Diabetologia

, Volume 57, Issue 5, pp 940–949

Validation of metabolic syndrome score by confirmatory factor analysis in children and adults and prediction of cardiometabolic outcomes in adults

  • Anna Viitasalo
  • Timo A. Lakka
  • David E. Laaksonen
  • Kai Savonen
  • Hanna-Maaria Lakka
  • Maija Hassinen
  • Pirjo Komulainen
  • Tuomo Tompuri
  • Sudhir Kurl
  • Jari A. Laukkanen
  • Rainer Rauramaa
Article

DOI: 10.1007/s00125-014-3172-5

Cite this article as:
Viitasalo, A., Lakka, T.A., Laaksonen, D.E. et al. Diabetologia (2014) 57: 940. doi:10.1007/s00125-014-3172-5

Abstract

Aims/hypothesis

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.

Keywords

Cardiovascular Children Confirmatory factor analysis Metabolic syndrome Metabolic syndrome score 

Abbreviations

CFA

Confirmatory factor analysis

CFI

Comparative fit index

CVD

Cardiovascular disease

MAP

Mean arterial pressure

MetS

Metabolic syndrome

RMSEA

Root mean square of approximation

Supplementary material

125_2014_3172_MOESM1_ESM.pdf (186 kb)
ESM Methods(PDF 185 kb)
125_2014_3172_MOESM2_ESM.pdf (99 kb)
ESM Table 1(PDF 98 kb)
125_2014_3172_MOESM3_ESM.pdf (99 kb)
ESM Table 2(PDF 99 kb)
125_2014_3172_MOESM4_ESM.pdf (99 kb)
ESM Table 3(PDF 98 kb)
125_2014_3172_MOESM5_ESM.pdf (99 kb)
ESM Table 4(PDF 98 kb)
125_2014_3172_MOESM6_ESM.pdf (145 kb)
ESM Fig 1(PDF 144 kb)

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Anna Viitasalo
    • 1
  • Timo A. Lakka
    • 1
    • 2
    • 3
  • David E. Laaksonen
    • 1
    • 4
  • Kai Savonen
    • 2
    • 3
  • Hanna-Maaria Lakka
    • 1
  • Maija Hassinen
    • 2
  • Pirjo Komulainen
    • 2
  • Tuomo Tompuri
    • 1
    • 3
  • Sudhir Kurl
    • 5
  • Jari A. Laukkanen
    • 5
  • Rainer Rauramaa
    • 2
    • 3
  1. 1.Department of Physiology, Institute of BiomedicineUniversity of Eastern FinlandKuopioFinland
  2. 2.Kuopio Research Institute of Exercise MedicineKuopioFinland
  3. 3.Department of Clinical Physiology and Nuclear MedicineKuopio University HospitalKuopioFinland
  4. 4.Institute of Clinical MedicineKuopio University HospitalKuopioFinland
  5. 5.Department of Public Health, Institute of Public Health and Clinical NutritionUniversity of Eastern FinlandKuopioFinland

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