ABSTRACT

INTRODUCTION

High prevalence of metabolic syndrome and its associated risk factors in adults represents both a Cuban and a worldwide public health problem.

OBJECTIVE

Determine prevalence of metabolic syndrome’s component risk factors in a representative sample of adults in Holguín Province, Cuba.

METHODS

A cross-sectional study was conducted using multistage probability sampling of four Holguín Province municipalities: Holguín, Gibara, Urbano Noris and Banes. We selected a sample of 2085 patients aged ≥20 years during 2004–2013 and measured clinical, anthropometric and biochemical variables. Risk factor prevalence rates were calculated using EPIDAT 3.1.

RESULTS

Crude metabolic syndrome prevalence rate was 27.2% (CI 25.3%–29.1%). Crude prevalence rates (with 95% CI) of risk factors were as follows: hypertriglyceridemia 36.1% (34.0%–38.2%); hypercholesterolemia 25.5% (23.6%–27.4%); low HDL cholesterol 26.3% (24.4%–28.2%); high LDL cholesterol 10.1% (8.8%–11.4%); prediabetes 2.2% (1.6%–2.8%); diabetes 14.6% (13.1 %–16.1%); prehypertension 3.5% (2.7%–4.3%); hypertension 34.5% (32.5%–36.5%); overweight 23.4% (21.6%–25.2%); obesity 32.0% (30.0%–34.0%) and central obesity 47.3% (45.2%–49.4%). They were significantly higher in women and older adults.

CONCLUSION

High prevalence of risk factors associated with metabolic syndrome confirms the magnitude of this health problem, particularly in women and older adults.

Metabolic syndrome; insulin resistance; hypertension; dyslipidemia; type 2 diabetes mellitus; obesity; risk factors; Cuba

INTRODUCTION

Chronic non-communicable diseases (NCD) represent a serious health problem, contributing greatly to the global burden of morbidity, mortality and disability.[¹1. Varona P, Bonet M, García R, Chang M, Ramón Suárez R. Implementation of chronic disease risk factor surveillance in 12 Cuban municipalities. MEDICC Rev. 2014 Jan;16(1):43-7.] They are the leading causes of death in adults in most countries,[²2. World Health Organization. Preventing chronic diseases: a vital investment: WHO global report. Geneva: World Health Organization; 2005. 200 p.] accounting for an estimated 63% of deaths worldwide in 2015.[²2. World Health Organization. Preventing chronic diseases: a vital investment: WHO global report. Geneva: World Health Organization; 2005. 200 p.]

NCDs are also the leading causes of death and disability in the Americas, accounting for over 3.9 million deaths annually, 75% of deaths in the region.[³3. Pan American Health Organization. Enfermedades no transmisibles en las Américas: construyamos un futuro más saludable. Washington, D.C.: Pan American Health Organization; 2011. Spanish.] In Cuba, NCDs account for 76% of deaths, and NCD-related mortality is 10 times the combined rates for communicable diseases and maternal, perinatal and nutritional causes.[¹1. Varona P, Bonet M, García R, Chang M, Ramón Suárez R. Implementation of chronic disease risk factor surveillance in 12 Cuban municipalities. MEDICC Rev. 2014 Jan;16(1):43-7.]

Metabolic syndrome comprises a set of NCD risk factors: hypertension, dyslipidemia, glucose intolerance and central obesity. Most metabolic syndrome patients have insulin resistance and a greater risk of atherosclerosis and its sequelae.[⁴4. Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C; American Heart Association. Definition of Metabolic Syndrome. Circulation [Internet]. 2004 Jan 27 [cited 2016 Mar 15];109:433-8. Available from: http://circ.ahajournals.org/content/109/3/433.short
http://circ.ahajournals.org/content/109/... ]

Most of these risk factors are preventable and controllable using cost-effective nonpharmacological measures, aimed primarily at lifestyle changes that include a healthy diet, increased physical activity and elimination of harmful habits such as smoking and excessive alcohol consumption. Controlling them may also require pharmacological measures.[⁵5. Ferrante D, Linetzky B, Konofino J, King A, Virgolini M, Laspiur S. Encuesta Nacional de Factores de Riesgo 2009: evolución de la epidemia de enfermedades crónicas no transmisibles en Argentina. Estudio de corte transversal. Rev Argent Salud Pública. 2011 Mar;2(6):34-41. Spanish.,⁶6. World Health Organization. Facts related to chronic diseases. Geneva: World Health Organization; c2013 [cited 2006 Jan 20]. Available from: http://www.who.int/topics/chronic_diseases/factsheets/en/index.html
http://www.who.int/topics/chronic_diseas... ]

The first step in vulnerable population groups is to identify metabolic syndrome risk factors. Determining their prevalence rates enables assessment of the magnitude of metabolic syndrome as a public health problem, as a basis for better allocation of material and human resources.

