Current Diabetes Reports

, Volume 10, Issue 3, pp 199–208 | Cite as

Metabolic Syndrome in Blacks: Are the Criteria Right?



Blacks have a lower prevalence of metabolic syndrome (MetS) that can be partly ascribed to the lower prevalent rates of some major components of MetS, namely the lower serum triglycerides and higher high-density lipoprotein cholesterol levels in blacks when compared with whites. Blacks manifest greater insulin resistance, the pivotal lesion underpinning MetS than whites. However, the relationships among insulin resistance and cardiovascular disease (CVD) risk factors are weaker in blacks than whites. The international bodies have recommended the use of European-based cutoff points for MetS for blacks. However, with the emerging inconsistencies in the association of insulin resistance and CVD risk factors in blacks, the use of these definitions and the cutoff points for MetS have become problematic. Therefore, it is important to review the limitations in the use of the current criteria and cutoff points of MetS in blacks to lessen the CVD risk burden in blacks.


Metabolic syndrome HDL cholesterol Triglycerides Insulin resistance Blood pressure and obesity Blacks 


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Gillum R, Mussolino M, Madans J: Diabetes mellitus, coronary heart disease incidence, and death from all cause in African American and European American women. The NHANES I Epidemiologic Follow-up Study. J Clin Epidemiol 2000, 53:511–518.CrossRefPubMedGoogle Scholar
  2. 2.
    •• Gu Q, Burt V, Paulose-Ram R, et al.: High blood pressure and cardiovascular disease mortality risk among U.S. adults: the third National Health and Nutrition Examination Survey mortality follow-up study. Ann Epidemiol 2008, 18:302–309. The study confirmed the racial and ethnic disparities on cardiovascular mortality attributed to blood pressure in the multiethnic populations of the United States.CrossRefPubMedGoogle Scholar
  3. 3.
    Tillin T, Foeouhi N, Johnson D, et al.: Metabolic syndrome and coronary heart disease in South Asians, African-Caribbeans and White Europeans: a UK population-based cross-sectional study. Diabetologia 2005, 48:649–656.CrossRefPubMedGoogle Scholar
  4. 4.
    Haffner SM, D’Agostino R Jr, Saad MF, et al.: Increased insulin resistance and insulin secretion in nondiabetic African-Americans and Hispanics compared with non-Hispanic whites. The Insulin Resistance Atherosclerosis Study. Diabetes 1996, 45:742–747.CrossRefPubMedGoogle Scholar
  5. 5.
    •. Kalk W, Joffe B: The metabolic syndrome, insulin resistance and its surrogates in African and White subjects with type 2 diabetes in South Africa. Metab Syndr Relat Disord 2008, 6:247–255. This study demonstrated differences in the markers of MetS and insulin resistance in native Africans and whites with type 2 diabetes in South Africans.CrossRefPubMedGoogle Scholar
  6. 6.
    Lteif A, Han K, Mather K: Obesity, Insulin resistance, and the metabolic syndrome: Determinants of endothelial dysfunction in whites and blacks. Circulation 2005, 112:32–38.CrossRefPubMedGoogle Scholar
  7. 7.
    Hutchinson RG, Watson RL, Davis CE, et al.: Racial differences in risk factors for atherosclerosis. The ARIC study: Atherosclerosis Risk in Communities. Angiology 197, 48:279–290Google Scholar
  8. 8.
    Tzou WS, Douglas PS, Srinivasan SR: Increased subclinical atherosclerosis in young adults with metabolic syndrome. The Bogalusa Heart Study. J. Am College of Cardiol 2005, 46:457–463CrossRefGoogle Scholar
  9. 9.
    Kalra L, Iveston E, Rambaran C, et al.: An international matched cohort study of the contribution of metabolic impairments to subclinical atherosclerosis in United Kingdom and Jamaican African-Caribbeans. Atherosclerosis 2008, 199:95–101.CrossRefPubMedGoogle Scholar
  10. 10.
    Strain W, Chaturvedi N, Nihoyannopoulos P, et al.: Differences in the association between type 2 diabetes and impaired microvascular function among Europeans and African Caribbeans. Diabetologia 2005, 48:2269–2277.CrossRefPubMedGoogle Scholar
