CoChat
Sign Up
Cited by 2,074Diabetes, Cardiovascular Risks, and LipoproteinsObesity, Physical Activity, DietDiet, Metabolism, and Disease

The Metabolic Syndrome: Prevalence and Associated Risk Factor Findings in the US Population From the Third National Health and Nutrition Examination Survey, 1988-1994

Open access
Park, Yong-Woo, Zhu, Shankuan, Palaniappan, Latha, Heshka, Stanley, Carnethon, Mercedes R., Heymsfield, Steven B.·2003·Archives of Internal Medicine
DOI 10.1001/archinte.163.4.427PMC PMC3146257
Open this paper in CoChat — free account

Abstract

BACKGROUND: The metabolic syndrome is an important cluster of coronary heart disease risk factors with common insulin resistance. The extent to which the metabolic syndrome is associated with demographic and potentially modifiable lifestyle factors in the US population is unknown. METHODS: Metabolic syndrome-associated factors and prevalence, as defined by Adult Treatment Panel III criteria, were evaluated in a representative US sample of 3305 black, 3477 Mexican American, and 5581 white men and nonpregnant or lactating women aged 20 years and older who participated in the cross-sectional Third National Health and Nutrition Examination Survey. RESULTS: The metabolic syndrome was present in 22.8% and 22.6% of US men and women, respectively (P =.86). The age-specific prevalence was highest in Mexican Americans and lowest in blacks of both sexes. Ethnic differences persisted even after adjusting for age, body mass index, and socioeconomic status. The metabolic syndrome was present in 4.6%, 22.4%, and 59.6% of normal-weight, overweight, and obese men, respectively, and a similar distribution was observed in women. Older age, postmenopausal status, Mexican American ethnicity, higher body mass index, current smoking, low household income, high carbohydrate intake, no alcohol consumption, and physical inactivity were associated with increased odds of the metabolic syndrome. CONCLUSIONS: The metabolic syndrome is present in more than 20% of the US adult population; varies substantially by ethnicity even after adjusting for body mass index, age, socioeconomic status, and other predictor variables; and is associated with several potentially modifiable lifestyle factors. Identification and clinical management of this high-risk group is an important aspect of coronary heart disease prevention.

AI snapshot

Written from the paper’s full text.

TL;DR

In NHANES III, the ATP III–defined metabolic syndrome was present in 22.8% of US men and 22.6% of US women aged 20 years or older. Prevalence varied substantially by ethnicity and BMI and was associated with several potentially modifiable lifestyle factors.

Key findings

  • Overall metabolic syndrome prevalence was 22.8% in men and 22.6% in women (P=.86).
  • Ethnic-specific prevalence ranged from 13.9% in black men to 27.2% in Mexican American women; among men, prevalence was 13.9%, 20.8%, and 24.3% for black, Mexican American, and white men, respectively, and among women it was 20.9%, 27.2%, and 22.9%, respectively.
  • By BMI category, metabolic syndrome was present in 4.6%, 22.4%, and 59.6% of normal-weight, overweight, and obese men, and in 6.2%, 28.1%, and 50.0% of normal-weight, overweight, and obese women.
  • In adjusted models, older age, postmenopausal status, Mexican American ethnicity in women, higher BMI, current smoking, low household income in women, high carbohydrate intake in men, no alcohol consumption in women, and physical inactivity in men were associated with increased odds of metabolic syndrome.

Methods

  • Cross-sectional analysis of the Third National Health and Nutrition Examination Survey (NHANES III), 1988–1994, including 3305 black, 3477 Mexican American, and 5581 white men and nonpregnant or lactating women aged 20 years and older.
  • Metabolic syndrome was defined by Adult Treatment Panel III criteria: 3 or more of abdominal obesity, high triglyceride level, low HDL cholesterol level, high blood pressure, and high fasting plasma glucose concentration.
  • Sex- and ethnicity-specific prevalence rates were calculated, and multiple logistic regression was used to estimate odds ratios for metabolic syndrome by demographic, socioeconomic, BMI, and lifestyle factors, incorporating sampling weights.

Limitations

  • Stated: cross-sectional data prevent inference of causal pathways.
  • Stated: only one dietary marker outside alcohol intake was examined—percentage of calories from carbohydrates—so future studies should consider additional dietary variables.
  • Stated: NHANES III was conducted in 1988–1994, so observed prevalence rates may differ from those in the current US population.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1001/archinte.163.4.427

Cites

Statistics

Nothing to recompute.

