Prevalence of metabolic syndrome and its association with obesity indices in a Chinese population

ORIGINAL ARTICLE

Prevalence of metabolic syndrome and its association withobesity indices in a Chinese populationYun HUANG,1* Zhiyun ZHAO,1* Xiaoying LI,1,2 Jiguang WANG,3 Min XU,1 Yufang BI,1

Weiqing WANG,1 Jianmin LIU1 and Guang NING1,2

1Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrinology and Metabolism, 2Shanghai Key

Laboratory of Endocrine Tumors; 3Centre for Epidemiological Studies and Clinical Trials, E Institute of Shanghai University, Rui-Jin Hospital,

Shanghai Jiao-Tong University School of Medicine, Shanghai, China

Introduction

The past two decades have witnessed rapid urbaniza-

tion in China. The transition from a rural to urban-

ized lifestyle, especially in terms of dietary habits, has

inevitably led to an increase in the prevalence of

obesity-related diseases, such as diabetes, hyper-

tension, and metabolic syndrome. A survey (InterASIA

survey) conducted in 2000–2001 reported that the

prevalence of metabolic syndrome in China was 9.8%

in men and 17.8% in women.1 Other surveys have

assessed the prevalence of metabolic syndrome in

rural or urban areas in other countries.2,3 These sur-

veys have consistently found that the prevalence of

metabolic syndrome is much higher in urban than

rural areas. However, with the spread of urbanization,

Correspondence

Guang Ning, Department of Endocrinology

and Metabolism, Rui-Jin Hospital, Shanghai

Jiao-Tong University School of Medicine,

Rui-Jin 2nd Road, Shanghai 200025, China.

Tel: +86 21 6437 0045 ext. 665344

Fax: +86 21 64373514

Email: [email protected]

*These two authors contributed equally to

this study.

Received 25 July 2008; revised 27 October

2008; accepted 11 November 2008.

doi: 10.1111/j.1753-0407.2008.00006.x

Abstract

Background: To investigate the prevalence of metabolic syndrome in an

urbanizing community in Qingpu, a suburb of Shanghai, and to determine

which obesity indices, including body mass index, waist circumference

(WC), and waist:hip (WHpR), and waist:height (WHtR) ratios, are most

closely associated with metabolic syndrome.

Methods: We conducted a cross-sectional health survey of 1634 individuals

(age 15–87 years) in the Jinhulu community located in Qingpu. The

National Cholesterol Education Program Expert Panel on Detection, Eval-

uation, and Treatment of High Blood Cholesterol in Adults (NCEP ATP

III) criteria were used to define metabolic syndrome, with central obesity

defined according to Asia–Pacific (APC) region criteria.

Results: The age-standardized prevalence of metabolic syndrome was 3.6%

in men and 7.2% in women. Using the criterion of central obesity in the

APC, the age-standardized prevalence of metabolic syndrome increased to

8.3% in men and 10.9% in women. Regardless of age, WHtR consistently

showed a higher odd ratios (OR) after adjustment for confounding factors

of 2.17 (95% confidence interval [CI] 1.12–4.20; P ¼ 0.022) in subjects

<52 years of age and 1.92 (95% CI 1.18–3.11; P ¼ 0.008) in those

‡52 years of age. In men, the WHtR was the only significant predictor

(OR 2.42; 95% CI 1.15–5.08; P ¼ 0.02) of metabolic syndrome after

adjustment, whereas in women WHtR (OR 1.87; 95% CI 1.37–2.85; P ¼0.0088) was slightly inferior to WHpR and WC.

Conclusion: Metabolic syndrome is prevalent in an urbanizing rural area in

Qingpu. Of the anthropometric parameters commonly used to identify meta-

bolic syndrome, WHtR may be the best.

Keywords: metabolic syndrome, obesity indices, prevalence.

Journal of Diabetes 1 (2009) 57–64

ª 2009 Ruijin Hospital and Blackwell Publishing Asia Pty Ltd 57

the prevalence of metabolic syndrome is increasing in

China.