  11. 11.
    Carnethon MR, Loria CM, Hill JO, et al.: Risk factors for the metabolic syndrome: the Coronary Artery Risk Development in Young Adults (CARDIA) study, 1985–2001. Diabetes Care 2004, 27:2707–2015.CrossRefPubMedGoogle Scholar
  12. 12.
    Osei K, Schuster DA: Effects of ethnicity and race on insulin sensitivity, ambulatory blood pressure and heart rates in three ethnic populations: comparative studies in African Americans, Ghanaian immigrants and white Americans. Am J Hypertension 1996, 9:1157–1164.CrossRefGoogle Scholar
  13. 13.
    Osei K, Schuster DA: Race and ethnicity determine serum insulin and c-peptide concentrations in insulin secretion and hepatic insulin extraction and insulin clearance: comparative studies of three populations of West African Ancestry Americans, and white Americans. Metabolism 1997, 46: 53–58.CrossRefPubMedGoogle Scholar
  14. 14.
    Meis SB, Schsuter D, Gaillard T, Osei K: Metabolic syndrome in non-diabetic, obese first degree relatives of African American patients with type 2 diabetes. African American triglycerides-HDL-C and insulin resistance paradox. Ethn Dis 2006, 16:830–836.PubMedGoogle Scholar
  15. 15.
    Gaillard T, Schuster D, Osei K: Differential impact of serum glucose, triglycerides and high-density lipoprotein cholesterol on cardiovascular risk factor burden in nondiabetic, obese African American women: implications for the prevalence of metabolic syndrome. Metabolism 2010 Jan 4 [Epub ahead of print].Google Scholar
  16. 16.
    •• Gaillard T, Schuster D, Osei K: Metabolic syndrome in Black people of the African diaspora: the paradox of current classification, definition and criteria. Ethn Dis 2009, 19(2 Suppl 2):S2–1-7. The article puts into perspective the disparities and paradoxes of insulin resistance and components of MetS in blacks and whites.PubMedGoogle Scholar
  17. 17.
    Burchfiel C, Skelton T, Andrew M, et al.: Metabolic syndrome and echocardiographic left ventricular mass in Blacks: the Atherosclerosis Risk in Communities (ARIC) Study. Circulation 2005, 112:819–827.CrossRefPubMedGoogle Scholar
  18. 18.
    St-Ong M, Jassen I, Heymsfield S: Metabolic syndrome in normal-weight Americans: new definition of the metabolically obese, normal-weight individual. Diabetes Care 2004, 27:2222–2228.CrossRefGoogle Scholar
  19. 19.
    Cowie CC, Howard BV, Harris MI: Serum lipoproteins in African Americans and whites with noninsulin-dependent diabetes in the U.S. population. Circulation 1991, 90:1185–1191.Google Scholar
  20. 20.
    The Diabetes Prevention Program: Lipid, lipoproteins, C-reactive protein, and hemostatic factors at baseline in the Diabetes Prevention Program. Diabetes Care 2005, 28:2472–2479.CrossRefGoogle Scholar
  21. 21.
    Li C, Ford E, Meng Y, et al.: Does the association of the triglyceride to high-density lipoprotein cholesterol ratio with fasting serum insulin differ by race/ethnicity? Cardiovasc Diabetol 2008, 7:4.CrossRefPubMedGoogle Scholar
  22. 22.
    Sumner A, Vega G, Genovese D, et al.: Normal triglyceride levels despite insulin resistance in African Americans: role of lipoprotein lipase. Metabolism 2005, 54:902–909.CrossRefPubMedGoogle Scholar
  23. 23.
    Sumner AE, Finley KB, Genovese DJ, et al.: Fasting triglycerides and the triglyceride-HDL-cholesterol ratio are not markers of insulin resistance in African Americans. Arch Intern Med 2005, 165:1395–1400.CrossRefPubMedGoogle Scholar
  24. 24.
    Zoratti R: A review on ethnic difference in plasma triglycerides and high density lipoprotein cholesterol: is the lipid pattern the key factor for the low coronary heart disease rates in people of African origins? Eur J Epidemiol 1998, 14:9–21.CrossRefPubMedGoogle Scholar
  25. 25.
