, Volume 60, Issue 7, pp 1261–1270 | Cite as

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

  • Matthew J. Gurka
  • Sherita H. Golden
  • Solomon K. Musani
  • Mario Sims
  • Abhishek Vishnu
  • Yi Guo
  • Michelle Cardel
  • Thomas A. Pearson
  • Mark D. DeBoer



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.


Insulin resistance Metabolic syndrome Risk Type 2 diabetes mellitus 



Akaike’s information criterion


Atherosclerosis Risk in Communities Study


Adult Treatment Panel III


ATP-III metabolic syndrome criteria


Cardiovascular disease


Jackson Heart Study


Receiver operating characteristic


Waist circumference



The authors thank the staff and participants of the ARIC study and JHS for their important contributions.

Data availability

These data are available through ancillary studies with the Atherosclerosis Risk in Communities Study (https://www2.cscc.unc.edu/aric/) and the Jackson Heart Study (https://www.jacksonheartstudy.org/).


This work was supported by NIH grants 1R01HL120960 (MJG and MDD). The JHS is supported by contracts HHSN268201300046C, HHSN268201300047C, HHSN268201300048C, HHSN268201300049C and HHSN268201300050C from the National Heart, Lung, and Blood Institute and the National Institute on Minority Health and Health Disparities. The ARIC Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C and HHSN268201100012C).

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Contribution statement

MJG participated in the design, analysis, interpretation and write-up of the research. SHG and MC participated in the interpretation of the research and editing of the manuscript. SKM and MS participated in the design and interpretation of the research, and editing of the manuscript. AV, YG and TAP participated in the design, analysis and interpretation of the research, and editing of the manuscript. MDD participated in the design and analysis, was responsible for the write-up and had primary responsibility for the final content. All authors gave final approval of the version to be published.

Supplementary material

125_2017_4267_MOESM1_ESM.pdf (448 kb)
ESM (PDF 447 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Matthew J. Gurka
    • 1
  • Sherita H. Golden
    • 2
    • 3
  • Solomon K. Musani
    • 4
  • Mario Sims
    • 4
  • Abhishek Vishnu
    • 1
    • 5
  • Yi Guo
    • 1
  • Michelle Cardel
    • 1
  • Thomas A. Pearson
    • 6
  • Mark D. DeBoer
    • 7
  1. 1.Department of Health Outcomes and Policy, College of MedicineUniversity of FloridaGainesvilleUSA
  2. 2.Department of MedicineJohns Hopkins UniversityBaltimoreUSA
  3. 3.Department of EpidemiologyJohns Hopkins UniversityBaltimoreUSA
  4. 4.Department of Medicine, Jackson Heart StudyUniversity of Mississippi Medical CenterJacksonUSA
  5. 5.Icahn School of Medicine at Mount SinaiNew YorkUSA
  6. 6.Department of Epidemiology, College of MedicineUniversity of FloridaGainesvilleUSA
  7. 7.Department of Pediatrics, Division of Pediatric EndocrinologyUniversity of VirginiaCharlottesvilleUSA

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