Metabolic syndrome is recognized as a constella-

tion of several metabolic abnormalities, including cen-

tral obesity, impaired glucose tolerance, high blood

pressure, and dyslipidemia, of which central obesity

appears to be the underlying risk factor.4 Many stud-

ies have demonstrated that intra-abdominal fat (IAF)

accumulation is an independent predictor of meta-

bolic risk and cardiovascular disease.5,6 According to

the International Diabetes Federation (IDF) defi-

nition of metabolic syndrome,7 central obesity is

regarded as a mandatory criterion. The commonly

used measures for central obesity include waist cir-

cumference (WC), the waist:hip ratio (WHpR), and

the waist:height ratio (WHtR). However, body mass

index (BMI) is still the most widely used measure to

evaluate overweight and obesity. Although many

studies have tried to clarify the correlation between

measures of obesity and the components of metabolic

syndrome, it is still not known whether BMI, WC,

WHpR, and WHtR have similar predictive effects in

age groups below and above middle age.8–17 In the

present study, we investigated the prevalence of meta-

bolic syndrome and compared various obesity indices

in the Jinhulu community, located in the Qingpu

region of Shanghai, which is undergoing rapid urban-

ization.

Methods

Study population

The community in the present study, Jinhulu from the

Qingpu district, is a suburban area located in west

Shanghai in which marked socioeconomic change has

occurred over the past two decades. Urbanization,

Westernization, and improvements in living standards

have led to substantial changes in dietary habits and

lifestyles. In 2006, most residents had moved away

from traditional farming to work in the industrial or

public service sectors, with the economic income from

farming in this area being 2.8%. Correspondingly, only

2.8% of residents made their living from farming.

Thus, this area has already developed into a highly

urbanized rural district.

The present study was conducted over the period

2004–2005 and included residents from the Jinhulu

community who were between 15 and 87 years of age.

Of the 2330 subjects who gave written informed con-

sent to participate in the study, only 1720 ended up

taking part (73.8% participation rate). These 1720 sub-

jects underwent physical examination and were issued

with standard questionnaires18 to obtain information

regarding demographic characteristics and detailed

lifestyle and medical histories. The Ethics Committee

of Ruijin Hospital and Shanghai Jiaotong University

Medical School approved the study.

Blood pressure was measured in seated subjects after

10 min rest in the non-dominant arm to the nearest

2 mmHg using a mercury sphygmomanometer. Five

consecutive measurements were taken at 1 min inter-

vals and the mean of the five measurements was used.

Weight and height were determined in subjects wearing

light clothing and no shoes. Body mass index (BMI)

was calculated as weight divided by height (kg ⁄m2).

Waist circumference was measured at the umbilical

level, whereas hip circumference was measured at the

level of maximum extension of the buttocks.

Fasting blood samples were obtained for the deter-

mination of plasma glucose, insulin, and serum lipids.

Subjects without a validated history of diabetes under-

went a 75 g oral glucose tolerance test. Plasma glucose

was measured using the glucose oxidase method, serum

lipids were measured using an automated biochemical

instrument (Beckman CX-7 Biochemical Autoanalyser;

Beckman, Brea, CA, USA), and serum insulin was

measured by radioimmunoassay (Sangon, Shanghai,

China). Eighty-six subjects were excluded from final

analysis because of a lack of blood glucose or serum

lipid values.

Metabolic syndrome was defined according to the

criteria of the National Cholesterol Education Pro-

gram Expert Panel on Detection, Evaluation, and

Treatment of High Blood Cholesterol in Adults

(NCEP ATP III)19 as the presence of three or more of

the following risk factors: (i) central obesity (WC

>102 cm in men or >88 cm in women); (ii) elevated

blood pressure (‡130 ⁄ 85 mmHg); (iii) elevated fast-

ing plasma glucose (FPG) concentration (FPG

‡6.1 mmol ⁄L); (iv) elevated triglyceride (TG) levels

(fasting TG>1.70 mmol ⁄L); and (v) decreased high-

density lipoprotein–cholesterol (HDL-C) levels (HDL-C

<1.0 mmol ⁄L in men or <1.3 mmol ⁄L in women).

Subjects who were being treated with antihypertensive

or antidiabetic medication also met the criteria for

hypertension or hyperglycemia. Because the NCEP

ATP III criteria for central obesity may not be appro-

priate for the current population because Asians gener-

ally tend to have leaner figures, we adopted modified

the NCEP ATP III criteria based on the Asia–Pacific

region criterion (APC) of central obesity7 (WC ‡90 cm

in men and ‡80 cm in women). In our analysis of the

relationship between anthropometric variables and

metabolic syndrome, we did not include central obesity

in the diagnosis because WC was one of the indices of

obesity investigated.10

Metabolic syndrome and obesity indices Y. HUANG et al.