    Gaillard T, Schuster D, Osei K: Independent role of blood pressure on cardiovascular risk factors in nondiabetic, obese African American women: Implications for metabolic syndrome thresholds. J Am Soc Hyper 2009, 3:25–34.CrossRefGoogle Scholar
  26. 26.
    Ford ES, Giles WH, Mokdad AH: Increasing prevalence of the metabolic syndrome among US adults. Diabetes Care 2004, 27:2444–2449.CrossRefPubMedGoogle Scholar
  27. 27.
    Park YW, Zhu S, Palaniappan L, et al.: The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Survey. 1988–1994. Arch Intern Med 2003, 24:427–362.CrossRefGoogle Scholar
  28. 28.
    Ford E, Giles W, Dietz W: Prevalence of the metabolic syndrome among US adults. Findings from the Third National Health and Nutrition Examination Survey. JAMA 2002, 287:356–359.CrossRefPubMedGoogle Scholar
  29. 29.
    Palaniappan L, Carnethon M, Wang Y, et al.: Predictors of the incident metabolic syndrome in adults. Diabetes Care 2004, 27:788–793.CrossRefPubMedGoogle Scholar
  30. 30.
    Zhu S, Heymsfield S, Toyoshima H, et al.: Race-ethnicity–specific waist circumference cutoffs for identifying cardiovascular disease risk factors. Am J Clin Nutr 2005, 81:409–415.PubMedGoogle Scholar
  31. 31.
    Jennings CI, Lambert EV, Collins M, et al.: The atypical presentation of the metabolic syndrome components in black African women: the relationship with insulin resistance and the influence of regional adipose tissue distribution. Metabolism 2009, 58:149–157.CrossRefPubMedGoogle Scholar
  32. 32.
    Njelekela M, Mpembeni R, Muhihi A, et al.: Gender-related differences in the prevalence of cardiovascular risk factors and their correlates in urban Tanzania. BMC Cardiovasc Disord 2009, 9:30.CrossRefPubMedGoogle Scholar
  33. 33.
    Garrido RA, Semeraro MB, Temesgen SM, Simi MR: Metabolic syndrome and obesity among workers at Kanye Seventh-Day Adventist Hospital, Botswana. S Afr Med J 2009, 99:331–334.PubMedGoogle Scholar
  34. 34.
    Fezeu L, Balkau B, Kenane A, et al.: Metabolic syndrome in a sub-Saharan African setting: central obesity may be the key determinant. Atherosclerosis 2007, 193:70–76.CrossRefPubMedGoogle Scholar
  35. 35.
    Taylor H, Liu J, Wilson G, et al.: Distinct component profiles and high risk among African American with the metabolic syndrome: the Jackson Heart Study. Diabetes Care 2008, 31:1248–1252.CrossRefPubMedGoogle Scholar
  36. 36.
    Kelliny C, Williams J, Riesen W, et al.: Metabolic syndrome according to different definitions in a rapidly developing country of the African region. Cardiovasc Diabetol 2008, 7:27.CrossRefPubMedGoogle Scholar
  37. 37.
    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) [no authors listed]. JAMA 2001, 285:2486–2497.Google Scholar
  38. 38.
    Alberti K, Zimmet P, Shaw J: Metabolic syndrome—a new world-wide definition. A consensus statement from the International Diabetes Federation. Diabet Med 2006, 23:469–480.CrossRefPubMedGoogle Scholar
  39. 39.
    Alberti KG, Zimmet PZ: Definition, diagnosis, and classification of diabetes mellitus and its complications: report of a WHO consultation. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998, 15:539–553.CrossRefPubMedGoogle Scholar
  40. 40.
    Agyemang C, Bhopal R: Is the blood pressure of people from African origin adults in the UK higher or lower than that in European origin white people? A review of cross-sectional data. J Hum Hypertens 2003, 17:523–534.CrossRefPubMedGoogle Scholar
  41. 41.
    Mokdad A, Bowman B, Ford E, et al.: The continuing epidemics of obesity and diabetes in the United States. JAMA 2001, 286:1195–1200.CrossRefPubMedGoogle Scholar
  42. 42.
    Amoah A: Sociodemographic variations in obesity among Ghanaian adults. Public Health Nutr 2003, 6:751–757.CrossRefPubMedGoogle Scholar
  43. 43.
    Sobngwi E, Effoe V, Boudou P, et al.: Waist circumference does not predict circulating adiponectin levels in sub-Saharan women. Cardiovasc Diabetol 2007, 6:31.CrossRefPubMedGoogle Scholar
  44. 44.