Claims the paper makes

0 of 62 cited sources checked · 0 supported · 0 flagged

  • Findingown data
    § RESULTS

    The ORs for the metabolic syndrome were 5.8 in men and 4.9 in women in the 65 years and older age group.

    “The ORs were 2.8 and 2.4 in the 35- to 64-year age group and 5.8 and 4.9 in those 65 years and older in men and women, respectively.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Exclusion of individuals who consumed food or beverages within 6 hours of venipuncture and pregnant or lactating women did not bias the metabolic syndrome prevalence estimates.
  • Findingown data
    § RESULTS

    Black men had lower frequencies of high triglyceride and low HDL cholesterol levels in the 35- to 64- and ≥65-year age groups compared with the other 2 ethnic groups.

    “Black men had a significantly higher frequency of high blood pressure (35- to 64-year age group) but lower frequencies of large waist (35- to 64-year age group) and high triglyceride and low HDL cholesterol levels (35- to 64- and ≥65-year age groups) compared with the other 2 ethnic groups.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Exclusion of individuals who consumed food or beverages within 6 hours of venipuncture and pregnant or lactating women did not bias the metabolic syndrome prevalence estimates.
  • Findingown data
    § RESULTS

    Approximately one fourth of US adults 20 years or older meet the diagnostic criteria for the metabolic syndrome.

    “The present study results, based on NHANES III, indicate that approximately one fourth of US adults 20 years or older meet the diagnostic criteria for the metabolic syndrome.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: NHANES III is representative of the US adult noninstitutionalized civilian population.
  • Findingown data
    § Results

    Current smoking was associated with increased odds of the metabolic syndrome.

    “Older age, postmenopausal status, Mexican American ethnicity, higher body mass index, current smoking, low household income, high carbohydrate intake, no alcohol consumption, and physical inactivity were associated with increased odds of the metabolic syndrome.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Self-reported smoking, drinking, physical activity, and menopausal status accurately classify participants.
  • Findingown data
    § Results

    The metabolic syndrome was present in 22.8% of US men.

    “The metabolic syndrome was present in 22.8% and 22.6% of US men and women, respectively (P=.86).”
    • Also stated in: § RESULTS · plain
      “The overall percentage of the metabolic syndrome in US adults, including blacks, Mexican Americans, whites, and others, was 22.8% for men and 22.6% for women as defined by the ATP III guidelines (P=.86).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults 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;285:2486–2496. doi: 10.1001/jama.285.19.2486. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

    • Rests on an assumption: Exclusion of individuals who consumed food or beverages within 6 hours of venipuncture and pregnant or lactating women did not bias the metabolic syndrome prevalence estimates.
  • May combine two claims. 26
  • Classified as probably not a substantial claim. 23

  • May combine two claims.

    Findingown data
    § Results

    Age-specific prevalence of the metabolic syndrome was highest in Mexican Americans and lowest in blacks of both sexes.

    “The age-specific prevalence was highest in Mexican Americans and lowest in blacks of both sexes.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Exclusion of individuals who consumed food or beverages within 6 hours of venipuncture and pregnant or lactating women did not bias the metabolic syndrome prevalence estimates.

  • May combine two claims.

    Findingown data
    § RESULTS

    The percentage of black and white women with the metabolic syndrome was 20.9% and 22.9%, respectively, with no significant between-ethnic group difference (P=.10).

    “The percentage of black and white women with the metabolic syndrome was 20.9% and 22.9%, respectively, and there was no significant between–ethnic group difference (P=.10; statistical significance set at P<.017).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Exclusion of individuals who consumed food or beverages within 6 hours of venipuncture and pregnant or lactating women did not bias the metabolic syndrome prevalence estimates.

  • May combine two claims.

    Findingown data
    § RESULTS

    The percentage of men with the metabolic syndrome was higher in Mexican American and white men than in black men (P<.001 and P=.006, respectively).

    “The percentage of men with the metabolic syndrome was higher in Mexican American and white men than in black men (P<.001 and P = .006, respectively; statistical significance set at P<.017); the difference between Mexican American and white men was not statistically significant (P=.06; statistical significance set at P<.017).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Exclusion of individuals who consumed food or beverages within 6 hours of venipuncture and pregnant or lactating women did not bias the metabolic syndrome prevalence estimates.

  • May combine two claims.

    Findingown data
    § Results

    In men, metabolic syndrome prevalence was 4.6% in normal-weight, 22.4% in overweight, and 59.6% in obese.

