Contact: Natasja van Schoor
The clustering of risk factors such as hypertension, obesity, dyslipidemia, and hyperglycemia, has been introduced as the concept of the metabolic syndrome. The metabolic syndrome is very common, especially among older persons, with a prevalence of 45% at the age of 60 years and over (1). The metabolic syndrome has been shown to increase the risk of diabetes mellitus and cardiovascular disease (CVD). Since its introduction in 1998, the metabolic syndrome has been subject to a large amount of research, and an even larger amount of discussion about the validity and utility of the concept (2). The metabolic syndrome often co-occurs with an increased inflammatory response, although it is unknown whether the metabolic syndrome leads to increased inflammation or vice versa.
Measurement instruments in LASA
The definition established by the US National Cholesterol Education Program (NCEP)-ATPIII (3) is used with few modifications. The metabolic syndrome was defined as a presence of 3 or more of the following criteria:
– Triglycerides ³ 1.7 mmol/L (150 mg/dl) *
– HDL cholesterol < 1.0 mmol/L (40 mg/dl) for men, <1.3 mmol/L (50 mg/dl) for women *
– Blood pressure ³ 160/90 mmHg or antihypertensive medication **
– Waist circumference >102 cm for men and >88 cm for women ***
– Fructosamine ³ 247 mmol/L or antidiabetic medication ****
Assessment of the components of the metabolic syndrome
Blood pressure was measured in sitting position using a standard mercury sphygmomanometer. Waist circumference was calculated as the average of two measurements measured to the nearest 0.1 cm midway between the lower rib margin and the iliac crest following a normal expiration. History of pharmacological medication was obtained using the drug inventory method (identification of prescription drugs taken in the previous two weeks).
Fructosamine was determined by a colorimetric test, and HDL cholesterol and triglycerides by an enzymatic colorimetric test (Roche diagnostics, Mannheim, Germany). The interassay coefficient of variation was <2.8% for fructosamine and triglycerides, and <6.4% for HDL cholesterol. All laboratory analyses (HDL cholesterol, triglycerides, and fructosamine) were performed in EDTA plasma samples stored at –80° C, at the Department of Clinical Chemistry of the VUmc in 2005.
Not applicable for this topic
Availability of information per wave ¹
¹ More information about the LASA data collection waves is available here.
² 2B=baseline second cohort;
3B=baseline third cohort;
MB=migrants: baseline first cohort
Previous use in LASA
- Dik MG, Jonker C, Comijs HC, Deeg DJ, Kok A, Yaffe K, Penninx BW. Contribution of metabolic syndrome components to cognition in older individuals. Diabetes Care. 2007 Oct;30(10):2655-60.
- Oosterwerff MM, van Schoor NM, Lips P, Eekhoff EM. Osteocalcin as a predictor of the metabolic syndrome in older persons: a population-based study. Clin Endocrinol (Oxf). 2013 Feb;78(2):242-7.
- Oosterwerff MM, Eekhoff EM, Heymans MW, Lips P, van Schoor NM. Serum 25-hydroxyvitamin D levels and the metabolic syndrome in older persons: a population-based study. Clin Endocrinol (Oxf). 2011 Nov;75(5):608-13.
- van Bunderen CC1, Oosterwerff MM, van Schoor NM, Deeg DJ, Lips P, Drent ML. Serum IGF1, metabolic syndrome, and incident cardiovascular disease in older people: a population-based study. Eur J Endocrinol. 2013 Feb 15;168(3):393-401.
- Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002 Jan 16;287(3):356-9.
- Kahn R, Buse J, Ferrannini E, Stern M. The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2005 Sep;28(9):2289-304.
- 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 May 16;285(19):2486-97.
- Langsted A, Freiberg JJ, Nordestgaard BG. Fasting and nonfasting lipid levels: influence of normal food intake on lipids, lipoproteins, apolipoproteins, and cardiovascular risk prediction. Circulation 2008 Nov 11;118(20):2047-56.
- Dahlof B, Lindholm LH, Hansson L, Schersten B, Ekbom T, Wester PO. Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension). Lancet 1991 Nov 23;338(8778):1281-5.
- Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhager WH, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet 1997 Sep 13;350(9080):757-64.
- Herdzik E, Safranow K, Ciechanowski K. Diagnostic value of fasting capillary glucose, fructosamine and glycosylated haemoglobin in detecting diabetes and other glucose tolerance abnormalities compared to oral glucose tolerance test. Acta Diabetol 2002 Apr;39(1):15-22.