    Jennings CL, Lambert EV, Collins M, et al.: Determinants of insulin-resistant phenotypes in normal-weight and obese Black African women. Obesity (Silver Spring) 2008, 16:1602–1609.CrossRefGoogle Scholar
  45. 45.
    Crowther NJ, Ferris WF, Ojwang PPJ, Rheeder P: The effect of abdominal obesity on insulin sensitivity and serum lipid and cytokine concentrations in African women. Clin Endocrinol 2006, 64:535–541.CrossRefGoogle Scholar
  46. 46.
    Lovejoy JC, Bretonne JA, Klemperer M, Tulley R: Abdominal fat distribution and metabolic risk factors: effects of race. Metabolism 1996, 45:1119–1124.CrossRefPubMedGoogle Scholar
  47. 47.
    Albu J, Murphy L, Frager D, et al.: Visceral fat and race dependant health risks in obese nondiabetic premenopausal women. Diabetes 1997, 46:456–462.CrossRefPubMedGoogle Scholar
  48. 48.
    Ntyintyane LM, Panz VR, Rall FJ, Gill GV: Postprandial lipaemia, metabolic syndrome and LDL particle size in urbanized South African blacks with and without coronary artery disease. Q J Med 208, 101:111–119Google Scholar
  49. 49.
    Haffner SM, D’Agistino RA, Goff D, et al.: LDL size in African Americans, Hispanics and non-Hispanic Whites: the Insulin Resistance Atherosclerosis Study. Arterioscler Thromb Vasc Biol 1999, 39:2234–2240.Google Scholar
  50. 50.
    Howard G, O’Leary D, Zaccaro D, et al.: Insulin sensitivity and atherosclerosis. The Insulin Resistance Atherosclerosis Study (IRAS) Investigators. Circulation 1996, 93:1809–1817.PubMedGoogle Scholar
  51. 51.
    McNeill A, Rosemond W, Girman C, et al.: The metabolic syndrome and 11-year risk of incident cardiovascular disease in the Atherosclerosis Risk in Communities Study. Diabetes Care 2005, 28:385–390.CrossRefPubMedGoogle Scholar
  52. 52.
    Davis T, Cull C, Holman R, et al.: Relationship between ethnicity and glycemic control, lipid profiles, and blood pressure during the first 9 years of type 2 diabetes. Diabetes Care 2001, 24:1167–1174.CrossRefPubMedGoogle Scholar
  53. 53.
    Amoah AG, Owusu SK, Schuster DP, et al.: Insulin resistance, beta cell function and cardiovascular risk in Ghanaians with varying degrees of glucose tolerance. Ethn Dis 2002, 12:S3–S10.PubMedGoogle Scholar
  54. 54.
    Bakari A, Onyemelukwe GC: Insulin resistance in type 2 diabetic Nigerians. Int J Diabetes Metab 2005, 13:24–27.Google Scholar
  55. 55.
    Kern PA, Saghisadeh M, Ong JM, et al.: The expression of tumor necrosis in human adipose tissue regulation by obesity, weight loss and relationship to lipoprotein lipase. J Clin Invest 1995, 93:211–2119.Google Scholar
  56. 56.
    Ferris WF, Naran NH, Crowther NJ, et al.: The relationship between insulin sensitivity and serum adiponectin levels in three population groups. Horm Metab Res 2005, 11:695–701.CrossRefGoogle Scholar
  57. 57.
    Hulver MW, Saleh O, MacDonald KG, et al.: Ethnic differences in adiponectin levels. Metabolism 2004, 53:1–5.CrossRefPubMedGoogle Scholar
  58. 58.
    Duncan BB, Schmidt MI, Pankow JS, et al.: Adiponectin and the development of type 2 diabetes. The Atherosclerosis Risk in Communities Study. Diabetes 2004, 53:2473–2478CrossRefPubMedGoogle Scholar
  59. 59.
    Osei K, Scott R, Gaillard T, Schuster D: Plasma adiponectin in first degree relatives of African Americans parents with type 2 diabetes with normal glucose tolerance, impaired glucose tolerance and type 2 diabetes Obes Res 2005, 13:179–185CrossRefPubMedGoogle Scholar
  60. 60.
    Kruger HS, Venter CS, Vorster HH: Obesity in African women in the North West Province, South African is associated with increased risk of non-communicable diseases: the THUSA study. Transition and Health during Urbanisation of South Africans. Br J Nutr 2001, 86:733–740.CrossRefPubMedGoogle Scholar

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© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Division, Endocrinology, Diabetes and MetabolismThe Ohio State University Medical Center,ColumbusUSA

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