58 ª 2009 Ruijin Hospital and Blackwell Publishing Asia Pty Ltd

Statistical analysis

Statistical analyses were performed using sas 8.1 (SAS

Institute, Cary, NC, USA). Continuous variables are

presented as the mean±SD or geometrical mean with

95% confidence intervals (CI) in parentheses. Fasting

TG and insulin levels were transformed logarithmically

before comparison owing to non-normal distribution.

Means of continuous variables between groups were

compared using Student’s t-test. Percentages between

groups were compared using the chi-squared test.

Multiple linear regression models were used to identify

the association between indices of obesity and the

components of metabolic syndrome. Logistic regres-

sion was used to assess the confounder-adjusted odds

ratio (OR) of having metabolic syndrome by gender-

specific quartiles of obesity indices. In model 1, age,

education level, smoking (yes ⁄no) and drinking

(yes ⁄no) status, and a family history of type 2 diabetes

and hypertension were the factors adjusted. In model

2, BMI was further adjusted for WC, WHpR and

WHtR based on model 1, while WHtR was further

adjusted for BMI. Age was stratified into six groups

(15–29, 30–39, 40–49, 50–59, 60–69, and ‡70 years) to

estimate the prevalence of metabolic syndrome in each

age group.

Results

Characteristics of the study population

The mean age of the Qingpu population was 52±

15 years. Subjects >50 years of age made up 56.9%

of the study population. Compared with women, men

had a significantly higher WC, WHpR, systolic and dia-

stolic blood pressure (SBP and DBP, respectively), and

TG concentration, but smaller WHtR, lower 2 h post-

loading plasma glucose, and lower HDL-C concentra-

tions. Moreover, more men were current smokers and

drinkers (P < 0.05 for all comparisons; Table 1).

Prevalence and the components of the metabolic

syndrome

Based on NCEP ATP III criteria, the prevalence of

metabolic syndrome in the study population was 8.4%

(5.6% adjusted for sex and age), with a prevalence of

5.3% in men (3.6% adjusted for age) and 10.4% in

women (7.2% adjusted for age). Using APC criteria,

the overall prevalence of metabolic syndrome in the

study population increased markedly to 13.5% (9.6%

adjusted for sex and age), with a prevalence of 11.0%

in men (8.3% adjusted for age) and 15.3% in women

(10.9% adjusted for age). For almost all age groups,

the prevalence of metabolic syndrome was significantly

higher in women than in men. In addition, the preva-

lence of metabolic syndrome increased with age, reach-

ing a peak at 60–69 years in women (cf. 50–59 years in

men). The incidence of metabolic syndrome started to

decrease in men at 60–69 years of age and in women

at ‡70 years of age (Fig. 1).

Of the disorders associated with metabolic syn-

drome, hypertension was the most frequently encoun-

tered, being present in 43.8% of men and in 40.4% of

women. However, the prevalence of hypertension and

high FPG levels did not differ significantly between

men and women. When compared with men, there was

a higher prevalence of low HDL-C levels and central

obesity in women and a lower prevalence of high TG

levels (P < 0.0001; Table 2).

However, according to NCEP ATP III criteria, the

prevalence of central obesity in men and women was

only 1.2% and 12.8%, respectively (Table 2). This sug-

gests that the NCEP ATP III criteria for central obes-

ity may not be appropriate for the current population

Table 1 Characteristics of the study population

Men

(n = 657)

Women

(n = 977) P-value

Age (years) 53 ± 15 51 ± 15 NS

Waist circumference

(cm)

81.0 ± 9.4 77.0 ± 9.2 <0.0001

Waist:hip ratio 0.86 ± 0.06 0.83 ± 0.06 <0.0001

Waist:height ratio 0.49 ± 0.05 0.50 ± 0.06 0.0009

BMI (kg ⁄ m2) 23.0 ± 3.2 22.7 ± 3.3 NS

Percentage

body fat

23.0 ± 6.2 31.7 ± 7.3 <0.0001

SBP (mmHg) 127 ± 20 125 ± 21 0.04

DBP (mmHg) 78 ± 10 75 ± 10 <0.0001

FPG (mmol ⁄ L) 5.26 ± 1.08 5.28 ± 1.22 NS

2hPPG (mmol ⁄ L) 5.98 ± 2.46 6.53 ± 2.91 <0.0001

Fasting insulin

(mU ⁄ L)

5.64 (5.33–5.98) 6.02 (5.74–6.31) NS

Triglycerides

(mmol ⁄ L)

