Diabetes & Metabolic Syndrome: Clinical Research & Reviews 9 (2015) 153–156

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Diabetes & Metabolic Syndrome: Clinical Research &

Reviews
journal homepage: www.elsevier.com/locate/dsx

Original Article

Prevalence of metabolic syndrome in adult population in Shiraz,

southern Iran
Amir Hossein Tabatabaie a,*, Mojtaba Shafiekhani b, Ali Asghar Nasihatkon a,
Iman Hafizi Rastani a, Mojgan Tabatabaie a, Ali Reza Borzoo a, Fatemeh Hojat a
a
Department of Family Medicine, Fars Petroleum Industry Health Organization, Shiraz, Iran
b
Department of Pharmacotherapy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran

A R T I C L E I N F O A B S T R A C T

Keywords: Aim: Metabolic syndrome (MSx) is associated with increased risk of cardiovascular diseases and type 2
Metabolic syndrome diabetes mellitus. This study evaluated the prevalence of MSx in adult population in Shiraz, southern
Obesity Iran.
Diabetes mellitus Methods: In a cross-sectional study conducted between October 2012 and April 2013, using a simple
random sampling method, 377 adults aged more than 20 years who were invited for periodic health
examinations to Petroleum Industry Health Organization Polyclinic, a general health care center, Shiraz,
southern Iran, were studied. The revised National Cholesterol Education Program–Adult Treatment Panel
III was used for the diagnosis of MSx.
Results: The participants included 190 women and 187 men with a mean  SD age of 43.8  11.0 (range:
20–86) years. Of 377 participants, 101 (26.8%, 95% CI: 22.3–31.3%) had MSx. The prevalence in men (16.6%)
was significantly (p < 0.001) lower than that in women (36.8%). The prevalence increased by almost 15% with
each decade of life (p < 0.001).
Conclusion: The prevalence of MSx in our population, particularly in women, is high. Strategies should be
planned to prevent the increasing prevalence of MSx in our country.
ß 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.

1. Introduction
Metabolic syndrome (MSx) is a cluster of various independent
cardiovascular risk factors that increase the risk of premature
death in people [1–3]. It is a conglomeration of glucose intolerance,
obesity, dyslipidemia, and hypertension. MSx is defined by
different organizations including World Health Organization
(WHO), International Diabetes Federation (IDF), and National
Cholesterol Education Program–Adult Treatment Panel III (NCEP-
ATPIII). However, the variables considered by all these organiza-
tions for the diagnosis of MSx are blood pressure, plasma
triglyceride (TG), high-density lipoprotein cholesterol (HDL-C),
plasma glucose, and waist circumference [4].
Industrialization, taking high-calorie food, low physical activi-
ty, and adopting a sedentary lifestyle in many developing countries
over the past three decades have resulted in increased incidence of
MSx and consequent ischemic heart disease among the population
of these countries and made the MSx one of the most important
non-communicable diseases, imposing a large burden on the
health care sector of the government [5].
According to the previous studies, the prevalence of MSx in
adults in the USA, Korea, and Iran is about 25% [6–8]. Ethnicity is
one of the important factors affecting the prevalence of MSx. The
prevalence was 23.7% (23.1% in men and 24.4% in women) in
western Iran [7]. In a study conducted in northern Iran, the
prevalence of MSx was 42.3% (36.5% in men and 47.1% in women)
[9]. Considering the observed large variance in the reported results,
we therefore conducted this study to better evaluate the current
situation of MSx in Shiraz, one of the largest cities in southern Iran.
2. Materials and methods
2.1. Setting

* Corresponding author. Tel.: +98 917 185 5545; fax: +98 71 3225 0357. The Petroleum Industry Health Organization (PIHO) Polyclinic,
E-mail address: amirhosseintbtb@gmail.com (A.H. Tabatabaie). where the study was conducted, sees about 400 patients a day. The

http://dx.doi.org/10.1016/j.dsx.2015.04.012
1871-4021/ß 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.
154 A.H. Tabatabaie et al. / Diabetes & Metabolic Syndrome: Clinical Research & Reviews 9 (2015) 153–156

