Is impaired energy regulation the core of the metabolic syndrome in various ethnic groups of the USA and Taiwan?
BACKGROUND
The metabolic syndrome (MetS) concept is widely used in public health and clinical settings without an agreed pathophysiology. We have re-examined the MetS in terms of body fuels, so as to provide a coherent cross-cultural pathogenesis.


METHODS
National Health and Nutrition Examination Survey (NHANES 2001-2) with n = 2254 and Taiwanese National Health Interview Survey (NHIS) sub-set for hypertension, hyperglycemia and hyperlipidemia assessment (TwSHHH 2002), n = 5786, were used to compare different ethnicities according to NCEP-ATPIII (NCEP-tw) criteria for METS. Exploratory factor analysis (EFA) using principal components (PC) was employed to differentiate and unify MetS components across four ethnicities, gender, age-strata, and urban-rural settings.


RESULTS
The first two factors from the PC analysis (PCA) accounted for from 55.2% (non-Hispanic white) to 63.7% (Taiwanese) of the variance. Rotated factor loadings showed that the six MetS components provided three clusters: the impaired energy regulation (IER) components (waist circumference, WC, fasting triglycerides, TG, and fasting plasma glucose, FPG), systolic and diastolic blood pressures (BPs), and HDL-cholesterol, where the IER components accounted for 25-26% of total variance of MetS components. For the three US ethnic subgroups, factor 1 was mainly determined by IER and HDL-cholesterol, and factor 2 was related to the BP components. For Taiwanese, IER was determinant for both factors, and BPs and HDL-cholesterol were related to factors 1 and 2 respectively.


CONCLUSIONS
There is a MetS core which unifies populations. It comprises WC, TG and FPG as a core, IER, which may be expressed and modulated in various second order ways.
Division of Health Policy Research and Development, Institute of Population Health Sciences, National Health Research Institutes, No, 35, Keyan Road, Zhunan, Miaoli County 35053, Taiwan. profmlw@nhri.org.tw.
Mark L
ML
Wahlqvist
Hsing-Yi
HY
Chang
Chu-Chih
CC
Chen
Chih-Cheng
CC
Hsu
Wan-Chi
WC
Chang
Wuan-Szu
WS
Wang
Chao A
CA
Hsiung