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Cardiovascular Drugs and Therapy

, Volume 29, Issue 4, pp 329–338 | Cite as

Metabolic Syndrome: Does it Differ Between Women and Men?

  • Yogita RochlaniEmail author
  • Naga Venkata Pothineni
  • Jawahar L. Mehta
ORIGINAL ARTICLE

Abstract

Cardiovascular disease represents a massive healthcare burden worldwide. Gender differences in the pathophysiology, presentation and prognosis of cardiovascular disease have been described in the literature. Metabolic syndrome, characterized by a cluster of metabolic abnormalities is associated with increased risk for type 2 diabetes mellitus and atherosclerotic cardiovascular disease. With the global obesity epidemic, the prevalence of metabolic syndrome is rising rapidly in the developed as well as developing world. However, there is considerable variation in the prevalence based on geography, age, sex and, definition used for diagnosis. Data on gender related differences in metabolic syndrome is relatively scarce. Here, we aim to review the gender differences in epidemiology and pathophysiology of metabolic syndrome as well as its individual components. Knowledge of gender differences in metabolic syndrome can help design gender specific preventative and therapeutic strategies that will have a positive impact on overall population health.

Keywords

Metabolic syndrome Gender differences Sex differences Cardiovascular disease Hypertension Dyslipidemia Insulin resistance Obesity Pathophysiology of metabolic syndrome Role of hormones in metabolic syndrome 

References

  1. 1.
    Grundy SM, Hansen B, Smith Jr SC, Cleeman JI, Kahn RA, American Heart Association, National Heart, Lung, and Blood Institute, American Diabetes Association. Clinical management of metabolic syndrome: report of the American heart association/national heart, lung, and blood institute/American diabetes association conference on scientific issues related to management. Arterioscler Thromb Vasc Biol. 2004;24(2):e19–24.CrossRefPubMedGoogle Scholar
  2. 2.
    Grundy SM. Metabolic syndrome pandemic. Arterioscler Thromb Vasc Biol. 2008;28(4):629–36.CrossRefPubMedGoogle Scholar
  3. 3.
    Wenger NK. Women and coronary heart disease: a century after herrick: understudied, underdiagnosed, and undertreated. Circulation. 2012;126(5):604–11.CrossRefPubMedGoogle Scholar
  4. 4.
    Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes. 1988;37(12):1595–607.CrossRefPubMedGoogle Scholar
  5. 5.
    DeFronzo RA, Ferrannini E. Insulin resistance. A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care. 1991;14(3):173–94.CrossRefPubMedGoogle Scholar
  6. 6.
    Lemieux I, Pascot A, Couillard C, Lamarche B, Tchernof A, Almeras N, et al. Hypertriglyceridemic waist: a marker of the atherogenic metabolic triad (hyperinsulinemia; hyperapolipoprotein B; small, dense LDL) in men? Circulation. 2000;102(2):179–84.CrossRefPubMedGoogle Scholar
  7. 7.
    Kaplan NM. The deadly quartet. Upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension. Arch Intern Med. 1989;149(7):1514–20.CrossRefPubMedGoogle Scholar
  8. 8.
    Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care. 2001;24(4):683–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15(7):539–53.CrossRefPubMedGoogle Scholar
  10. 10.
    Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA. 2001;285(19):2486–97.CrossRefGoogle Scholar
  11. 11.
    Alberti KG, Zimmet P, Shaw J. Metabolic syndrome—a new world-wide definition. A consensus statement from the international diabetes federation. Diabet Med. 2006;23(5):469–80.CrossRefPubMedGoogle Scholar
  12. 12.
    Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American heart association/national heart, lung, and blood institute scientific statement. Circulation. 2005;112(17):2735–52.CrossRefPubMedGoogle Scholar
  13. 13.
    Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; National heart, Lung, and blood institute; American heart association; World heart federation; International atherosclerosis society; and International association for the study of obesity. Circulation. 2009;120(16):1640–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Lin CC, Liu CS, Li CI, Lin WY, Lai MM, Lin T, et al. The relation of metabolic syndrome according to five definitions to cardiovascular risk factors—a population-based study. BMC Public Health. 2009;9:484.PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Ervin RB. Prevalence of metabolic syndrome among adults 20 years of age and over, by sex, age, race and ethnicity, and body mass index: United states, 2003–2006. Natl Health Stat Rep. 2009;13:1–7.Google Scholar
  16. 16.