Previously published papers on metabolic syndrome’s frequency and its component risk factors in Holguín Province focused on only a few health areas (primary health care catchment areas) and studied relatively small samples, limiting extrapolation of their results.[⁷7. Miguel Soca PE, Niño Escofet S, Rodríguez López M, Almaguer Herrera A. Pesquisaje de síndrome metabólico en mujeres obesas. Correo Científico Médico Holguín [Internet]. 2004 [cited 2013 Oct 13]; [about 4 screens]. Available from: http://www.cocmed.sld.cu/no84/n84ori5.htm. Spanish.
http://www.cocmed.sld.cu/no84/n84ori5.ht... 8. Hernández Tamayo M, Miguel Soca PE, Marrero Hidalgo MM, Pérez López LM, Peña Pérez I, Rivas Estévez M. Comportamiento de variables clínicas, antropométricas y de laboratorio en pacientes con síndrome metabólico. Medisur [Internet]. 2011 Mar-Apr [cited 2013 Sep 15];9(2). Available from: http://medisur.sld.cu/index.php/medisur/article/view/1260/716. Spanish.
http://medisur.sld.cu/index.php/medisur/... –⁹9. Hernández Tamayo M, Miguel Soca PE, Marrero Hidalgo M, Rodríguez Graña T, Niño Escofet S. Caracterización del síndrome metabólico en pacientes adultos con obesidad. MEDISAN [Internet]. 2012 Mar [cited 2014 Jan 9];16(3):341-8. Available from: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1029-30192012000300005. Spanish.
http://scielo.sld.cu/scielo.php?script=s... ] It is important to determine prevalence of metabolic syndrome risk factors in adults in representative samples from the province, the objective of this research.

METHODS

Setting

With an area of 9293 km² (8.5% of Cuba) the northeastern province of Holguín has an estimated population of 1,037,770 (9.3% of Cuba’s), with the sexes evenly distributed and some 789,265 persons (76.1%) aged >20 years. The province has 46 health areas (each served by a community-based polyclinic and the neighborhood family doctor-and-nurse offices it supervises) in 14 municipalities, the most populous of which is Holguín, with 348,965 residents, 33.6% of the provincial population.[¹⁰10. National Statistics Bureau (CU). Anuario Estadístico de Cuba 2013 [Internet]. [cited 2014 May 12]. Havana: National Statistics Bureau (CU). Available from: http://www.one.cu/aec2013/esp/20080618_tabla_cuadro.htm. Spanish.
http://www.one.cu/aec2013/esp/20080618_t... ]

Design and sampling strategy

This was a descriptive study. A complex sampling strategy was used to ensure a representative population from the province and minimize selection bias. In the first stage, simple random sampling (SRS) was used to select 4 of the province’s 14 municipalities—Holguín, Gibara, Urbano Noris and Banes—comprising 51.3% of the population. Second-stage units were chosen by SRS among the 18 health areas in the selected municipalities: 1 health area for each of the smaller municipalities and 4 from Holguín Municipality, home to over 30% of the sample. For third-stage units, 4 family doctor-and-nurse offices from each health area were chosen by SRS, for a total of 28 (Figure 1).

SRS was used to select participants from the chosen doctor-and-nurse offices, progressively added to the complex sample from 2004 through 2013. The final sample consisted of 2085 adults aged >20 years. The desired sample size was calculated using EPIDAT 3.1 (Xunta de Galicia, Spain, PAHO, 2006) according to WHO criteria for observational studies,[¹¹11. Lwanga SK, Lemeshow S. Sample size determination in health studies. Geneva: World Health Organization; 1991. 22 p.] specifying an expected proportion of 0.30, 95% confidence interval (CI), 3% precision and design effect of 2.3.