    “The metabolic syndrome was present in 4.6%, 22.4%, and 59.6% of normal-weight, overweight, and obese men, respectively, and a similar distribution was observed in women.”
    • Also stated in: § RESULTS · plain
      “Overall, 4.6%, 22.4%, and 59.6% of normal-weight, overweight, and obese men, respectively, met the metabolic syndrome diagnostic criteria.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Exclusion of individuals who consumed food or beverages within 6 hours of venipuncture and pregnant or lactating women did not bias the metabolic syndrome prevalence estimates.

  • May combine two claims.

    Findingown data
    § RESULTS

    The percentage of Mexican American women with the metabolic syndrome was 27.2%, significantly higher than that of black and white women (P<.001 and P=.002, respectively).

    “The percentage of Mexican American women with the metabolic syndrome was significantly higher, 27.2%, than that of black and white women (P<.001 and P=.002, respectively; statistical significance set at P<.017).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Exclusion of individuals who consumed food or beverages within 6 hours of venipuncture and pregnant or lactating women did not bias the metabolic syndrome prevalence estimates.

  • May combine two claims.

    Findingown data
    § RESULTS

    The lower prevalence of metabolic syndrome in black men was accompanied by significantly lower frequencies of large waist, high triglyceride levels, and low HDL cholesterol levels, but black men had a greater frequency of high blood pressure.

    “This lower prevalence in black men was accompanied by significantly lower frequencies of large waist, high triglyceride levels, and low HDL cholesterol levels, but black men had a greater frequency of high blood pressure.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: NHANES III is representative of the US adult noninstitutionalized civilian population.

  • May combine two claims.

    Findingown data
    § RESULTS

    In both sexes, the prevalence of the metabolic syndrome increased steeply after the third decade and reached a peak in men aged 50 to 70 years and in women aged 60 to 80 years.

    “In both sexes, the prevalence of the metabolic syndrome increased steeply after the third decade and reached a peak in men aged 50 to 70 years and in women aged 60 to 80 years.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Exclusion of individuals who consumed food or beverages within 6 hours of venipuncture and pregnant or lactating women did not bias the metabolic syndrome prevalence estimates.

  • May combine two claims.

    Findingown data
    § RESULTS

    The percentage of men with the metabolic syndrome was 13.9% for black, 20.8% for Mexican American, and 24.3% for white men.

    “The percentage of participants with the metabolic syndrome was 13.9%, 20.8%, and 24.3%, for black, Mexican American, and white men, respectively.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Exclusion of individuals who consumed food or beverages within 6 hours of venipuncture and pregnant or lactating women did not bias the metabolic syndrome prevalence estimates.

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).

    Findingnone given
    § Results

    No alcohol consumption was associated with increased odds of the metabolic syndrome.

    “Older age, postmenopausal status, Mexican American ethnicity, higher body mass index, current smoking, low household income, high carbohydrate intake, no alcohol consumption, and physical inactivity were associated with increased odds of the metabolic syndrome.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Self-reported smoking, drinking, physical activity, and menopausal status accurately classify participants.

  • May combine two claims.

    Findingown data
    § RESULTS

    In women, metabolic syndrome prevalence was 6.2% in normal-weight, 28.1% in overweight, and 50.0% in obese.

    “Similarly, in women, the corresponding prevalence rates were 6.2%, 28.1%, and 50.0%, respectively.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Exclusion of individuals who consumed food or beverages within 6 hours of venipuncture and pregnant or lactating women did not bias the metabolic syndrome prevalence estimates.

  • May combine two claims.

    Findingcitation
    § RESULTS

    More than 1 in 5 patients, and more in some populations, will meet the ATP III criteria for metabolic syndrome.

    “Our findings and those of Ford et al11 indicate that more than 1 in 5 patients, and more in some populations, will meet these criteria”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] 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;287:356–359. doi: 10.1001/jama.287.3.356. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

    • Rests on an assumption: NHANES III is representative of the US adult noninstitutionalized civilian population.

  • May combine two claims.

    Findingown data
    § RESULTS

    The risk of having the metabolic syndrome increases steeply even within the overweight or 'pre-obese' range, with approximately 20% of individuals affected between a BMI of 25 and 29.9.

    “Although for many obese patients risk is already evident, our findings reveal that the risk of having the metabolic syndrome increases steeply even within the overweight or “pre-obese” range, with approximately 20% of individuals affected between a BMI of 25 and 29.9.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: NHANES III is representative of the US adult noninstitutionalized civilian population.

  • May combine two claims.

    Findingown data
    § RESULTS

    Rates of metabolic syndrome increased in overweight participants and reached a prevalence of approximately 60% in moderately obese participants with a BMI of approximately 35.