    Meigs JB, Wilson PW, Nathan DM, D’Agostino RBS, Williams K, Haffner SM. Prevalence and characteristics of the metabolic syndrome in the San Antonio heart and Framingham offspring studies. Diabetes. 2003;52(8):2160–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Mozumdar A, Liguori G. Persistent increase of prevalence of metabolic syndrome among U.S. adults: NHANES III to NHANES 1999–2006. Diabetes Care. 2011;34(1):216–9.PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Miller JM, Kaylor MB, Johannsson M, Bay C, Churilla JR. Prevalence of metabolic syndrome and individual criterion in US adolescents: 2001–2010 national health and nutrition examination survey. Metab Syndr Relat Disord. 2014;12(10):527–32.CrossRefPubMedGoogle Scholar
  19. 19.
    Loucks EB, Rehkopf DH, Thurston RC, Kawachi I. Socioeconomic disparities in metabolic syndrome differ by gender: evidence from NHANES III. Ann Epidemiol. 2007;17(1):19–26.CrossRefPubMedGoogle Scholar
  20. 20.
    Cherry CO, Serieux E, Didier M, Nuttal ME, Schuster RJ. Prevalence of risk factors for the metabolic syndrome in the middle income Caribbean nation of St. Lucia. Adv Prev Med. 2014;2014:501972.PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Ishii S, Tanaka T, Akishita M, Ouchi Y, Tuji T, Iijima K, et al. Metabolic syndrome, Sarcopenia and role of sex and age: cross-sectional analysis of Kashiwa cohort study. PLoS One. 2014;9(11), e112718.PubMedCentralCrossRefPubMedGoogle Scholar
  22. 22.
    Sobko T, Trindade D, Lao QX, Wong M, Io TK, Wa CK, et al. Men in Macau SAR have higher prevalence in metabolic syndrome and among related metabolic components: a cross-sectional Macau health survey. BMC Public Health. 2014;14:1065.PubMedCentralCrossRefPubMedGoogle Scholar
  23. 23.
    Yu S, Guo X, Yang H, Zheng L, Sun Y. An update on the prevalence of metabolic syndrome and its associated factors in rural northeast China. BMC Public Health. 2014;14:877, 2458-14-877.Google Scholar
  24. 24.
    Xi B, He D, Hu Y, Zhou D. Prevalence of metabolic syndrome and its influencing factors among the Chinese adults: the china health and nutrition survey in 2009. Prev Med. 2013;57(6):867–71.PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    Mabry RM, Reeves MM, Eakin EG, Owen N. Gender differences in prevalence of the metabolic syndrome in gulf cooperation council countries: a systematic review. Diabet Med. 2010;27(5):593–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Erem C, Hacihasanoglu A, Deger O, Topbas M, Hosver I, Ersoz HO, et al. Prevalence of metabolic syndrome and associated risk factors among Turkish adults: Trabzon MetS study. Endocrine. 2008;33(1):9–20.CrossRefPubMedGoogle Scholar
  27. 27.
    Athyros VG, Bouloukos VI, Pehlivanidis AN, Papageorgiou AA, Dionysopoulou SG, Symeonidis AN, et al. The prevalence of the metabolic syndrome in Greece: the MetS-Greece multicentre study. Diabetes Obes Metab. 2005;7(4):397–405.CrossRefPubMedGoogle Scholar
  28. 28.
    Balkau B, Charles MA, Drivsholm T, Borch-Johnsen K, Wareham N, Yudkin JS, et al. Frequency of the WHO metabolic syndrome in European cohorts, and an alternative definition of an insulin resistance syndrome. Diabetes Metab. 2002;28(5):364–76.PubMedGoogle Scholar
  29. 29.
    Dallongeville J, Cottel D, Arveiler D, Tauber JP, Bingham A, Wagner A, et al. The association of metabolic disorders with the metabolic syndrome is different in men and women. Ann Nutr Metab. 2004;48(1):43–50.CrossRefPubMedGoogle Scholar
  30. 30.