Variables and procedures

Venous blood samples were taken following 12–14 hours fasting and at least three days of a low-fat diet. Most test reagents were produced domestically (EPB Carlos J. Finlay, Havana): blood glucose, Rapiglucotest; triglycerides, Triglitest; total cholesterol, Colestest; HDL cholesterol, C-HDL Inmuno FS. LDL cholesterol was calculated using the Friedewald formula.[¹²12. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972 Jun;18(6):499-502.] Laboratory tests were performed in duplicate by the health areas’ chemistry laboratories and the Applied Biochemistry Laboratory at the Medical University of Holguín.

Metabolic syndrome was diagnosed according to the National Cholesterol Education Program (ATP-III) by presence of three or more of the following criteria:[¹³13. 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). Final Report. Circulation. 2002 Dec 17;106:3143-421.]

• fasting blood glucose ≥5.55 mmol/L (≥100 mg/dL) or treatment for diabetes

• fasting plasma triglycerides ≥1.70 mmol/L (≥150 mg/dL)

• HDL cholesterol <1.03 mmol/L (<40 mg/dL) for men and <1.29 mmol/L (<50 mg/dL) for women

• systolic blood pressure ≥130 mmHg or diastolic ≥85 mmHg or antihypertensive treatment

• abdominal obesity (waist circumference ≥102 cm for men, ≥88 cm for women)

Prediabetes and diabetes were classified according to American Diabetes Association guidelines.[¹⁴14. American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2012;35(Suppl 1):S64-71.] Cuban guidelines were followed to determine blood pressure and hypertension classification.[¹⁵15. Comisión Nacional Técnica Asesora del Programa de Hipertensión arterial. Hipertensión arterial. Guía para la prevención, diagnóstico y tratamiento. Havana: Editorial Ciencias Médicas; 2008. Spanish.] Weight and height were determined using a calibrated scale and stadiometer, with precision of 0.1 kg and 1 cm, respectively. Body mass index was calculated by dividing weight in kg by height in m². Waist circumference was measured above the iliac crest and the mid-axillary line, with the patient standing, and a precision of 0.5 cm.

All measurements were done twice by technicians and other personnel previously trained for the study, taking the average of the two measurements. Table 1 describes study variables and lists reference values.

Analysis

EPIDAT 3.1 was used to calculate risk factor prevalence rates (percentages with 95% CI). Because of the long data collection period, rates were not age adjusted.

Ethics

The study was approved by the Scientific Council and Ethics Committee of the Medical University of Holguín, the institution that funded the research (code 0804099). Participants provided written informed consent and anonymity preserved.

RESULTS

Mean age was 45 years (SD 12.0, 95% CI 44.5–45.5, range 20–94). Mean age in women was 45.4 years (SD 12.0, 95% CI 44.7–46.1, range 20–94) and in men 44.4 years, (SD 12.1, 95% CI 43.6–45.2, range 20–86).

Crude metabolic syndrome prevalence was 27.2% (CI 25.3%–29.1%). Rates for groups aged 20–29, 30–39, 40–49, 50–59 and ≥60 years were 10.2% (CI 4.9%–15.5%), 13.2% (CI 10.3%–16.1%), 22.7% (CI 19.6%–25.8%), 36.6% (CI 32.0%–41.2%), and 56.6% (CI 50.9%–62.3%), respectively.

Prevalence rates for metabolic syndrome risk factors are listed by age group in Table 2 and by sex in Table 3.

DISCUSSION

The high prevalence rates for metabolic syndrome risk factors found in this study may be related to underreporting of patients with occult disease. For example, the US CDC found 26% of adults in the USA had multiple chronic diseases.[¹⁶16. Ward BW, Schiller JS. Prevalence of multiple chronic conditions among US adults: estimates from the National Health Interview Survey, 2010. Prev Chronic Dis [Internet]. 2013 Apr [cited 2014 Jan 12];10:E65. DOI: 10:120203. Available from: http://www.cdc.gov/pcd/issues/2013/12_0203.htm
10:120203... ] Population studies in the USA have found high prevalence of risk factors and undiagnosed NCDs, supporting the importance of active searching for these factors in the general population and in higherrisk groups in particular.[¹⁷17. Ayanian JZ, Zaslavsky AM, Weissman JS, Schneider EC, Ginsburg JA. Undiagnosed hypertension and hypercholesterolemia among uninsured and insured adults in the Third National Health and Nutrition Examination Survey. Am J Public Health. 2003 Dec;93(12):2051-4.]

