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Metabolic Syndrome

Julia Smith

April16th , 2016

Mrs. Holiday


I. Introduction

a. Definition of MetS

b. Metabolic Syndrome ( MetS) Worldwide

II. Data Collection

a. Criteria and condition

III. Predisposing Factors Associated with MetS

a. Modifiable Lifestyle Behaviors

b. Modifiable Lifestyle Behaviors Index

IV. Participants

V. Analysis of Data

VI. Results of the Study

VII. Discussion about Study’s Results

VIII. Public Health Education

IX. Study’s limitation

X. Conclusion

Metabolic Syndrome

It is estimated that around 21% to 25% of the adult population from USA, Europe, Korea,

China and Taiwan have metabolic syndrome (MetS). Also experts have pointed to an increased

risk of developing MetS among adult population worldwide (Kuei-Man et al., 2015). Metabolic

syndrome is a cluster of several symptoms: hypertension, hyperglycemia, hyperlipidemia and

low serum high-density lipoprotein (HDL) level. People with MetS have a higher risk for

developing other diseases such as: coronary heart disease or type 2 diabetes mellitus (Xi et al., as

cited in Kuei-Man et al., 2015).

This paper will discuss about the increased risk of developing MetS in adult Taiwanese

population due to the interaction of several unhealthy modifiable lifestyle behaviors with each

other and with other non modifiable risk factors (Kuei-Man et al., 2015).

Data Collection

Other studies done in the past were focusing mostly on the association between MetS and

one single unhealthy behavior (Katano, as cited in Kuei-Man et al., 2015).This study focused on

the association between MetS , demographic characteristics, and a combination of modifiable

lifestyle behaviors and several non modifiable factors (age and gender). The data was collected

from a Taiwanese population database survey called Nutrition and Health Survey in Taiwan

(NAHSIT), which used a stratified multistage sampling design.

The data was collected from standard questionnaires obtained by face–to-face interviews

and physical examinations: (circumference of the waist, blood pressure, fasting blood glucose,

triglycerides and HDL levels). The survey sample of NAHSIT was obtained from 6,144 people

of all ages from 358 townships and city districts. This study used a smaller sample of data

because children younger than 6 years old were not taken into consideration.

MetS criteria

According to the National Cholesterol Education Program Adult Treatment Panel

guidelines and modified criteria, MetS is characterized by the existence of any three from a

group of five conditions: triglycerides levels more or equal 150 mg/dl, HDL cholesterol levels

less or equal 40mg/dl for men and less or equal 50 mg/dl for women; waist circumference

more or equal 90 cm for men and 80 cm for women; systolic blood pressure more or equal 130

mmHg, diastolic blood pressure more or equal 85 mmHg, or using blood pressure medication;

and fasting blood glucose more or equal 100 mg/dl or using of medication for diabetes.

Predisposing Factors Associated with MetS

Healthy lifestyle behaviors such as a healthy diet, not smoking, less alcohol consumption,

regular physical exercise, have been linked with low risk of MetS in Japan. (Katano, as cited in

Kuei-Man et al., 2015).Whereas unhealthy behaviors, such as smoking, drinking, sedentary

behavior, nine or more hours of sleep per night, have been linked with developing of MetS in

China (Yu et al., as cited in Kuei-Man et al., 2015). In Taiwan, the most common unhealthy

behaviors associated with MetS are the combination of chewing betel quid (a nut) with smoking

behavior and a low level of physical activity (less than 75 min per week).Chewing betel quid is

an important social ritual used in Taiwan due to its effect: euphoria, increased alertness and

energy(Guo et al., as cited in Kuei-Man et al., 2015).

According to Campbell (as cited in Kuei-Man et al., 2015) these unhealthy behaviors

affect the human body by decreasing HDL cholesterol levels and by increasing the risk of

atherosclerosis and adipocytes dysfunction. Also, there are some non modifiable factors that in

combination with the unhealthy behaviors previously mentioned increase even more the risk of

developing MetS. This study used age as a non modifiable risk factor and several social-

economic risk factors, such living with family or married, and the education level (Lim, Nguyen,

Choue, &Wang, as cited in Kuei-Man et al., 2015).