    Levine DA, Lewis CE, Williams OD, Safford MM, Liu K, Calhoun DA, et al. Geographic and demographic variability in 20-year hypertension incidence: the CARDIA study. Hypertension. 2011;57(1):39–47.PubMedCentralCrossRefPubMedGoogle Scholar
  31. 31.
    Ong KL, Tso AW, Lam KS, Cheung BM. Gender difference in blood pressure control and cardiovascular risk factors in Americans with diagnosed hypertension. Hypertension. 2008;51(4):1142–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Denton KM, Hilliard LM, Tare M. Sex-related differences in hypertension: seek and ye shall find. Hypertension. 2013;62(4):674–7.CrossRefPubMedGoogle Scholar
  33. 33.
    Rossi P, Frances Y, Kingwell BA, Ahimastos AA. Gender differences in artery wall biomechanical properties throughout life. J Hypertens. 2011;29(6):1023–33.CrossRefPubMedGoogle Scholar
  34. 34.
    Hilliard LM, Mirabito KM, Denton KM. Unmasking the potential of the angiotensin AT2 receptor as a therapeutic target in hypertension in men and women: what we know and what we still need to find out. Clin Exp Pharmacol Physiol. 2013;40(8):542–50.CrossRefPubMedGoogle Scholar
  35. 35.
    Harris MI, Eastman RC, Cowie CC, Flegal KM, Eberhardt MS. Comparison of diabetes diagnostic categories in the U.S. population according to the 1997 american diabetes association and 1980–1985 world health organization diagnostic criteria. Diabetes Care. 1997;20(12):1859–62.CrossRefPubMedGoogle Scholar
  36. 36.
    Glucose tolerance and mortality: comparison of WHO and American diabetes association diagnostic criteria. The DECODE study group. European diabetes epidemiology group. Diabetes epidemiology: Collaborative analysis of diagnostic criteria in Europe. Lancet. 1999;354(9179):617–21.Google Scholar
  37. 37.
    Unwin N, Shaw J, Zimmet P, Alberti KG. Impaired glucose tolerance and impaired fasting Glycaemia: the current status on definition and intervention. Diabet Med. 2002;19(9):708–23.CrossRefPubMedGoogle Scholar
  38. 38.
    Varlamov O, Bethea CL, Roberts Jr CT. Sex-specific differences in lipid and glucose metabolism. Front Endocrinol (Lausanne). 2015;5:241.Google Scholar
  39. 39.
    Aldhoon-Hainerova I, Zamrazilova H, Dusatkova L, Sedlackova B, Hlavaty P, Hill M, et al. Glucose homeostasis and insulin resistance: prevalence, gender differences and predictors in adolescents. Diabetol Metab Syndr. 2014;6(1):100. eCollection 2014.PubMedCentralCrossRefPubMedGoogle Scholar
  40. 40.
    Barrett-Connor E, Ferrara A. Isolated postchallenge hyperglycemia and the risk of fatal cardiovascular disease in older women and men. The Rancho Bernardo study. Diabetes Care. 1998;21(8):1236–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Goff Jr DC, Bertoni AG, Kramer H, Bonds D, Blumenthal RS, Tsai MY, et al. Dyslipidemia prevalence, treatment, and control in the Multi-Ethnic Study of Atherosclerosis (MESA): gender, ethnicity, and coronary artery calcium. Circulation. 2006;113(5):647–56.CrossRefPubMedGoogle Scholar
  42. 42.
    Johnson JL, Slentz CA, Duscha BD, Samsa GP, McCartney JS, Houmard JA, et al. Gender and racial differences in lipoprotein subclass distributions: the STRRIDE study. Atherosclerosis. 2004;176(2):371–7.CrossRefPubMedGoogle Scholar
  43. 43.
    Bittner V. Perspectives on dyslipidemia and coronary heart disease in women. J Am Coll Cardiol. 2005;46(9):1628–35.CrossRefPubMedGoogle Scholar
  44. 44.
    Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2014;384(9945):766–81.CrossRefPubMedGoogle Scholar
  45. 45.
    Beydoun MA, Wang Y. Gender-ethnic disparity in BMI and waist circumference distribution shifts in US adults. Obesity (Silver Spring). 2009;17(1):169–76.CrossRefGoogle Scholar
  46. 46.