- Van Ancum, J.M., Jonkman, N.H., Van Schoor , N.M., Tressel, E., Meskers, C.G.M., Pijnappels, M., Maier, A.B. (2018). Predictors of metabolic syndrome in community-dwelling older adults. PLoS One, 13, 10, e0206424, 1-12.
- Hoogendijk, E.O., Huisman, M., Van Ballegooijen, A.J. (2017). The role of frailty in explaining the association between the metabolic syndrome and mortality in older adults. Experimental Gerontology, 91, 5-8.
- Heima, N.E., Eekhoff, E.M.W., Oosterwerff, M.M., Lips, P.T.A., Van Schoor , N.M., Simsek, S. (2013). Thyroid function and the metabolic syndrome in older persons: a population-based study. European Journal of Endocrinology, 168, 59-65.
- Oosterwerff, M.M., Van Schoor , N.M., Lips, P.T.A., Eekhoff, E.M.W. (2013). Osteocalcin as a predictor of the metabolic syndrome in older persons: a population-based study. Clinical Endocrinology, 78, 242-247.
- Van Bunderen, C.C., Oosterwerff, M.M., Van Schoor , N.M., Deeg, D.J.H., Lips, P.T.A., Drent, M.L. (2013). Serum IGF1, metabolic syndrome, and incident cardiovascular disease in older people: a population-based study. European Journal of Endocrinology, 168, 393-401.
- Heima, N.E., Eekhoff, E.M.W., Oosterwerff, M.M., Lips, P.T.A., Van Schoor , N.M., Simsek, S. (2012). Thyroid function and the metabolic syndrome in older persons: a population-based study. European Journal of Endocrinology, 168, 1, 59-65.
- Oosterwerff, M.M., Eekhoff, E.M.W., Heymans, M.W., Lips, P.T.A., Van Schoor , N.M. (2011). Serum 25-hydroxyvitamin D levels and the metabolic syndrome in older persons: a population-based study. Clinical Endocrinology, 75, 5, 608-613.
- Vogelzangs, N., Beekman, A.T.F., Dik, M.G., Bremmer, M.A., Comijs, H.C., Hoogendijk, W.J.G., Deeg, D.J.H., Penninx, B.W.J.H. (2009). Late-life depression, cortisol and the metabolic syndrome (Brief report). American Journal of Geriatric Psychiatry, 17, 8, 716-721.
- Dik, M.G., Jonker, C., Comijs, H.C., Deeg, D.J.H., Kok, A., Yaffe, K., Penninx, B.W.J.H. (2007). Contribution of metabolic syndrome components to cognition in older individuals. Diabetes Care, 30, 10, 2655-2660.
* Because the instructions before blood sampling allowed subjects to take tea and plain toast, we could not guarantee fasting blood samples. Triglycerides, and to a lesser extend HDL cholesterol, could be affected. However, it has been demonstrated that lipid profiles change minimally in response to normal food intake, and nonfasting levels still predict cardiovascular events (4).
** An increased cut-off for blood pressure is used, adjusted for an older population (systolic ³160 or diastolic ³90). If we used 130/85 mmHg (as definition) almost 90% of the subjects would be hypertensive. This lower cut-off would not discriminate between the groups. In hypertension trials with elderly, higher cut-off values are often used (5;6).
Antihypertensive medication: In the file: LASACH02, for the component hypertension, diuretics have not been included as antihypertensive medication. It is advised to include diuretics as antihypertensive drugs when composing the metabolic syndrome variable.
*** At cycle C (1995/1996) there are a number of missing values for waist circumference. In the syntax of metabolic syndrome these missings have been imputed using BMI measurement corrected for age and sex.
**** The cut-off of 247 mmol/L for fructosamine corresponds to the cut-off of 6.1 mmol/L for fasting plasma glucose in terms of sensitivity and specificity in discriminating subjects with glucose intolerance from subjects with normal glucose tolerance (7). Because the instructions prior to blood sampling allowed respondents to take tea and dry toast, but no dairy products, we cannot guarantee fasting blood samples. Fructosamine is little affected by eating, unlike the plasma glucose level. Therefore, we used serum fructosamine as a proxy for plasma glucose.
Date of last update: April 20, 2020 (LvZ)