Validation of metabolic syndrome score by confirmatory factor analysis in children and adults and prediction of cardiometabolic outcomes in adults.
OBJECTIVE
We validated the metabolic syndrome (MetS) score by confirmatory factor analysis (CFA) in children, middle-aged men, and older women and men and by investigating the relationships of the MetS score to incident type 2 diabetes, myocardial infarction, and cardiovascular and overall death in middle-aged men.


METHODS
We assessed the core features of MetS, calculated the MetS score using z scores for waist circumference, insulin, glucose, triacylglycerols, HDL-cholesterol and blood pressure, and carried out CFA to investigate whether MetS represents a single entity in population samples of 491 children, 1,900 middle-aged men, 614 older women and 555 older men from Finland. We also followed-up incident type 2 diabetes for 11 years and other outcomes for 17-18 years in middle-aged men.


RESULTS
We carried out second-order CFAs in which the MetS was represented by a second-order latent variable underlying four latent variables characterised by abdominal obesity, insulin resistance, dyslipidaemia and raised blood pressure in different age groups. These second-order factors and factors derived from first-order CFA using previously proposed models were strongly associated with a composite MetS score in all age groups (r = 0.84-0.94) and similarly predicted type 2 diabetes, cardiovascular outcomes and mortality in middle-aged men. The risk of type 2 diabetes, myocardial infarction, cardiovascular death and overall death increased 3.67-, 1.38-, 1.56- and 1.44-fold, respectively, for a 1 SD increase in the MetS score.


CONCLUSIONS
The MetS can be described as a single entity in all age groups. The MetS score is a valid tool for research evaluating cardiometabolic risk in different age groups. Further research is needed to define cut-off points for risk estimation in clinical practice.
Department of Physiology, Institute of Biomedicine, University of Eastern Finland, Kuopio Campus, PO Box 1627, FIN-70211, Kuopio, Finland.
Anna
A
Viitasalo
Timo A
TA
Lakka
David E
DE
Laaksonen
Kai
K
Savonen
Hanna-Maaria
HM
Lakka
Maija
M
Hassinen
Pirjo
P
Komulainen
Tuomo
T
Tompuri
Sudhir
S
Kurl
Jari A
JA
Laukkanen
Rainer
R
Rauramaa
D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D002648:Child; D008076:Cholesterol, HDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood; D004032:Diet; D015444:Exercise; D005163:Factor Analysis, Statistical; D005260:Female; D005387:Finland; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications; D012307:Risk Factors; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference
D001786:Blood Glucose; D008076:Cholesterol, HDL; D007328:Insulin; D014280:Triglycerides