    Garawi F, Devries K, Thorogood N, Uauy R. Global differences between women and men in the prevalence of obesity: is there an association with gender inequality? Eur J Clin Nutr. 2014;68(10):1101–6.CrossRefPubMedGoogle Scholar
  47. 47.
    Kahn HS, Bullard KM, Barker LE, Imperatore G. Differences between adiposity indicators for predicting all-cause mortality in a representative sample of United States non-elderly adults. PLoS One. 2012;7(11), e50428.PubMedCentralCrossRefPubMedGoogle Scholar
  48. 48.
    Pradhan AD. Sex differences in the metabolic syndrome: implications for cardiovascular health in women. Clin Chem. 2014;60(1):44–52.CrossRefPubMedGoogle Scholar
  49. 49.
    Meyer MR, Clegg DJ, Prossnitz ER, Barton M. Obesity, insulin resistance and diabetes: sex differences and role of oestrogen receptors. Acta Physiol (Oxf). 2011;203(1):259–69.CrossRefGoogle Scholar
  50. 50.
    Brand JS, van der Tweel I, Grobbee DE, Emmelot-Vonk MH, van der Schouw YT. Testosterone, sex hormone-binding globulin and the metabolic syndrome: a systematic review and meta-analysis of observational studies. Int J Epidemiol. 2011;40(1):189–207.CrossRefPubMedGoogle Scholar
  51. 51.
    Bhasin S, Jasjua GK, Pencina M, D’Agostino RS, Coviello AD, Vasan RS, et al. Sex hormone-binding globulin, but not testosterone, is associated prospectively and independently with incident metabolic syndrome in men: the Framingham heart study. Diabetes Care. 2011;34(11):2464–70.PubMedCentralCrossRefPubMedGoogle Scholar
  52. 52.
    Janssen I, Powell LH, Crawford S, Lasley B, Sutton-Tyrrell K. Menopause and the metabolic syndrome: the study of women’s health across the nation. Arch Intern Med. 2008;168(14):1568–75.PubMedCentralCrossRefPubMedGoogle Scholar
  53. 53.
    Kupelian V, Hayes FJ, Link CL, Rosen R, McKinlay JB. Inverse association of testosterone and the metabolic syndrome in men is consistent across race and ethnic groups. J Clin Endocrinol Metab. 2008;93(9):3403–10.PubMedCentralCrossRefPubMedGoogle Scholar
  54. 54.
    Duskova M, Pospisilova H. The role of non-aromatizable testosterone metabolite in metabolic pathways. Physiol Res. 2011;60(2):253–61.PubMedGoogle Scholar
  55. 55.
    Bjorntorp P. The origins and consequences of obesity. Diab Ciba Found Sym. 1996;201:68–80. discussion 80–9, 188–93.Google Scholar
  56. 56.
    Kalyani RR, Franco M, Dobs AS, Ouyang P, Vaidya D, Bertoni A, et al. The association of endogenous sex hormones, adiposity, and insulin resistance with incident diabetes in postmenopausal women. J Clin Endocrinol Metab. 2009;94(11):4127–35.PubMedCentralCrossRefPubMedGoogle Scholar
  57. 57.
    Laaksonen DE, Niskanen L, Punnonen K, Nyyssonen K, Tuomainen TP, Valkonen VP, et al. Testosterone and sex hormone-binding globulin predict the metabolic syndrome and diabetes in middle-aged men. Diabetes Care. 2004;27(5):1036–41.CrossRefPubMedGoogle Scholar
  58. 58.
    Li C, Ford ES, Li B, Giles WH, Liu S. Association of testosterone and sex hormone-binding globulin with metabolic syndrome and insulin resistance in men. Diabetes Care. 2010;33(7):1618–24.PubMedCentralCrossRefPubMedGoogle Scholar
  59. 59.
    Ding EL, Song Y, Malik VS, Liu S. Sex differences of endogenous sex hormones and risk of type 2 diabetes: a systematic review and meta-analysis. JAMA. 2006;295(11):1288–99.CrossRefPubMedGoogle Scholar
  60. 60.