    “rates increased in over-weight participants and reached a prevalence of approximately 60% in moderately obese participants with a BMI of approximately 35.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: NHANES III is representative of the US adult noninstitutionalized civilian population.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § METHODS

    NHANES III was conducted to assess the health and nutritional status of the noninstitutionalized US population.

    “The Third National Health and Nutrition Examination Survey (NHANES III) was conducted in two 3-year phases (October 18, 1988, to October 24, 1991, and September 20, 1991, to October 15, 1994) by the National Center for Health Statistics to assess the health and nutritional status of the noninstitutionalized US population.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] National Center for Health Statistics Plan and operation of the Third National Health and Nutrition Examination Survey, 1988-1994. Vital Health Stat 1. 1994;32:1–407. [PubMed] [Google Scholar]

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data
    § METHODS

    All analyses incorporated sampling weights to produce nationally representative estimates.

    “All analyses incorporated sampling weights to produce nationally representative estimates.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § RESULTS

    Coronary heart disease remains the leading cause of mortality in the United States, accounting for more than 460,000 deaths in 2000.

    “Coronary heart disease remains the leading cause of mortality in the United States, accounting for more than 460 000 deaths in 2000.1”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] American Heart Association . 2001 Heart and Stroke Statistical Update. American Heart Association; Dallas, Tex: 2000. [Google Scholar]

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation
    § Background

    The metabolic syndrome is an important cluster of coronary heart disease risk factors with common insulin resistance.

    “The metabolic syndrome is an important cluster of coronary heart disease risk factors with common insulin resistance.”
    • Also stated in: § Conclusions · plain
      “Factors associated with an increased risk of developing CHD that tend to cluster in individuals include older age, high blood pressure, a low level of high-density lipoprotein (HDL) cholesterol, a high triglyceride level, a high plasma glucose concentration, and obesity.2 These associated risk factors have been called syndrome X,3 the insulin resistance syndrome,4 or the metabolic syndrome.5”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [2] Wilson PWF, Kannel WB, Silbershatz H, D’Agostino RB. Clustering of metabolic factors and coronary heart disease. Arch Intern Med. 1999;159:1104–1109. doi: 10.1001/archinte.159.10.1104. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

    • cites [3] Reaven GM. Role of insulin resistance in human disease. Diabetes. 1988;37:1595–1607. doi: 10.2337/diab.37.12.1595. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

    • cites [5] Grundy SM. Hypertriglyceridemia, insulin resistance, and the metabolic syndrome. Am J Cardiol. 1999;83:25F–29F. doi: 10.1016/s0002-9149(99)00211-8. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § RESULTS

    Blacks have the highest overall CHD mortality rate of any ethnic group.

    “Blacks also have the highest overall CHD mortality rate of any ethnic group,26”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Gillum RF. Cardiovascular disease in the United States: an epidemiologic overview. In: Saunders E, editor. Cardiovascular Disease in Blacks. FA Davis Co Publishers; Philadelphia, Pa: 1991. pp. 3–16. [PubMed] [Google Scholar]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § RESULTS

    Compared with whites, Mexican Americans are more prone to develop hyperinsulinemia, insulin resistance, and an unfavorable distribution of body fat, which are central features of the metabolic syndrome.

    “Our findings are consistent with those of earlier studies indicating that compared with whites, Mexican Americans are more prone to develop hyperinsulinemia, insulin resistance, and an unfavorable distribution of body fat, which are the central features of the metabolic syndrome.22,23”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [22] Okosun IS, Liao Y, Rotimi CN, Prewitt TE, Cooper RS. Abdominal adiposity and clustering of multiple metabolic syndrome in White, Black and Hispanic Americans. Ann Epidemiol. 2000;10:263–270. doi: 10.1016/s1047-2797(00)00045-4. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

    • cites [23] Haffner SM, Stern MP, Hazuda HP, Pugh JA, Patterson JK, Malina RM. Upper body and centralized adiposity in Mexican Americans and non-Hispanic whites: relationship to body mass index and other behavioral and demographic variables. Int J Obes. 1986;10:493–502. [PubMed] [Google Scholar]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § RESULTS

    Black men have a 60% higher incidence of type 2 diabetes mellitus than white men.

    “and black men have a 60% higher incidence of type 2 diabetes mellitus than white men.27”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Harris MI. Noninsulin-dependent diabetes mellitus in black and white Americans. Diabetes Metab Rev. 1990;6:71–90. doi: 10.1002/dmr.5610060202. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § RESULTS

    The primary target of CHD prevention, according to ATP III guidelines, is identification and appropriate treatment of patients with elevated LDL cholesterol levels.