1.20 (1.16–1.25) 1.08 (1.05–1.12) <0.0001

Total cholesterol

(mmol ⁄ L)

4.48 ± 0.98 4.58 ± 1.03 NS

HDL-C (mmol ⁄ L) 1.47 ± 0.34 1.52 ± 0.32 0.02

LDL-C (mmol ⁄ L) 2.77 ± 0.80 2.83 ± 0.85 NS

Current smoker (%) 53.3 0.3 <0.0001

Current alcohol

consumption (%)

40.5 1.0 <0.0001

Normal data are given as the mean ± SD; skewed data are

given as the geometric mean with 95% confidence intervals in

parentheses.

BMI, body mass index; SBP, systolic blood pressure; DBP,

diastolic blood pressure; FPG, fasting plasma glucose; 2hPPG, 2 h

post-loading plasma glucose; HDL-C, high-density lipoprotein–

cholesterol; LDL-C, low-density lipoprotein–cholesterol.

Y. HUANG et al. Metabolic syndrome and obesity indices


owing to the generally leaner figures of Asian popula-

tions. Consequently, we used the APC criterion for

central obesity. Adopting the APC criterion, the preva-

lence of central obesity increased markedly to 18.4%

and 37.4% in men and women, respectively. The over-

all prevalence of metabolic syndrome also increased

markedly to 13.5% (9.6% adjusted for sex and age),

with a prevalence of 11.0% in men (8.3% adjusted for

age) and 15.3% in women (10.9% adjusted for age).

The prevalence of metabolic syndrome differed signifi-

cantly between men and women using either criteria

(P ¼ 0.0003 using NCEP ATP III criteria; P = 0.013

using modified ATPIII criteria).

Association between obesity indices and metabolic

syndrome

Using multiple linear regression, we found that BMI,

WC, WHpR, and WHtR were all significantly related to

the disorders of metabolic syndrome, although the mag-

nitude of the associations varied (Table 3). Of all these

indices examined, somewhat stronger correlations were

observed for WHtR with SBP and TG, for WC with

DBP, for WHpR with FPG, and for BMI with HDL-C.

Multiple logistic regressions were performed to

determine which index was independently associated

with metabolic syndrome. Because of the effects of

aging on fat distribution, we stratified individuals into

two groups according to the mean age (52 years) of

the overall population (Fig. 2a,b). In the group

<52 years of age (Fig. 2a), all obesity indices were sig-

nificantly associated with metabolic syndrome (P<

0.0001), with WHtR exhibiting the highest OR for

metabolic syndrome in model 1 (OR 3.00; 95% CI:

1.91–4.73). In model 2, after further adjustment for

BMI or WHtR, the relationship between metabolic

syndrome and BMI disappeared, whereas the domi-

nant predictive role of WHtR remained significant

(OR 2.17; 95% CI 1.12–4.20; P ¼ 0.022). Similar

results (Fig. 2b) were found after adjustment for con-

founding factors in subjects <52 years of age, with

WHtR presenting the highest OR (1.92, 95% CI 1.18–

3.11; P ¼ 0.008) in this group also.

Given the different distribution of body fat between

men and women, sex-specific OR for metabolic syn-

drome for the different obesity indices were also ana-

lyzed (Fig. 2c). In model 1, all obesity indices were

significantly associated with metabolic syndrome in men

and women (all P < 0.0001). However, WHtR had the

highest OR for metabolic syndrome in men (3.17; 95%

CI 1.89–5.32), whereas WHpR had a slightly higher OR

than WHtR in women (2.43 [95% CI 1.77–3.32] vs 2.41

[95% CI 1.77–3.27], respectively). However, in model 2,

WHtR was the only index that remained significant

(OR 2.46; 95% CI 1.11–4.95) in men (Fig. 2c). In

women (Fig. 2d), the magnitude of the association was

Figure 1 Prevalence of metabolic syndrome according to modified

National Cholesterol Education Program Expert Panel on Detection,

Evaluation, and Treatment of High Blood Cholesterol in Adults

(NCEP ATP III) criteria in men ( ) and women (s) in different age

groups. The prevalence of metabolic syndrome increased with

aging (Pfor trend = 0.39 in men; Pfor trend < 0.0001 in women).