    Vikan T, Schirmer H, Njolstad I, Svartberg J. Low testosterone and sex hormone-binding globulin levels and high estradiol levels are independent predictors of type 2 diabetes in men. Eur J Endocrinol. 2010;162(4):747–54.CrossRefPubMedGoogle Scholar
  61. 61.
    Ding EL, Song Y, Manson JE, Hunter DJ, Lee CC, Rifai N, Buring JE, Gaziano JM, Liu S. Sex Hormone–Binding globulin and risk of type 2 diabetes in women and men. N Engl J Med. 2009; 2015/02;361(12):1152–63.Google Scholar
  62. 62.
    Haring R, Volzke H, Spielhagen C, Nauck M, Wallaschofski H. The role of sex hormone-binding globulin and testosterone in the risk of incident metabolic syndrome. Eur J Prev Cardiol. 2013;20(6):1061–8.CrossRefPubMedGoogle Scholar
  63. 63.
    Daka B, Rosen T, Jansson PA, Larsson CA, Rastam L, Lindblad U. Low sex hormone-binding globulin is associated with hypertension: a cross-sectional study in a Swedish population. BMC Cardiovasc Disord. 2013;13:30.PubMedCentralCrossRefPubMedGoogle Scholar
  64. 64.
    Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the women’s health initiative randomized controlled trial. JAMA. 2002;288(3):321–33.CrossRefPubMedGoogle Scholar
  65. 65.
    Velez LM, Motta AB. Association between polycystic ovary syndrome and metabolic syndrome. Curr Med Chem. 2014;21(35):3999–4012.CrossRefPubMedGoogle Scholar
  66. 66.
    Apridonidze T, Essah PA, Iuorno MJ, Nestler JE. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2005;90(4):1929–35.CrossRefPubMedGoogle Scholar
  67. 67.
    Hillman JK, Johnson LN, Limaye M, Feldman RA, Sammel M, Dokras A. Black women with Polycystic Ovary Syndrome (PCOS) have increased risk for metabolic syndrome and cardiovascular disease compared with white women with PCOS [corrected]. Fertil Steril. 2014;101(2):530–5.CrossRefPubMedGoogle Scholar
  68. 68.
    Essah PA, Nestler JE. The metabolic syndrome in polycystic ovary syndrome. J Endocrinol Investig. 2006;29(3):270–80.CrossRefGoogle Scholar
  69. 69.
    Mottillo S, Filion KB, Genest J, Joseph L, Pilote L, Poirier P, et al. The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis. J Am Coll Cardiol. 2010;56(14):1113–32.CrossRefPubMedGoogle Scholar
  70. 70.
    Ford ES. Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. Diabetes Care. 2005;28(7):1769–78.CrossRefPubMedGoogle Scholar
  71. 71.
    Kuk JL, Ardern CI. Age and sex differences in the clustering of metabolic syndrome factors: association with mortality risk. Diabetes Care. 2010;33(11):2457–61.PubMedCentralCrossRefPubMedGoogle Scholar
  72. 72.
    Guize L, Thomas F, Pannier B, Bean K, Jego B, Benetos A. All-cause mortality associated with specific combinations of the metabolic syndrome according to recent definitions. Diabetes Care. 2007;30(9):2381–7.CrossRefPubMedGoogle Scholar
  73. 73.
    Hari P, Nerusu K, Veeranna V, Sudhakar R, Zalawadiya S, Ramesh K, et al. A gender-stratified comparative analysis of various definitions of metabolic syndrome and cardiovascular risk in a multiethnic U.S. population. Metab Syndr Relat Disord. 2012;10(1):47–55.PubMedCentralCrossRefPubMedGoogle Scholar
  74. 74.
    Beltrán-Sánchez H, Harhay MO, Harhay MM, McElligott S. Prevalence and trends of metabolic syndrome in the adult U.S. population, 1999–2010. J Am Coll Cardiol. 2013;62(8):697–703.PubMedCentralCrossRefPubMedGoogle Scholar
  75. 75.
    Riediger ND, Clara I. Prevalence of metabolic syndrome in the Canadian adult population. CMAJ. 2011;183(15):E1127–34.PubMedCentralCrossRefPubMedGoogle Scholar
  76. 76.
