title: Prevalence of metabolic syndrome in Nepalese type 2 diabetic patients according to WHO, NCEP ATP III, IDF and Harmonized criteria.
abstract: BACKGROUND
  Metabolic syndrome (MetS) present in type 2 diabetic patients greatly increases the risk of strokes and cardiovascular diseases. Timely detection and mapping of MetS facilitates appropriate preventive and therapeutic approaches to minimize these risks. Our study aimed to determine the prevalence of MetS among Nepalese type 2 diabetic patients using WHO (1999), NCEP ATP III (2001), IDF (2005) and Harmonized (2009) definitions and identify the diagnostic concordance and disparity resulting from these four definitions.
  
  
  METHODS
  Clinical and biochemical data were collected for 1061 type 2 diabetic patients at Manipal Teaching Hospital, Pokhara, Nepal. The data was analyzed in order to identify prevalence of MetS in these patients. Statistical analysis included usage of Student's t- and Chi-square tests, kappa statistics and 95% confidence intervals.
  
  
  RESULTS
  The total age adjusted prevalence rates of MetS were 80.3%, 73.9%, 69.9% and 66.8% according to Harmonized, NCEP ATP III, WHO and IDF definitions, respectively. Prevalence increased with the age and was higher in females (p <0.001) according to WHO, NCEP ATP III and Harmonized definitions. Patients of Dalit community had the highest prevalence (p<0.05) according to NCEP ATP III and Harmonized definitions while Mongoloid and Newar patients had the highest prevalence (p <0.05) according to WHO and IDF definitions, respectively. Prevalence was also highest among patient engaged in agriculture occupation. Central obesity and hypertension were respectively the most and the least prevalent components of MetS. The highest overall agreement was between Harmonized and NCEP ATP III definitions (κ =0.62, substantial) and the lowest between WHO & IDF definitions (κ=0.26, slight). The Harmonized definition had the highest sensitivity (99.9%) and negative predictive value (98.9%) while NCEP ATP III definition had the highest specificity (98.9%) and positive predictive values (99.9%) in identifying the cases of MetS.
  
  
  CONCLUSIONS
  The prevalence of MetS among Nepalese type 2 diabetic patients was very high suggesting that these patients were at increased risk of strokes, cardiovascular diseases and premature death. The Harmonized definition was the most sensitive while NCEP ATP III and IDF definitions were the most specific in detecting the presence of MetS in Nepalese type 2 diabetic patients.
authors.affiliation: Department of Biochemistry, Manipal College of Medical Sciences and Teaching Hospital, Pokhara, Nepal.
authors.forename: Daya Ram
authors.initials: DR
authors.lastname: Pokharel
authors.affiliation: Department of Laboratory Medicine, Gandaki Medical College Teaching Hospital and Research Center, Prithvi Chowk, Pokhara Nepal.
authors.forename: Dipendra
authors.initials: D
authors.lastname: Khadka
authors.affiliation: Department of Biochemistry, Manipal College of Medical Sciences and Teaching Hospital, Pokhara, Nepal.
authors.forename: Manoj
authors.initials: M
authors.lastname: Sigdel
authors.affiliation: Department of Biochemistry, Manipal College of Medical Sciences and Teaching Hospital, Pokhara, Nepal.
authors.forename: Naval Kishor
authors.initials: NK
authors.lastname: Yadav
authors.affiliation: Department of Planning and Research, Cambrian College of Arts and Technology, 1400 Barrydowne Road, Sudbury, ON P3A 3 V8 Canada.
authors.forename: Shreedhar
authors.initials: S
authors.lastname: Acharya
authors.affiliation: Department of Internal Medicine, Manipal College of Medical Sciences and Teaching Hospital, Pokhara, Nepal.
authors.forename: Ram Chandra
authors.initials: RC
authors.lastname: Kafle
authors.affiliation: Department of Biochemistry, Manipal College of Medical Sciences and Teaching Hospital, Pokhara, Nepal.
authors.forename: Pramod Shankar
authors.initials: PS
authors.lastname: Shukla
keywords: Manipal Teaching Hospital; Metabolic syndrome; Nepal; Pokhara; Prevalence; Type 2 diabetes mellitus