    “The primary target of CHD prevention, according to ATP III guidelines,10 is identification and appropriate treatment of patients with elevated LDL cholesterol levels.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults 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;285:2486–2496. doi: 10.1001/jama.285.19.2486. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § RESULTS

    US blacks had a lower education level, were more likely to have a family history of diabetes mellitus, and engaged in less physical activity during leisure time than whites.

    “Brancati et al28 reported that US blacks had a lower education level, were more likely to have a family history of diabetes mellitus, and engaged in less physical activity during leisure time than whites.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Brancati FL, Kao WH Linda, Folsom AR, Watson RL, Szklo M. Incident type 2 diabetes mellitus in African American and white adults. JAMA. 2000;283:2253–2259. doi: 10.1001/jama.283.17.2253. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § METHODS

    NHANES III used stratified, multistage probability cluster sampling at 89 locations.

    “Conducted at 89 locations, the study used stratified, multistage probability cluster sampling, similar to that used in the 2 previous surveys.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] National Center for Health Statistics Plan and operation of the Third National Health and Nutrition Examination Survey, 1988-1994. Vital Health Stat 1. 1994;32:1–407. [PubMed] [Google Scholar]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Conclusions

    Ford et al reported un-adjusted and age-adjusted metabolic syndrome prevalences of 21.8% and 23.7%, respectively, for the US population.

    “In an initial study, Ford et al11 reported un-adjusted and age-adjusted metabolic syndrome prevalences of 21.8% and 23.7%, respectively, for the US population.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] 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;287:356–359. doi: 10.1001/jama.287.3.356. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § METHODS

    Weights indicating the probability of being sampled were assigned to each respondent, enabling results to represent the entire noninstitutionalized US population.

    “Weights indicating the probability of being sampled were assigned to each respondent, enabling results to represent the entire noninstitutionalized US population.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] National Center for Health Statistics Plan and operation of the Third National Health and Nutrition Examination Survey, 1988-1994. Vital Health Stat 1. 1994;32:1–407. [PubMed] [Google Scholar]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § RESULTS

    The metabolic syndrome has been recognized for several decades but only recently was provided with consensus-generated diagnostic criteria by ATP III.

    “A secondary target, the metabolic syndrome, has been recognized for several decades3 but only recently was provided with consensus-generated diagnostic criteria by the ATP III.10”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [3] Reaven GM. Role of insulin resistance in human disease. Diabetes. 1988;37:1595–1607. doi: 10.2337/diab.37.12.1595. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

    • cites [10] Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults 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;285:2486–2496. doi: 10.1001/jama.285.19.2486. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § RESULTS

    Slight and moderate alcohol consumption is associated with low CHD risk, possibly through beneficial alterations in HDL cholesterol and blood pressure.

    “Slight and moderate alcohol consumption has been found in epidemiologic studies to be associated with low CHD risk, possibly through beneficial alterations in HDL cholesterol and blood pressure.51-53”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [51] Jackson R, Stewart A, Beaglehole R, Scragg R. Alcohol consumption and blood pressure. Am J Epidemiol. 1985;122:1037–1044. doi: 10.1093/oxfordjournals.aje.a114185. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

    • cites [52] Gillman MW, Cook NR, Evans DA, et al. Relationship of alcohol intake with blood pressure in young adults. Hypertension. 1995;25:1106–1110. doi: 10.1161/01.hyp.25.5.1106. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

    • cites [53] Gaziano JM, Buring JE, Breslow JL, et al. Moderate alcohol intake, increased levels of high-density lipoprotein and its subtractions, and decreased risk of myocardial infarction. N Engl J Med. 1993;329:1829–1831. doi: 10.1056/NEJM199312163292501. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § RESULTS

    Increased physical activity promotes weight loss and maintenance in obese individuals and favorably modifies obesity-associated risk factors, including promoting visceral adipose tissue loss, improving insulin sensitivity, increasing HDL cholesterol levels, and lowering triglyceride levels.

    “Increased physical activity promotes weight loss and maintenance in obese individuals56 and favorably modifies obesity-associated risk factors, including promoting visceral adipose tissue loss, improving insulin sensitivity, increasing HDL cholesterol levels, and lowering triglyceride levels.45,46,49”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [56] National Institutes of Health . The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. National Institutes of Health; Bethesda, Md: 2000. NIH publication 00-4084. [Google Scholar]

      Not checked in the free run.