Variability in prevalence of metabolic syndrome risk factors is strikingly wide in Cuban and international studies, depending on criteria used, sample size, and genetic and environmental factors, which differ among countries and regions.[¹⁸18. Naranjo AA, Rodríguez áY, Llera RE, Aroche R. Diabetes risk in a Cuban primary care setting in persons with no known glucose abnormalities. MEDICC Rev. 2013 Apr;15(2):16-9. 19. Valdés Ramos E, Bencosme Rodríguez N. Síndrome metabólico y enfermedad cardiovascular en personas con diabetes mellitus tipo 2. Rev CubanaEndocrinol [Internet]. 2013 May-Aug [cited 2013 Dec 13];24(2):125-35. Available from: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1561-29532013000200003&lng=es. Spanish.
http://scielo.sld.cu/scielo.php?script=s... 20. Agramonte Martínez M, Barnés Dominguez JA, Pinto Correa Má. Prevalencia del síndrome metabólico en pacientes diabéticos tipo 2. Rev Cubana Med [Internet]. 2009 [cited 2014 Jan 8];48(1). Available from: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-75232009000100002&lng=es. Spanish.
http://scielo.sld.cu/scielo.php?script=s... –³⁹39. Prasad DS, Kabir Z, Dash AK, Das BC. Prevalence and risk factors for metabolic syndrome in Asian Indians: a community study from urban Eastern India. J Cardiovasc Dis Res. 2012 Jul;3(3):204-11.] Most studies agree that rates increase with aging. Genetic risk factors explain 40%–50% of prevalence variability by ethnic group.[⁴⁰40. Miguel-Soca P, Cruz-Lage L, Edwards-Scringer I. Genes de la obesidad monogénica. An Sist Sanit Navar. 2013 Jan-Apr;36(1):125-7. Spanish.] Environmental factors are mainly lifestyle related, such as diet, physical activity and harmful substance use.

The higher prevalence of metabolic syndrome risk factors in older adults in this study could be explained by the metabolic and hormonal changes of aging responsible for high morbidity in this stage of life; these results coincide in part with those of other studies in the Middle East and North Africa.[³¹31. Al Zenki S, Al Omirah H, Al Hooti S, Al Hamad N, Jackson RT, Rao A, et al. High prevalence of metabolic syndrome among Kuwaiti adults—a wakeup call for public health intervention. Int J Environ Res Public Health. 2012 May;9(5):1984-96. 32. Ferguson TS, Tulloch-Reid MK, Younger NO, Knight-Madden JM, Samms-Vaughan M, Ashley D, et al. Prevalence of the metabolic syndrome and its components in relation to socioeconomic status among Jamaican young adults: a crosssectional study. BMC Public Health [Internet]. 2010 Jun 3 [cited 2013 Dec 28];10:307. DOI: 10.1186/1471-2458-10-307. Available from: http://www.biomedcentral.com/1471-2458/10/3G7
http://www.biomedcentral.com/1471-2458/1... 33. Chen CM, Yeh MC. The prevalence and deter minants of impaired fasting glucose in the population of Taiwan. BMC Public Health [Internet]. 2013 Dec 5 [cited 2013 Dec 29];13:1123. DOI: 10.1186/1471-2458-13-1123. Available from: http://www.biomedcentral.com/1471-2458/13/1123
http://www.biomedcentral.com/1471-2458/1... 34. Kotwani P, Kwarisiima D, Clark TD, Kabami J, Geng EH, Jain V, et al. Epidemiology and awareness of hypertension in a rural Ugandan community: a cross-sectional study. BMC Public Health [Internet]. 2013 Dec 9 [cited 2013 Dec 28];13:1151. DOI: 10.1186/1471-2458-131151. Available from: http://www.biomedcentral.com/1471-2458/13/1151
10.1186/1471-2458-131151... 35. Capingana DP, Magalhäes P, Silva AB, Gonçalves MA, Baldo MP, Rodrigues SL, et al. Prevalence of cardiovascular risk factors and socioeconomic level among public-sector workers in Angola. BMC Public Health [Internet]. 2013 [cited 2013 Dec 28];13:732. Available from: http://www.biomedcentral.com/1471-2458/13/732
http://www.biomedcentral.com/1471-2458/1... 36. Pan L, Song YS, Ma R, Ye XD, Liao YH. [An epidemiology study on hypertension in the Zhuang nationality village from the Guangxi Zhuang autonomous region]. Zhonghua Xin Xue Guan Bing Za Zhi. 2013 Sep;41(9):790-4. Chinese. 37. Ballesteros Hernández M, Guirado Blanco O. Los estrógenos como protectores cardiovasculares. Medicentro Electrón [Internet]. 2012 Jul-Sep [cited 2013 Nov 11];16(3):148-53. Available from: http://www.medicentro.sld.cu/index.php/medi centro/article/view/1273/1197
http://www.medicentro.sld.cu/index.php/m... 38. Lee MH, Kim HC, Ahn SV, Hur NW, Choi DP, Park CG, et al. Prevalence of dyslipidemia among Korean adults: Korea National Health and Nutrition Survey 1998-2005. Diabetes Metab J. 2012 Feb;36(1):43-55.,⁴¹41. Majeed A, El-Sayed AA, Khoja T, Alshamsan R, Millett C, Rawaf S. Diabetes in the Middle-East and North Africa: an update for 2013 for the IDF Diabetes Atlas. Diabetes Res Clin Pract [Internet]. 2013 Dec [cited 2014 Jan 29]. Epub ahead of print. Available from: http://dx.doi.org/10.1016/j.diabres.2013.11.00826
http://dx.doi.org/10.1016/j.diabres.2013... ]

