Data shown are odds ratios of future disease for every 1-point (ie, 1 standard deviation score) increase in MetS severity at baseline time point and for the change in MetS severity (Δ MetS) between childhood and mid-adulthood. Data from DeBoer et al.^73,74
Abbreviations: MetS, metabolic syndrome; CVD, cardiovascular disease; T2DM, type 2 diabetes mellitus.

Gurka MJ Lilly CL Norman OM DeBoer MD An examination of sex and racial/ethnic differences in the metabolic syndrome among adults: a confirmatory factor analysis and a resulting continuous severity score Metabolism 2014 63 2 218 225 24290837

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DeBoer MD Gurka MJ Morrison JA Woo JG Inter-relationships between the severity of metabolic syndrome, insulin and adiponectin and their relationship to future type 2 diabetes and cardiovascular disease Int J Obes (Lond) Epub 2016 5 24

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DeBoer MD Gurka MJ Woo JG Morrison JA Severity of metabolic syndrome as a predictor of cardiovascular disease between childhood and adulthood: the Princeton Lipid Research Cohort Study J Am Coll Cardiol 2015 66 6 755 757 26248997

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DeBoer MD Gurka MJ Woo JG Morrison JA Severity of the metabolic syndrome as a predictor of type 2 diabetes between childhood and adulthood: the Princeton Lipid Research Cohort Study Diabetologia 2015 58 12 2745 2752 26380985

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