title: The effect of age, gender, TG/HDL-C ratio and behavioral lifestyles on the metabolic syndrome in the high risk Mediterranean Island population of Malta.
abstract: OBJECTIVE
  Metabolic syndrome (MetS) is a public health epidemic, typically with female predominance. The aim was to analyse the effect of gender and age on MetS and its components; analyse effects of lifestyle, diabetes mellitus and identify predictors for MetS including TG/HDL ratio, on a national level in a Mediterranean island. Findings will provide evidence-based data for neighboring countries to aid in combat of this epidemic.
  
  
  METHODS
  A cross-sectional survey was conducted in Malta (2014-2016) on a randomized adults population sample. Various components of MetS were measured along with lifestyle habits (smoking, alcohol and physical activity) and family history (cardiovascular and diabetes). Both descriptive and statistical analyses were performed.
  
  
  RESULTS
  A total of 80,788 Maltese adults estimated to suffer from MetS. Males were predominantly affected with significant difference from females. All MetS components were found to be significant predictors along with alcohol habits but not smoking. Neither physical inactivity nor family history of cardiovascular disease, showed any predictive ability for MetS even after adjustment. Elevated triglyceride levels exhibited highest predictive effect on MetS. TG/HDL ratio showed predictive ability in the Maltese population.
  
  
  CONCLUSIONS
  Males were at higher risk for MetS in Malta. A number of predictors were established but not sedentary lifestyle. TG/HDL ratio may provide to be a good indicator for development of MetS.
authors.affiliation: Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta. Electronic address: sarah.cuschieri@um.edu.mt.
authors.forename: Sarah
authors.initials: S
authors.lastname: Cuschieri
authors.affiliation: Professor of Medicine, Faculty of Medicine and Surgery, University of Malta, Msida, Malta. Electronic address: josanne.vassallo@um.edu.mt.
authors.forename: Josanne
authors.initials: J
authors.lastname: Vassallo
authors.affiliation: Department of Public Health, Faculty of Medicine and Surgery, University of Malta, Msida, Malta; Director of the Department of Health Information and Research, Ministry of Health, Gwardamangia, Malta. Electronic address: neville.calleja@um.edu.mt.
authors.forename: Neville
authors.initials: N
authors.lastname: Calleja
authors.affiliation: Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta. Electronic address: nikolai.p.pace@um.edu.mt.
authors.forename: Nikolai
authors.initials: N
authors.lastname: Pace
authors.affiliation: Head of Department of Public Health, Faculty of Medicine and Surgery, University of Malta, Msida, Malta. Electronic address: julian.mamo@um.edu.mt.
authors.forename: Julian
authors.initials: J
authors.lastname: Mamo
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D008076:Cholesterol, HDL / Q000097:blood*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D008319:Malta / Q000453:epidemiology; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D012737:Sex Factors; D014280:Triglycerides / Q000097:blood*; D055815:Young Adult
chemical_list: D008076:Cholesterol, HDL; D014280:Triglycerides
keywords: Epidemiology; Malta; Mediterranean; Metabolic syndrome; Risk factors