Hypercholesterolemia is an independent risk factor for metabolic syndrome, in which dyslipidemia is characterized by hypertriglyceridemia, high LDL cholesterol and decreasing HDL cholesterol.[⁴4. Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C; American Heart Association. Definition of Metabolic Syndrome. Circulation [Internet]. 2004 Jan 27 [cited 2016 Mar 15];109:433-8. Available from: http://circ.ahajournals.org/content/109/3/433.short
http://circ.ahajournals.org/content/109/... ] The high rates of dyslipidemia we found are consistent with the variability and high prevalence of metabolic syndrome risk factors.

This study found type 2 diabetes rates in Holguín Province higher than those reported in 2013 for the province (3.4%) and Cuba (5.4%).[⁴²42. National Health Statistics and Medical Records Division (CU). Anuario Estadístico 2013. Havana: Ministry of Public Health (CU). Available from: http://bvscuba.sld.cu/anuario-estadisticode-cuba. 189 p. Spanish.
http://bvscuba.sld.cu/anuario-estadistic... ] Other authors, such as Bustillo[²¹21. Bustillo Solano EE, Bustillo Madrigal EE, Pérez Francisco Y, Pérez Sosa R, Brito García á, González Iglesia á, et al. Prevalencia de la diabetes mellitus y de la glucemia alterada en ayunas en un área de la ciudad de Sancti Spíritus. Rev Cubana Endocrinol [Internet]. 2013 May-Aug [cited 2013 Oct 10];24(2): 107-24. Available from: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1561-29532013000200002&lng=es. Spanish.
http://scielo.sld.cu/scielo.php?script=s... ] in Sancti Spíritus, found a diabetes prevalence of 13.6%, mainly type 2, starting in the fifth decade of life and predominantly in women; the figure was even higher in a primary care setting in Pinar del Río Province.[¹⁸18. Naranjo AA, Rodríguez áY, Llera RE, Aroche R. Diabetes risk in a Cuban primary care setting in persons with no known glucose abnormalities. MEDICC Rev. 2013 Apr;15(2):16-9.]

