title: Can we apply the National Cholesterol Education Program Adult Treatment Panel definition of the metabolic syndrome to Asians?
abstract: OBJECTIVE
  Limited information is available about the metabolic syndrome in Asians. Furthermore, the definition of central obesity using waist circumference may not be appropriate for Asians. The objectives of this study were to determine the optimal waist circumference for diagnosing central obesity in Asians and to estimate the prevalence of the metabolic syndrome in an Asian population.
  
  
  METHODS
  We used data from the 1998 Singapore National Health Survey, a cross-sectional survey involving 4,723 men and women of Chinese, Malay, and Asian-Indian ethnicity aged 18-69 years. Receiver operating characteristic analysis suggested that waist circumference >80 cm in women and >90 cm in men was a more appropriate definition of central obesity in this population. The prevalence of the metabolic syndrome was then determined using the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria with and without the modified waist circumference criteria.
  
  
  RESULTS
  In Asians, decreasing waist circumference increased the crude prevalence of the metabolic syndrome from 12.2 to 17.9%. Using the modified Asian criteria, the prevalence of the metabolic syndrome increased from 2.9% in those aged 18-30 years to 31.0% in those aged 60-69 years. It was more common in men (prevalence 20.9% in men versus 15.5% in women; P < 0.001) and Asian Indians (prevalence 28.8% in Asian-Indians, 24.2% in Malays, and 14.8% in Chinese; P < 0.001).
  
  
  CONCLUSIONS
  NCEP ATP III criteria, applied to an Asian population, will underestimate the population at risk. With a lower waist circumference cutoff, the prevalence of the metabolic syndrome is comparable to that in Western populations. Ethnic differences are likely to exist between populations across Asia.
authors.affiliation: Department of Endocrinology, Singapore General Hospital, Singapore, Republic of Singapore. ce_tan@sgh.com.sg
authors.forename: Chee-Eng
authors.initials: CE
authors.lastname: Tan
authors.forename: Stefan
authors.initials: S
authors.lastname: Ma
authors.forename: Daniel
authors.initials: D
authors.lastname: Wai
authors.forename: Suok-Kai
authors.initials: SK
authors.lastname: Chew
authors.forename: E-Shyong
authors.initials: ES
authors.lastname: Tai
mesh_terms: D000328:Adult; D000368:Aged; D002784:Cholesterol; D005006:Ethnicity; D005260:Female; D006306:Health Surveys; D006801:Humans; D006937:Hypercholesterolemia / Q000517:prevention & control*; D008297:Male; D024821:Metabolic Syndrome / Q000534:rehabilitation*; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D012846:Singapore
chemical_list: D002784:Cholesterol