Table 2 Prevalence of components of metabolic syndrome in men and women

Men Women Total P-value

High blood pressure 288 (43.8) 395 (40.4) 683 (41.8) NS

High fasting glucose 71 (10.8) 92 (9.4) 163 (10.0) NS

Hypertriglyceride 165 (25.1) 166 (17.0) 331 (20.3) <0.0001

Low HDL-C 39 (5.9) 237 (24.3) 276 (16.9) <0.0001

Central obesity

Defined by NCEP ATP III 8 (1.2) 125 (12.8) 133 (8.1) <0.0001

Defined using the ACP criterion 121 (18.4) 365 (37.4) 486 (29.7) <0.0001

Metabolic syndrome

Defined by NCEP ATP III 35 (5.3) 102 (10.4) 137 (8.4) 0.0003

Defined using the ACP criterion 72 (11.0) 149 (15.3) 221 (13.5) 0.013

Data show the number of subjects in each group, with percentages given in parentheses.

NCEP ATP III, National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in

Adults; ACP, criterion for Asia–Pacific (APC) region.



diminished after further adjustments, although the rela-

tionship between all indices of obesity with metabolic

syndrome persisted. The relationship between metabolic

syndrome and both WHpR (OR 1.92; 95% CI 1.34–

2.74; P ¼ 0.0004) and WC (OR 1.93; 95% CI 1.23–3.05;

P ¼ 0.0046) was of a similar magnitude and was closely

followed by that with WHtR (OR 1.87; 95% CI 1.17–

2.98; P ¼ 0.0088).

Discussion

Using NCEP ATP III criteria, three consecutive

national representative surveys in the US showed an

age-adjusted prevalence of metabolic syndrome of

23.7%.7 Many surveys conducted in urban Asian popu-

lations have reported a prevalence of metabolic

syndrome ranging between 7.8% and 31.6%, as defined

by NCEP ATP III criteria.1,2,20–23 The lifestyle in urban

populations is usually sedentary and is associated with

high calorie food intake, which drives the progression

of obesity. A cross-sectional survey conducted in 2005

in east China revealed that 12.7% of men and 10.1%

of women in an urban area, compared with 1.7% of

men and 9.7% of women in a rural area, had metabolic

syndrome.24 The results of the present study, using

NCEP ATP III criteria, revealed a prevalence of meta-

bolic syndrome in an urbanizing area of 5.6% in men

and 10.2% in women. Compared with findings of the

previous survey in east China,24 the prevalence of meta-

bolic syndrome in Qingpu in the present study is higher

than that in rural areas, but lower than that in urban

areas. These results could imply an essential role of

urbanization in the development of metabolic syn-

drome. Hence, it is crucial to take measures to prevent

Table 3 Associations between obesity indices and components of metabolic syndrome

Body mass index Waist circumference Waist:hip ratio Waist:height ratio

b P-value b P-value b P-value b P-value

SBP 0.185 <0.0001 0.209 <0.0001 0.200 <0.0001 0.225 <0.0001

DBP 0.302 <0.0001 0.330 <0.0001 0.284 <0.0001 0.317 <0.0001

FPG 0.121 <0.0001 0.169 <0.0001 0.182 <0.0001 0.163 <0.0001

Log TG 0.353 <0.0001 0.357 <0.0001 0.340 <0.0001 0.374 <0.0001

HDL-C )0.219 <0.0001 )0.212 <0.0001 )0.213 <0.0001 )0.216 <0.0001

Variables in models of multiple linear regressions included age, sex, education levels, smoking and drinking habits, a family history of

diabetes, and hypertension. Values in bold represent the variable that had stronger associations with components of metabolic syndrome.

SBP, systolic blood pressure; DBP, diastolic blood pressure; FPG, fasting plasma glucose; TG, triglycerides; HDL-C, high-density lipoprotein–

cholesterol.

(a) (b)

(c) (d)

Figure 2 Odds ratios (OR) for metabolic

syndrome for one-quartile increase in anthro-

pometric variables in individuals (a) <52 and

(b) >52 years of age, as well as in (c) men

and (d) women (vertical bars show 95%

confidence intervals). ( ), Model 1 (adjusted

for age, education levels, smoking and drink-

ing habits, family history of diabetes, and

hypertension); (d), model 2 (body mass

index [BMI] further adjusted for waist

circumference [WC], waist:hip ratio [WHpR],

and waist:height [WHtR]; WHtR further

adjusted for BMI based on model 1).



the development of metabolic disorders in rural areas

that are undergoing urbanization.