Prevalence of type 2 diabetes also varies around the world. The Middle East and North Africa region have one of the highest diabetes rates, at 9.2%, led by Saudi Arabia with 23.8% and Kuwait with 23.1%.[⁴¹41. Majeed A, El-Sayed AA, Khoja T, Alshamsan R, Millett C, Rawaf S. Diabetes in the Middle-East and North Africa: an update for 2013 for the IDF Diabetes Atlas. Diabetes Res Clin Pract [Internet]. 2013 Dec [cited 2014 Jan 29]. Epub ahead of print. Available from: http://dx.doi.org/10.1016/j.diabres.2013.11.00826
http://dx.doi.org/10.1016/j.diabres.2013... ] In Europe, 2013 prevalence was 8.5%, with rates in different countries varying from 2.4% to 14.9%. [⁴³43. Tamayo T, Rosenbauer J, Wild SH, Spijkerman AMW, Baan C, Forouhi NG, et al. Diabetes in Europe: an update for 2013 for the IDF Diabetes Atlas. Diabetes Res Clin Pract [Internet]. 2013 Dec 3 [cited 2014 Jan 19]. Available from: http://dx.doi.org/10.1016/j.diabres.2013.11.007
http://dx.doi.org/10.1016/j.diabres.2013... ] Diabetes prevalence also varies in Latin America, at 6% in Mexico,[³⁰30. Meaney A, Ceballos-Reyes G, Gutiérrez-Salmean G, Samaniego-Méndez V, Vela-Huerta A, Alcocer L, et al. Cardiovascular risk factors in a Mexican middle-class urban population. The Lindavista Study. Arch Cardiol Mex. 2013 Oct-Dec;83(4):249-56.] 6.3% in Brazil,[³3. Pan American Health Organization. Enfermedades no transmisibles en las Américas: construyamos un futuro más saludable. Washington, D.C.: Pan American Health Organization; 2011. Spanish.] 9.5% in Costa Rica[³3. Pan American Health Organization. Enfermedades no transmisibles en las Américas: construyamos un futuro más saludable. Washington, D.C.: Pan American Health Organization; 2011. Spanish.] and 9.6% in Argentina.[⁵5. Ferrante D, Linetzky B, Konofino J, King A, Virgolini M, Laspiur S. Encuesta Nacional de Factores de Riesgo 2009: evolución de la epidemia de enfermedades crónicas no transmisibles en Argentina. Estudio de corte transversal. Rev Argent Salud Pública. 2011 Mar;2(6):34-41. Spanish.]

Hypertension prevalence rates were also found to be higher than those previously reported for the province (21.3%) and Cuba (21.5%), while concurring on predominance of women and older adults.[⁴⁴44. Bonet Gorbea M, Varona Pérez P. III Encuesta Nacional de factores de riesgo y actividades preventivas de enfermedades no transmisibles. Cuba 2010-2011. Havana: Editorial de Ciencias Médicas; 2014. Spanish.] However, Cuba’s Third National Survey on Risk Factors and Chronic Diseases found higher hypertension rates with no differences by sex.[⁴⁴44. Bonet Gorbea M, Varona Pérez P. III Encuesta Nacional de factores de riesgo y actividades preventivas de enfermedades no transmisibles. Cuba 2010-2011. Havana: Editorial de Ciencias Médicas; 2014. Spanish.]

