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Prevalence and Associated Risk Factor Findings in the US Population From the Third National Health and Nutrition Examination Survey, 1988-1994

Yong-Woo Park, MD, PhD; Shankuan Zhu, MD, PhD; Latha Palaniappan, MD; Stanley Heshka, PhD; Mercedes R. Carnethon, PhD; Steven B. Heymsfield, MD

Arch Intern Med. 2003;163:427-436.

Background  The metabolic syndrome is an important cluster of coronary heart disease risk factors with common insulin resistance. The extent to which the metabolic syndrome is associated with demographic and potentially modifiable lifestyle factors in the US population is unknown.

Methods  Metabolic syndrome–associated factors and prevalence, as defined by Adult Treatment Panel III criteria, were evaluated in a representative US sample of 3305 black, 3477 Mexican American, and 5581 white men and nonpregnant or lactating women aged 20 years and older who participated in the cross-sectional Third National Health and Nutrition Examination Survey.

Results  The metabolic syndrome was present in 22.8% and 22.6% of US men and women, respectively (P = .86). The age-specific prevalence was highest in Mexican Americans and lowest in blacks of both sexes. Ethnic differences persisted even after adjusting for age, body mass index, and socioeconomic status. The metabolic syndrome was present in 4.6%, 22.4%, and 59.6% of normal-weight, overweight, and obese men, respectively, and a similar distribution was observed in women. Older age, postmenopausal status, Mexican American ethnicity, higher body mass index, current smoking, low household income, high carbohydrate intake, no alcohol consumption, and physical inactivity were associated with increased odds of the metabolic syndrome.

Conclusions  The metabolic syndrome is present in more than 20% of the US adult population; varies substantially by ethnicity even after adjusting for body mass index, age, socioeconomic status, and other predictor variables; and is associated with several potentially modifiable lifestyle factors. Identification and clinical management of this high-risk group is an important aspect of coronary heart disease prevention.

From the Department of Family Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea (Dr Park); the Obesity Research Center, St Luke's–Roosevelt Hospital, Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, NY (Drs Zhu, Heshka, and Heymsfield); and the Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, Palo Alto, Calif (Drs Palaniappan and Carnethon).

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