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Development of a metabolic syndrome severity score and its association with incident diabetes in an Asian population—results from a longitudinal cohort in Singapore

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Abstract

Purpose

Metabolic syndrome (MetS) is a constellation of clinical factors that indicates elevated risk of diabetes. It is diagnosed based on three or more abnormalities in its components. This does not take into account that MetS can likely present as a continuum of risk. We aim to develop a MetS severity score and assess its association with incident diabetes.

Methods

In total, 4149 subjects without baseline diabetes participated in a community screening programme in 2013–2017. MetS was defined according to International Diabetes Federation criteria. A MetS severity z-score was derived from standardised loading coefficients of a confirmatory factor analysis for waist circumference, triglycerides, HDL-cholesterol, blood pressure and fasting plasma glucose (FPG). Multivariable cox proportional hazards regression model was used to assess the risk of diabetes by the score with adjustment for demographics and MetS components.

Results

Diabetes occurred in 130 subjects. Quintile 5 of the baseline MetS severity z-score was significantly associated with development of diabetes even in fully adjusted model with HR 2.63 (95% CI: 1.04–6.64; p = 0.040). The relationship between MetS and incident diabetes became attenuated and non-significant in fully adjusted model with HR 0.67 (95% CI: 0.34–1.29; p = 0.228). Mediation analysis showed that MetS severity z-score accounted 61.0% of the association between increasing body mass index and development of diabetes (p < 0.001).

Conclusions

The MetS severity z-score is an inexpensive and clinically-available continuous measure of MetS to identify individuals at high risk of diabetes.

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Acknowledgements

We would like to thank Colleagues from Population Health Department for making their kind assistance.

Author information

Author notes

  1. These authors contributed equally: Serena Low, Kay Chin Jonathon Khoo

Authors and Affiliations

  1. Diabetes Centre, Admiralty Medical Centre, Singapore, Singapore

    Serena Low, Chee Fang Sum, Tavintharan Subramaniam & Su Chi Lim

  2. Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore

    Serena Low, Kay Chin Jonathon Khoo, Jiexun Wang & Su Chi Lim

  3. Transformation Office, Hospital Administration, Khoo Teck Puat Hospital, Singapore, Singapore

    Bastari Irwan

  4. Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore

    Su Chi Lim

  5. Family and Community Medicine, Khoo Teck Puat Hospital, Singapore, Singapore

    Tack Keong Michael Wong

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  1. Serena Low
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  3. Jiexun Wang
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  4. Bastari Irwan
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Corresponding author

Correspondence to Su Chi Lim.

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Ethical approval

The National Healthcare Group Domain Specific Review Board in Singapore approved this study. Since it excluded all identifiable personal information, the Board waived the requirement for informed consent and ethical review of the study (DSRB reference 2017/00735, date 11.04.2017).

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The authors declare that they have no conflict of interest.

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Low, S., Khoo, K.C.J., Wang, J. et al. Development of a metabolic syndrome severity score and its association with incident diabetes in an Asian population—results from a longitudinal cohort in Singapore. Endocrine 65, 73–80 (2019). https://doi.org/10.1007/s12020-019-01970-5

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