In this study, prevalence of obesity is higher than overweight, contrary to most researchers’ findings and in contrast to a national Cuban study (which found 30.8% overweight and 11.8% obesity),[²²22. Díaz ME, Jiménez S, García RG, Bonet M, Wong I. Overweight, obesity, central adiposity and associated chronic diseases in Cuban adults. MEDICC Rev. 2009 Apr;11(4):23-8. 23. Valdés Pacheco E, Morrees Abella A, Alonso Díaz NL. Prevalencia y factores de riesgo de cardiopatía isquémica. Rev Cubana Med Gen Integr [Internet]. 1998 [cited 2013 Sep 10] ;14(6):590-4. Available from: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-21251998000600014&lng=es. Spanish.
http://scielo.sld.cu/scielo.php?script=s... 24. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics association 2014 update: a report from the American Heart Association. Circulation. 2014 Jan 21;129(3):e28-e292. 25. Sherpa LY, Deji, Stigum H, Chongsuvivatwong V, Nafstad P, Bjertness E. Prevalence of metabolic syndrome and common metabolic components in high altitude farmers and herdsmen at 37GG m in Tibet. High Alt Med Biol. 2013 Mar;14(1):37-44. 26. Deng B, Luo T, Huang Y, Shen T, Ma J. Prevalence and determinants of hyperlipidemia in moderate altitude areas of the Yunnan-Kweichow Plateau in Southwestern China. High Alt Med Biol. 2012 Mar;13(1):13-21. 27. Hou X, Liu Y, Lu H, Ma X, Hu C, Bao Y, et al. Ten-year changes in the prevalence of overweight, obesity and central obesity among the Chinese adults in urban Shanghai, 1998-2GG7 —comparison of two cross-sectional surveys. BMC Public Health [Internet]. 2013 Nov 12 [cited 2014 Jan 19];13:1064. Available from: http://www.biomedcentral.com/1471-2458/13/1G64
http://www.biomedcentral.com/1471-2458/1... 28. Tanaka S, Takase H, Dohi Y, Kimura G. The prevalence and characteristics of microalbuminuria in the general population: a cross-sectional study. BMC Research Notes [Internet]. 2013 Jul 7 [cited 2014 Jan 9];6:256. DOI: 10.1186/1756-0500-6256. Available from: http://www.biomedcentral.com/1756-0500/6/256
10.1186/1756-0500-6256... 29. Guallar-Castillón P, Gil-Montero M, León-Muñoz LM, Graciani A, Bayán-Bravo A, Taboada JM, et al. Magnitud y manejo de la hipercolesterolemia en la población adulta de España, 2008-201G: el estudio ENRICA. Rev Esp Cardiol. 2012;65(6):551-8. Spanish.] but consistent with those of Pérez[⁴⁵45. Pérez CM, Sánchez H, Ortiz AP. Prevalence of overweight and obesity and their cardiometabolic comorbidities in Hispanic adults living in Puerto Rico. J Community Health. 2013 Dec;38(6):1140-6.] in Puerto Rico and Rodríguez[⁴⁶46. Rodríguez-Rodríguez E, López-Plaza B, López-Sobaler AM, Ortega RM. Prevalencia de sobrepeso y obesidad en adultos españoles. Nutr Hosp. 2011 Mar-Apr;26(2):355-63. Spanish.] in Spain, who found higher rates for obesity.

Knowing community-level prevalence of metabolic syndrome risk factors enables assessment of its magnitude serves as evidence for more effective resource allocation. This is crucial in countries such as Cuba that provide free delivery of health care in a public system with universal access and coverage.

Moreover, although metabolic syndrome is itself considered a multiplex risk factor,[⁴4. Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C; American Heart Association. Definition of Metabolic Syndrome. Circulation [Internet]. 2004 Jan 27 [cited 2016 Mar 15];109:433-8. Available from: http://circ.ahajournals.org/content/109/3/433.short
http://circ.ahajournals.org/content/109/... ] it would be useful to measure prevalence of risk factors for metabolic syndrome, to be able to go further upstream in the prevention chain. This study did not attempt to measure such common risk factors as sedentary lifestyle, alcohol consumption and dietary habits, a study limitation.

Research on these factors is recommended. However, this study is the broadest to date on prevalence of metabolic syndrome risk factors in Holguín Province, as a first step for design and implementation of intervention strategies based primarily on lifestyle changes in the affected population.

Prevalence, of course, cannot be used as a risk surrogate, because it is affected by survival rates. Period prevalence for longer periods (≥10 years) is used internationally in chronic disease surveillance as an indicator of population burden,[⁴⁷47. National Cancer Intelligence Network (UK). One, Five and Ten Year Cancer Prevalence by Cancer Network, UK, 2006 [Internet]. London: NCIN; 2009 [cited 2016 Mar 6]. Available from: http://www.ncin.org.uk/view?rid=76
http://www.ncin.org.uk/view?rid=76... ] although, as noted by Ward, may not reflect current population status.[⁴⁸48. Ward MM. Estimating disease prevalence and incidence using administrative data: some assembly required. J Rheumatol. 2013 Aug; 40(8):1241-3. D0I:10.3899/jrheum.130675
10.3899/jrheum.130675... ] Our lengthy data collection period may mean the period prevalence observed does not precisely reflect current population burden.

Nevertheless, this study provides an indication of the magnitude of metabolic syndrome as a public health problem in Holguín Province. Few studies using representative samples have been published on metabolic syndrome risk factor prevalence in the province, representing a disadvantage when judging this study’s external validity, but an advantage when considering the data gap it fills for clinical and epidemiological characterization of these conditions.

CONCLUSIONS

High prevalence of metabolic syndrome risk factors confirms the magnitude of this public health problem in Holguín Province, Cuba.

ACKNOWLEDGMENTS

The authors thank the managers and workers in the study health areas and at the Medical University of Holguín.

REFERENCES

Publication Dates

History