    • cites [45] Hoeymans N, Smit HA, Verkleij H, Kromhout D. Cardiovascular risk factors in relation to educational level in 36,000 men and women in the Netherlands. Eur Heart J. 1996;17:518–524. doi: 10.1093/oxfordjournals.eurheartj.a014903. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

    • cites [46] Choinniere R, Lafontaine P, Edwards AC. Distribution of cardiovascular disease risk factors by socioeconomic status among Canadian adults. CMAJ. 2000;162(suppl):S13–S24. [PMC free article] [PubMed] [Google Scholar]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § RESULTS

    Aging per se is associated with evolution of insulin resistance, other hormonal alterations, and increases in visceral adipose tissue, all of which are important in the pathogenesis of the metabolic syndrome.

    “In addition, aging per se is associated with evolution of insulin resistance, other hormonal alterations, and increases in visceral adipose tissue,31 all of which are important in the pathogenesis of the metabolic syndrome.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Boden G, Chen X, DeSantis RA, Kendrick Z. Effects of age and body fat on insulin resistance in healthy men. Diabetes Care. 1993;16:728–733. doi: 10.2337/diacare.16.5.728. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning
    § RESULTS

    The association of low education levels with elevated risk of metabolic syndrome is likely mediated by other risk factors, such as low household income, smoking, high carbohydrate intake, and physical inactivity.

    “The association of low education levels with elevated risk is likely mediated by other risk factors, such as low household income, smoking, high carbohydrate intake, and physical inactivity.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning
    § RESULTS

    The increasing number of overweight and obese individuals of all ages combined with the growing number of elderly people promises to make the metabolic syndrome an increasingly common condition amenable to preventive lifestyle interventions.

    “The increasing number of overweight and obese individuals of all ages combined with the growing number of elderly people promises to make the metabolic syndrome an increasingly common condition amenable to preventive lifestyle interventions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation
    § RESULTS

    The association between smoking and the metabolic syndrome is possibly a reflection of the effect of cigarette smoking on insulin resistance.

    “possibly a reflection of the effect of cigarette smoking on insulin resistance.50”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] Attvall S, Fowelin J, Lager I, Von Schenck H, Smith U. Smoking induces insulin resistance: a potential link with the insulin resistance syndrome. J Intern Med. 1993;233:327–332. doi: 10.1111/j.1365-2796.1993.tb00680.x. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning
    § RESULTS

    The principal limitation relevant to the interpretation of our results is the use of cross-sectional data; thus, causal pathways underlying the observed relationships cannot be inferred.

    “The principal limitation relevant to the interpretation of our results is the use of cross-sectional data; thus, causal pathways underlying the observed relationships cannot be inferred.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation
    § RESULTS

    Insulin resistance is associated with blood pressure levels in white but not black Americans.

    “Insulin resistance is also associated with blood pressure levels in white but not black Americans.30”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] Saad MF, Lillioja S, Nyomba BL, et al. Racial differences in the relation between blood pressure and insulin resistance. N Engl J Med. 1991;324:733–739. doi: 10.1056/NEJM199103143241105. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § RESULTS

    Low socioeconomic status is associated with a higher mortality rate for cardiovascular disease.

    “Many studies41-43 have reported that low socioeconomic status is associated with a higher mortality rate for cardiovascular disease.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [41] Pekkanen J, Tuomilehto J, Uutela A, Vartiainen E, Nissinen A. Social class, health behaviors, and mortality among men and women in eastern Finland. BMJ. 1995;311:589–593. doi: 10.1136/bmj.311.7005.589. [DOI] [PMC free article] [PubMed] [Google Scholar]

      Not checked in the free run.

    • cites [42] Smith G Davey, Neaton JD, Wentworth D, Stamler R, Stamler J. Mortality differences between black and white men in the USA: contribution of income and other risk factors among men screened for the MRFIT. Lancet. 1998;351:934–939. doi: 10.1016/s0140-6736(00)80010-0. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

    • cites [43] Kaplan GA, Keil JE. Socieconomic factors and cardiovascular disease: a review of the literature. Circulation. 1993;88:1973–1998. doi: 10.1161/01.cir.88.4.1973. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § RESULTS

    A low education level links cardiovascular disease with risk factors such as smoking, hypertension, impaired glucose tolerance, diabetes mellitus, physical inactivity, and overweight with associated metabolic disturbances.

