title: Independent associations between a metabolic syndrome severity score and future diabetes by sex and race: the Atherosclerosis Risk In Communities Study and Jackson Heart Study.
abstract: The study aimed to assess for an association between the degree of severity of the metabolic syndrome and risk of type 2 diabetes beyond that conferred by the individual components of the metabolic syndrome.
  
  
  
  We assessed HRs for an Adult Treatment Panel III (ATP-III) metabolic syndrome score (ATP-III MetS) and a sex- and race-specific continuous metabolic syndrome severity z score related to incident diabetes over a median of 7.8 years of follow-up among participants of two observational cohorts, the Atherosclerosis Risk in Communities study (n = 10,957) and the Jackson Heart Study (n = 2137).
  
  
  
  The ATP-III MetS had an HR for incident diabetes of 4.36 (95% CI 3.83, 4.97), which was attenuated in models that included the individual metabolic syndrome components. By contrast, participants in the fourth quartile of metabolic syndrome severity (compared with the first quartile) had an HR of 17.4 (95% CI 12.6, 24.1) for future diabetes; in models that also included the individual metabolic syndrome components, this remained significant, with an HR of 3.69 (95% CI 2.42, 5.64). There was a race × metabolic syndrome interaction in these models such that HR was greater for black participants (5.30) than white participants (2.24). When the change in metabolic syndrome severity score was included in the hazard models, this conferred a further association, with changes in metabolic syndrome severity score of ≥0.5 having a HR of 2.66 compared with changes in metabolic syndrome severity score of ≤0.
  
  
  
  Use of a continuous sex- and race-specific metabolic syndrome severity z score provided an additional prediction of risk of diabetes beyond that of the individual metabolic syndrome components, suggesting an added risk conferred by the processes underlying the metabolic syndrome. Increases in this score over time were associated with further risk, supporting the potential clinical utility of following metabolic syndrome severity over time.
authors.affiliation: Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Gurka
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.|Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Sherita H
authors.initials: SH
authors.lastname: Golden
authors.affiliation: Department of Medicine, Jackson Heart Study, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Solomon K
authors.initials: SK
authors.lastname: Musani
authors.affiliation: Department of Medicine, Jackson Heart Study, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Sims
authors.affiliation: Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA.|Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Vishnu
authors.affiliation: Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Yi
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Cardel
authors.affiliation: Department of Epidemiology, College of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Pearson
authors.affiliation: Department of Pediatrics, Division of Pediatric Endocrinology, University of Virginia, 409 Lane Road, Room 2017, PO Box 800386, Charlottesville, VA, 22908, USA. deboer@virginia.edu.
authors.forename: Mark D
authors.initials: MD
authors.lastname: DeBoer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000208:ethnology* / Q000503:physiopathology*; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000208:ethnology* / Q000503:physiopathology*; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007333:Insulin Resistance; D053208:Kaplan-Meier Estimate; D008297:Male; D024821:Metabolic Syndrome / Q000503:physiopathology*; D008875:Middle Aged; D015233:Models, Statistical; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012737:Sex Factors; D055815:Young Adult
keywords: Insulin resistance; Metabolic syndrome; Risk; Type 2 diabetes mellitus