In the present study, using either NCEP ATP III or

ACP criteria, the prevalence of metabolic syndrome

was significantly higher in women than in men. This

result is in accordance with findings in other Asian

populations.23,25 Of the disorders of metabolic syn-

drome, women had a nearly threefold higher preva-

lence of low HDL-C levels and a higher prevalence of

central obesity according to NCEP ATP III criteria

(¼ twofold higher prevalence of central obesity accord-

ing to the APC criterion) than men. This may explain,

in part, why the prevalence of metabolic syndrome was

significantly higher in women than in men.

Aging has been regarded as an established risk factor

for metabolic syndrome. The NCEP defined the high-

risk age for men and women to be 35–65 and 45–

75 years, respectively.26 In the Qingpu population, the

prevalence of metabolic syndrome also increased with

increasing age, reaching a peak in women at 60–69 years,

compared with 50–59 years in men. Similar results have

been reported for other Asian populations.20

The prevalence of obesity is increasing not only in

Western countries, but also in Asian countries. Com-

pared with Caucasians, Asians have a lower BMI but

a higher prevalence of metabolic risks. In the present

study, the Qingpu population had a prevalence of meta-

bolic syndrome of 8.3% using NCEP ATP III criteria,

but a prevalence of obesity of only 2.02% according to

WHO criteria.27 In some studies, BMI was the most

predictive index of diabetes, hypertension, and cardio-

vascular diseases.9,28,29 However, an increasing number

of studies argue that BMI, as a measure of general

obesity, cannot reflect intra-abdominal fat (IAF) distri-

bution, which is thought to be tied closely to metabolic

risks.5,6 Moreover, other studies have claimed that

BMI cannot distinguish fat from muscle mass; subse-

quently, the risks tended to be overestimated in young

people and underestimated in older people whose mus-

cle mass has been replaced by fat to varying extents.30

In line with previous findings, the results of the present

study also indicate that the association between BMI

and metabolic syndrome is lost after adjustment for

central obesity, regardless of age. In contrast, the

WHtR was consistently and highly correlated with

metabolic syndrome irrespective of age.

Height has been reported to have an independent

and inverse effect on mortality from ischemic heart

disease and stroke.31,32 In the present study, WHtR

exhibited the strongest and most consistent relation-

ship with metabolic syndrome in men, even after

adjustment for BMI. Although slightly inferior to

WHpR and WC, WHtR was still the second best

predictor of metabolic syndrome in women. In Thai

men, WHtR was strongly associated with coronary

heart disease.33 In addition, in a prospective study,

WHtR appeared to be the strongest predictor than any

other obesity index in identifying men with type 2 dia-

betes.12 These findings imply that WHtR may be the

best predictor of cardiovascular risks in men. In partic-

ular, height is inversely correlated with aging and

increases in the accumulation of IAF may be offset by

declines in subcutaneous fat with aging.34 In addition

to aging, taking height into account could also provide

more accurate information on fat distribution. Unlike

WC and WHpR, WHtR exhibited fewer differences

between men and women, as well as between different

ethnic populations.35 Moreover, WHtR has been report-

ed to be an accurate early index for evaluating obesity

and a good predictor of metabolic risks in children

and adolescents.36,37 Notably, urbanization-related

changes in lifestyle will markedly increase the preva-

lence of obesity-related diseases, consequently hasten-

ing the onset of these diseases, especially in children

and young people who are prone to consuming a high-

fat and high-glucose diet. The WHtR can serve as an

effective index to assess fat distribution and cardiovas-

cular risks not only in adults, but also in children and

adolescents.

There are some limitations of the present study.

First, the study was a cross-sectional study and the

number of children and young people included in the

study population was relatively small. The interpreta-

tion of the results requires considerable caution. The

effectiveness of WHtR in predicting metabolic syn-

drome needs further validation in prospective studies.

Second, in the present study, no direct measures of

body composition were performed. WC, WHpR, and

WHtR are somewhat crude surrogate indices of central

obesity; consequently, it is difficult to define the rela-

tionship between surrogate indices and real body fat

distribution.

Acknowledgments

The present study would not have been possible with-

out the participation of the volunteers. This research

was supported by grants from 973 Project (No. 2006

CB 503904), Shanghai Commission for Science and

Technology (No. 04DZ19502), and E-Institute of

Shanghai Universities, Shanghai Education Commis-

sion (No. E03007).

Disclosure

The authors report no conflicts of interest.



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Prevalence of metabolic syndrome and its association with obesity indices in a Chinese population