    “A low education level links cardiovascular disease with risk factors such as smoking,41,44-46 hypertension,41,45 impaired glucose tolerance,47 diabetes mellitus,48 physical inactivity,45,46,49 and overweight with associated metabolic disturbances.41,45-47”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [41] Pekkanen J, Tuomilehto J, Uutela A, Vartiainen E, Nissinen A. Social class, health behaviors, and mortality among men and women in eastern Finland. BMJ. 1995;311:589–593. doi: 10.1136/bmj.311.7005.589. [DOI] [PMC free article] [PubMed] [Google Scholar]

      Not checked in the free run.

    • cites [44] Jacobsen BK, Thelle DS. Risk factors for coronary heart disease and level of education: the Tromso Heart Study. Am J Epidemiol. 1988;127:923–932. doi: 10.1093/oxfordjournals.aje.a114895. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

    • cites [45] Hoeymans N, Smit HA, Verkleij H, Kromhout D. Cardiovascular risk factors in relation to educational level in 36,000 men and women in the Netherlands. Eur Heart J. 1996;17:518–524. doi: 10.1093/oxfordjournals.eurheartj.a014903. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

    • cites [46] Choinniere R, Lafontaine P, Edwards AC. Distribution of cardiovascular disease risk factors by socioeconomic status among Canadian adults. CMAJ. 2000;162(suppl):S13–S24. [PMC free article] [PubMed] [Google Scholar]

      Not checked in the free run.

    • cites [47] Brunner EJ, Marmot MG, Nanchahal K, et al. Social inequality in coronary risk: central obesity and the metabolic syndrome: evidence from the Whitehall II Study. Diabetologia. 1997;40:1341–1349. doi: 10.1007/s001250050830. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation
    § RESULTS

    Participants with BMI less than 25 meeting the metabolic syndrome criteria may be the 'metabolically obese, normal-weight' individuals referred to by Ruderman et al who purportedly have insulin resistance as the central feature of their cluster of metabolic abnormalities.

    “Participants with BMI less than 25 meeting the metabolic syndrome criteria may be the “metabolically obese, normal-weight” individuals referred to by Ruderman et al32 who purportedly have insulin resistance as the central feature of their cluster of metabolic abnormalities.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Ruderman N, Chisholm D, Pi-Sunyer X, Schneider S. The metabolically obese, normal-weight individual revisited. Diabetes. 1998;47:699–713. doi: 10.2337/diabetes.47.5.699. [DOI] [PubMed] [Google Scholar]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given
    § RESULTS

    The NHANES III database was developed between 1988 and 1994, and the observed prevalence rates may differ from those actually present in the current US population.

    “Finally, the NHANES III database was developed between 1988 and 1994, and the observed prevalence rates may differ from those actually present in the current US population.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given
    § RESULTS

    The investigation included only one dietary marker outside of alcohol intake: percentage of calories from carbohydrates.

    “In addition, our investigation included only one dietary marker outside of alcohol intake: percentage of calories from carbohydrates.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § RESULTS

    Physical inactivity imparts an increased risk for CHD and type 2 diabetes mellitus and exacerbates the severity of other risk factors.

    “Physical inactivity also imparts an increased risk for CHD and type 2 diabetes mellitus and exacerbates the severity of other risk factors.55”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [55] Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion . Surgeon General’s Report on Physical Activity and Health. Centers for Disease Control and Prevention; Atlanta, Ga: 1996. [Google Scholar]

      Not checked in the free run.

40 of 40

  • The paper relies on this without support.

    The extent to which the metabolic syndrome is associated with demographic and potentially modifiable lifestyle factors in the US population is unknown.

    “The extent to which the metabolic syndrome is associated with demographic and potentially modifiable lifestyle factors in the US population is unknown.”

  • The paper relies on this without support.

    Self-reported smoking, drinking, physical activity, and menopausal status accurately classify participants.

    “Smoking was categorized as current, past, and never. Past smokers were those who reported that they had smoked at least 100 cigarettes during their lifetime but who did not currently smoke cigarettes. Drinking was categorized as heavy, moderate, never, and unknown.”
    “Physical activity level was defined based on the participant’s physical activity density rating scores obtained from participating in one of the following activities during the past month: walking, jogging or running, bicycle riding, swimming, lifting weights, or doing aerobics or aerobic dancing, other dancing, calisthenics, or garden or yard work.”
    “Menopausal status was defined according to self-reported cessation of menstruation at interview.”

  • The paper relies on this without support.

    Exclusion of individuals who consumed food or beverages within 6 hours of venipuncture and pregnant or lactating women did not bias the metabolic syndrome prevalence estimates.