    Heiss G, Snyder ML, Teng Y, Schneiderman N, Llabre MM, Cowie C, et al. Prevalence of metabolic syndrome among Hispanics/Latinos of diverse background: the Hispanic community health study/study of Latinos. Diabetes Care. 2014;37(8):2391–9.PubMedCentralCrossRefPubMedGoogle Scholar
  77. 77.
    Scuteri A, Najjar SS, Morrell CH, Lakatta EG, Cardiovascular Health Study. The metabolic syndrome in older individuals: prevalence and prediction of cardiovascular events: the cardiovascular health study. Diabetes Care. 2005;28(4):882–7.CrossRefPubMedGoogle Scholar
  78. 78.
    Ford ES, Li C, Zhao G. Prevalence and correlates of metabolic syndrome based on a harmonious definition among adults in the US. J Diabetes. 2010;2(3):180–93.CrossRefPubMedGoogle Scholar
  79. 79.
    Yang JJ, Yoon HS, Lee SA, Choi JY, Song M, Han S, et al. Metabolic syndrome and sex-specific socio-economic disparities in childhood and adulthood: the Korea national health and nutrition examination surveys. Diabet Med. 2014;31(11):1399–409.CrossRefPubMedGoogle Scholar
  80. 80.
    Podang J, Sritara P, Narksawat K. Prevalence and factors associated with metabolic syndrome among a group of Thai working population: a cross sectional study. J Med Assoc Thai. 2013;96 Suppl 5:S33–41.PubMedGoogle Scholar
  81. 81.
    Deepa M, Farooq S, Datta M, Deepa R, Mohan V. Prevalence of metabolic syndrome using WHO, ATPIII and IDF definitions in Asian Indians: the Chennai urban rural epidemiology study (CURES-34). Diabetes Metab Res Rev. 2007;23(2):127–34.CrossRefPubMedGoogle Scholar
  82. 82.
    Deedwania PC, Gupta R, Sharma KK, Achari V, Gupta B, Maheshwari A, et al. High prevalence of metabolic syndrome among urban subjects in India: a multisite study. Diabetes Metab Syndr. 2014;8(3):156–61.CrossRefPubMedGoogle Scholar
  83. 83.
    El Brini O, Akhouayri O, Gamal A, Mesfioui A, Benazzouz B. Prevalence of metabolic syndrome and its components based on a harmonious definition among adults in Morocco. Diabetes Metab Syndr Obes. 2014;7:341–6.PubMedCentralPubMedGoogle Scholar
  84. 84.
    Malik M, Razig SA. The prevalence of the metabolic syndrome among the multiethnic population of the United Arab Emirates: a report of a national survey. Metab Syndr Relat Disord. 2008;6(3):177–86.CrossRefPubMedGoogle Scholar
  85. 85.
    Al-Daghri NM, Alkharfy KM, Al-Attas OS, Khan N, Alfawaz HA, Alghanim SA, et al. Gender-dependent associations between socioeconomic status and metabolic syndrome: a cross-sectional study in the adult Saudi population. BMC Cardiovasc Disord. 2014;14:51.PubMedCentralCrossRefPubMedGoogle Scholar
  86. 86.
    Vernay M, Salanave B, de Peretti C, Druet C, Malon A, Deschamps V, et al. Metabolic syndrome and socioeconomic status in France: the French nutrition and health survey (ENNS, 2006–2007). Int J Public Health. 2013;58(6):855–64.CrossRefPubMedGoogle Scholar
  87. 87.
    Maggi S, Noale M, Gallina P, Bianchi D, Marzari C, Limongi F, et al. Metabolic syndrome, diabetes, and cardiovascular disease in an elderly Caucasian cohort: the Italian longitudinal study on aging. J Gerontol A Biol Sci Med Sci. 2006;61(5):505–10.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Yogita Rochlani
    • 1
    Email author
  • Naga Venkata Pothineni
    • 2
  • Jawahar L. Mehta
    • 2
  1. 1.Department of Internal MedicineUniversity of Arkansas for Medical SciencesLittle RockUSA
  2. 2.Division of Cardiovascular MedicineUniversity of Arkansas for Medical SciencesLittle RockUSA

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