patients are employees of Petroleum Industry and their family variables with normal distribution were presented as mean  SD;
members and receive health care services free of charge according non-normal variables were reported as median (interquartile range
to the PIHO health insurance policy. They therefore range in age [IQR]). Means of two continuous normally distributed variables were
from children to old people. Almost 20,000 of these people are aged compared by independent samples Student’s t test. Mann–Whitney U
more than 20 years. Around 70–80% of the attendees are from test and Kruskal–Wallis test were used respectively to compare
urban areas; the remaining patients come from suburban/rural means of two and three or more groups of variables not normally
regions. distributed. The frequencies of categorical variables were compared
using Pearson x2 or Fisher’s exact test, when appropriate. Linear
2.2. Sampling regression analysis with the prevalence of MSx as dependent variable
and age as the independent variable was used to determine the trend
Assuming an expected prevalence of MSx of 50%, an acceptable of the prevalence with age. A p value < 0.05 was considered
error of 5%, 95% confidence interval for the prevalence, and the statistically significant.
population size of 20,000, we came to a minimum sample size of
377.
3. Results
Using a simple random sampling, from October 2012 to April
2013, in a cross-sectional study, 377 participants aged more than
The participants (190 women and 187 men) had a mean  SD
20 years who were invited for periodic health examinations to
age of 43.8  11.0 (range: 20–86) years. Of 377 studied participants,
PIHO Polyclinic, Shiraz, southern Iran, regardless of their health
101 (26.8%, 95% CI: 22.3–31.3%) had MSx. The prevalence was 16.6%
status, were invited to enrol in this study. The study participants
in men and 36.8% in women (p < 0.001). The prevalence of MSx
were selected using a random number generator from the list of
increased significantly with age (Fig. 1); it increased by almost 15%
almost 20,000 individuals who were aged more than 20 years and
with each decade of life.
eligible for periodic health screening program.
Of 31 men with MSx, 20 (65%) had three, 7 (23%) had four, and 4
(13%) had all five components of the syndrome. Of 70 women with
2.3. Ethics
MSx, 36 (51%), 21 (30%), and 13 (19%) had three, four, and all five
components, respectively. The age-adjusted prevalence rates of
All participants were informed of the study objectives and given
various components of MSx (NCEP-ATPIII criteria) stratified by sex
informed consents to participate in this research. We reassured
are shown in Table 1. Having a waist circumference higher than the
them that the collected data would remain confidential and their
normal value was more common for women than men, when the
identity would be kept anonymous. The study protocol was
prevalence was adjusted for age. Before the age of 40, the
reviewed and approved by NIOC Medical Education and Research
prevalence of abnormal FPG was similar in both sexes; however,
Center Institutional Review Board.
after the age of 40, the rate was much higher in women than men.
Before the age of 40, hypertriglyceridemia was more prevalent in
2.4. Measurements
men than women. The prevalence became almost equal in both
sexes after the age of 40 years. Similar changes were also apparent
We used a mercury sphygmomanometer (Riester, Germany) to
for HDL-C level lower than the normal value; while before the age
measure blood pressure using a standard method [10]. The blood
of 50 the frequency of low HDL-C was much higher in men than
pressure was measured twice with an interval of at least five
women, after the age of 50, the rate was almost similar in men and
minutes in a sitting position; the mean of the two readings was
women. The age-adjusted prevalence of hypertension did not
considered the final result. The participants had not received
change significantly with sex (Table 1). Obesity was found in 16
caffeine or smoked cigarette at least 30 min before blood pressure
(8.6%) men and 46 (24.2%) women.
measurement.
Waist circumference was measured with a flexible tape at the
level between the lowest rib cage and the highest point of the iliac 4. Discussion
crest at the end of expiration. Height was measured to the nearest
0.1 cm and weight to the nearest 0.5 kg using a portable In the present study, the prevalence of MSx was 26.8% in adult
stadiometer (Porsa, ZT-120, China). population aged 20 years and older, according to the (NCEP-ATPIII)
After 12–14 h of fasting, venous blood samples were taken from
all participants and fasting plasma glucose (FPG), high-density
lipoprotein cholesterol (HDL-C), and triglyceride (TG)were
checked by an auto-analyzer (Hitachi-902, Japan).
The revised NCEP-ATPIII criteria [11] were used for the
diagnosis of MSx. Participants with three or more of the following
risk factors were considered to have MSx: (1) FPG  100 mg/dL or
consumption of antidiabetic drugs; (2) TG  150 mg/dL; (3) HDL-
C < 40 mg/dL in men and < 50 mg/dL in women (consumption of
lipid-lowering drugs was an equivalent risk factor for items 2 or 3);
(4) systolic blood pressure 130 mm Hg, diastolic blood pressure
85 mm Hg, or consumption of antihypertensive drugs; and (5)
waist circumference >102 cm in men and >88 cm in women.
Obesity was defined as a body mass index (BMI) 30 kg/m2.

2.5. Statistical analysis

The data were coded and analyzed by SPSS1 ver 20 for

Windows1. The normality of distribution of continuous variables
was tested by one-sample Kolmogorov–Smirnov test. Continuous Fig. 1. Prevalence of metabolic syndrome in each age group.
 A.H. Tabatabaie et al. / Diabetes & Metabolic Syndrome: Clinical Research & Reviews 9 (2015) 153–156 155

Table 1
Prevalence of various components of the metabolic syndrome (NCEP-ATPIII criteria) in various age groups in studied men and women.