    “Of 14852 individuals, we excluded 1756 who consumed food or beverages other than water within 6 hours of venipuncture. In addition, we also excluded 235 women who were pregnant or lactating at base-line.”

  • The paper relies on this without support.

    NHANES III is representative of the US adult noninstitutionalized civilian population.

    “evaluating the main features of the metabolic syndrome in the US adult noninstitutionalized civilian population.”

  • The paper relies on this without support.

    The metabolic syndrome is usually a clinically silent aggregate of CHD risk factors.

    “harbor what is usually a clinically silent aggregate of CHD risk factors.”

  • The paper relies on this without support.

    All 5 components of the ATP III criteria for the metabolic syndrome can be easily evaluated in the clinical setting.

    “all 5 components can be easily evaluated in the clinical setting.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Age-group population figures double the reported black male total

    Minor

    Table 3's age-group populations for black men sum to 12.1 million, but Table 1 gives 6.1 million black men overall.

    Reported 6.1 · recomputed 12.1

  • Black women's past-smoking estimate falls outside its confidence interval

    Minor

    Table 2 reports 2.6% with a 95% confidence interval of 11.5% to 13.7%. The interval is centered on 12.6%, not 2.6%, and does not contain the reported estimate.

    Reported 2.6 · recomputed 12.6

  • Conflicting rankings for age-specific prevalence in women

    Minor

    The abstract says blacks have the lowest age-specific prevalence in both sexes, but the results rank black women above white women.

3 of 3

The citation lists haven’t been fetched yet

References 63 · Cited by 2,074

Research works printed but not linked: 4

  1. [1]American Heart Association . 2001 Heart and Stroke Statistical Update. American Heart Association; Dallas, Tex: 2000. [Google Scholar]
  2. [12]National Center for Health Statistics Plan and operation of the Third National Health and Nutrition Examination Survey, 1988-1994. Vital Health Stat 1. 1994;32:1–407. [PubMed] [Google Scholar]
  3. [40]Siedell JC, Oosterlee A, Deurenberg P, Hautvast JGMJ, Ruys JHJ. Abnormal fat depots measured with computed tomograph: effect of obesity, sex and age. Eur J Clin Nutr. 1988;42:805–807. [PubMed] [Google Scholar]
  4. [56]National Institutes of Health . The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. National Institutes of Health; Bethesda, Md: 2000. NIH publication 00-4084. [Google Scholar]

Authors
Park, Y.-W., Zhu, S., Palaniappan, L., Heshka, S., Carnethon, M. R., & Heymsfield, S. B.
Affiliations
  • Sungkyunkwan University (KR)
  • Columbia University (US)
  • Stanford University (US)
  • St. Luke's-Roosevelt Hospital Center (US)
Corresponding author
Heymsfield, Steven B.
ORCID
Venue
Archives of Internal Medicine
Publisher
American Medical Association (AMA)
Published
2003-02-24
Volume
163
Issue
4
Pages
427
ISSN
0003-9926 (ISSN-L)
DOI
10.1001/archinte.163.4.427
PMC
PMC3146257
OpenAlex
W2001657480
Semantic Scholar
41bc803f2e32b9222bc2d7ef2ccc3b2fa5e66e74
Cited by
2,074
References
63
Citations by year
2026: 13 · 2025: 27 · 2024: 33 · 2023: 38 · 2022: 50 · 2021: 61 · 2020: 62 · 2019: 62 · 2018: 92 · 2017: 81 · 2016: 103 · 2015: 94 · 2014: 117 · 2013: 119 · 2012: 130
FWCI
74.86
Type
journal article
Language
en
Open access
Locations
  • Archives of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (5p01dk042618-15)
  • National Heart, Lung, and Blood Institute (F32HL010338)
  • National Institute of Diabetes and Digestive and Kidney Diseases (DK 42618, R01DK081371, P01-DK042618)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
Keywords
metabolic syndrome, prevalence, coronary risk factors, insulin resistance, ethnic differences, Mexican Americans, African Americans, body mass index, obesity, postmenopausal status, smoking, socioeconomic status, physical inactivity, carbohydrate intake, alcohol consumption, lifestyle risk factors, coronary heart disease prevention
MeSH terms
Adult, Age Factors, Aged, Aged, 80 and over, Black or African American, Female, Humans, Male, Middle Aged, Nutrition Surveys, Risk Factors, United States, Body Mass Index, Prevalence, Chi-Square Distribution, Logistic Models, Mexican Americans, Metabolic Syndrome, White People

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-08.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-08.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review