Age group FPG  100 mg/dL or TG  150 mg/dL HDL-C < 40/50 mg/dL Waist circumference > BP  130/85 or on
(years) known diabetes 102/88 cm antihypertensives

Men Women Men Women Men Women Men Women Men Women
(n = 187) (n = 187) (n = 187) (n = 189) (n = 187) (n = 187) (n = 184) (n = 190) (n = 186) (n = 190)

20–29 0 (0) 0 (0) 4 (24) 4 (15) 4 (24) 4 (15) 1 (6) 7 (25) 2 (12) 1 (4)
30–39 1 (3) 0 (0) 21 (53) 9 (23) 21 (53) 11 (29) 4 (10) 25 (64) 3 (8) 1 (3)
40–49 6 (10) 15 (20) 30 (48) 30 (40) 35 (57) 21 (28) 9 (15) 53 (70) 14 (23) 21 (28)
50–59 14 (24) 15 (41) 24 (41) 21 (55) 29 (49) 17 (45) 11 (19) 32 (84) 21 (36) 21 (55)
60 2 (22) 3 (33) 4 (44) 3 (33) 5 (56) 4 (44) 2 (22) 7 (78) 8 (89) 7 (78)
Total 23 (12.3) 33 (17.6) 83 (44.4) 67 (35.4) 94 (50.3) 57 (30.5) 27 (14.7) 124 (65.3) 48 (25.8) 51 (26.8)

criteria. This rate is in the range of 23–43% previously reported
from Iran [4,7,9,12]. MSx was almost twice more prevalent in
women than men. This was in contrast with the results reported in
a study conducted almost 10 years ago in the USA showing that
more than 20% of Americans had MSx and that the prevalence was
not significantly different between men and women [13]. That
might be attributed to the fact that in our study when corrected for
age, women were more likely to have a higher than normal waist
circumference compared to men. There was also a higher
prevalence of obesity in studied women than men. That might
be due to relative physical inactivity among Iranian women
Compared to men [14,15]. Preferring not to be slim, particularly
after marriage, might be a cultural issue in Iran. Other reports also
showed that the prevalence of MSx in Iranian women was
significantly higher than that in men [4,6–8,16].
The prevalence of MSx increased significantly with age (Fig. 1).
This is in agreement with other previous reports [12,17]. The age-
adjusted prevalence rates of various components of MSx varied
differently in men and women. With increasing age, the
prevalence of glucose intolerance, hypertriglyceridemia, and
having lower than normal HDL-C increased in both sexes,
however the trend is much steeper in women than men. This
would be attributed to menopause. After the age of 40–50 when
women experience menopausal-related hormonal changes, the
protective effects of sex hormones abolish. This is clearly
apparent in the observed trend in abnormal HDL-C in men and
women after the age of 50, before which time the prevalence of
abnormal HDL-C is much higher in men than women. After the
age of 50, when most of women develop menopause, there is no
significant difference in the prevalence between men and
women.
In our study the most common component of MSx in men and
women was low HDL-C and high waist circumference, respectively,
both of which are caused by low physical activity and taking high-
calorie diets. Sharifi et al., also showed that low HDL-C was the most
common abnormal metabolic finding in both men and women [7].
Comparing to previous reports, the prevalence of MSx is
increasing [8,18]. This would be attributed to change in diet habits
from traditional to western-like patterns and adopting a sedentary
lifestyle and lower physical activity that have introduced in eastern
communities with industrialization.
One of the limitations of our study is its cross-sectional
methodology. However, we had to conduct such a preliminary
cross-sectional study to find where we are. Another limitation
would be the selection of the study population from the population
under coverage of PIHO who might be different in terms of some of
the confounding variables such as free access to health care
services. However, this should not be considered a weakness; it is
strength. Considering our close system of health care, we can
follow each person over years and evaluate his health on a periodic
basis. Furthermore, most of the important variables like income,
family size, etc., of the people under coverage of PIHO are not
significantly different from those of the general population and
thus the sample studied can be considered representative of adult
population residing in Shiraz.
Considering the high prevalence of MSx among our population
and its grave consequences on the quality of life of people, and
taking into account that many of the components responsible for
the syndrome can be corrected by change in lifestyle, it is necessary
to emphasize on education of people to adopting a healthy life,
having more physical activity, and consuming lower fat and salt. To
reach a better perspective of the ailment in a national scale, it is
necessary to conduct similar studies in other regions and re-
evaluate the problem on a periodic basis to better delineate the
temporal trend of MSx.
Acknowledgements
We would like to thank Dr. Farrokh Habibzadeh for his
invaluable suggestions and editing the manuscript.
Conflicts of interest: The authors have no conflicts of interest.
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