This study has included 1132 men and 1205 women. More than half of the participants

(55.1%) were between 20 and 45 years old, 71.6% were living with family or were married , and

38.4% were college educated. The participants of this study were grouped as: never, former or

current smokers; never, former, or current betel quid chewing; never, moderate, or heavy

drinking behavior, and more or less of 75 min physical activity per week within the last past year

Participants were 29.3% former or current smokers, 43.6% drinkers, 10% chewed betel quid and

60.9% with reported physical activity of less than 75 min per week.

Analysis of Data

In order to establish the association between the variables and the risk of developing

MetS, this study used descriptive statistics, univariate, and multivariate logistic regression

analysis. Data were analyzed with the program Stata version 11.0. The variables used in this

study are several health-related behaviors such as smoking, betel quid chewing, drinking,

physical activity, waist circumference, blood pressure, HDL cholesterol level, fasting blood

glucose level and triglycerides level. Other variables used in this study are some demographic

characteristics such as age, living with family or married, gender and education. (Kuei-Man Lin,

2015).The study used also the modifiable lifestyle behaviors index that took into consideration

both the healthy and unhealthy modifiable behaviors. This index was ranging from 0 to 4, one

point being assigned for each modified lifestyle behavior performed.


Results of the Study

The study’s results show that 25% of participants had MetS. The study’s findings were

similar for various ethnic groups (Beltran-Sanchez et al, 2013). Also, the study shows that the

risk for developing MetS was higher for participants older than 65 years, individuals married or

living with family, smokers, heavy drinkers, betel nut chewing, individuals with less than

elementary education, and participants with physical activity less than 75 min per week.Results

also show that the most important risk factor for MetS among Taiwanese adults was the

combination of betel quid chewing and smoking behaviors. Former smokers and current betel

quid chewers had the highest risk of developing MetS, followed by current betel chewers and

current smokers.

Discussion about the Study’s Results

Another conclusion of the study was that individuals with higher modifiable lifestyle

behavior index have a decreased risk of having MetS. Higher education of participants decreases

the risk of developing MetS because they have adopted a healthier lifestyle .Also, participants

married or living with family have an increased risk of developing MetS because of sharing of a

similar lifestyle. For that reason, another conclusion of the study was that it is important to assess

the family as a group. According to this study, physical activity less than 75 min per week has a

high risk of developing of MetS. Other studies had conflicting results regarding physical activity

and MetS prevention. The relation between the intensity of physical activity and MetS requires

additional study.The risk of MetS is higher in heavy drinkers than nondrinkers. Other studies

regarding alcohol consumption had controversy results. The difference was because of different

types of alcohol drinks. The exception was the moderate drink of wine that lowers the risk of

MetS. Smoking and betel quid chewers have the highest risk for developing MetS due to

increased risk for hyperlipidemia and high cholesterol levels.

Public health Education

It is important for the Taiwanese population to be informed that about the fact that the

risk of developing MetS is three to five times higher for those who smoke or chew betel quid.

The population should be educated also, that by decreasing alcohol consumption and increasing

physical activity the risk of MetS is lower for any age.

Study’s Limitations

This study had some limitations. The data were obtained from face-to-face interviews, the

fact that it might have been affected the objectivity of some answers. Another limitation was that

this study excluded the sleep quality factor. Also, this study did not assess family as a group; the

study and did not take into consideration the influence of the intensity of physical exercise and

the types of alcohol drinks consumed. Because of all these limitations of this study, additional

studies are required to understand the impact of all these factors on MetS.


The results of this study show that MetS is an important public health problem in Taiwan

and that the factors associated with increased risk of MetS are the combination of smoking and

betel quid chewing, alcohol consumption, the lack of healthy lifestyle of the elderly, being

married or living with family, and the lack of physical activity. It is imperative to inform the

Taiwanese population about these unhealthy life style behaviors associated with MetS and also,

to implement strategies to educate Taiwanese population about the ways to prevent MetS by

changing the unhealthy life style behaviors and promoting healthy life style behaviors.


Kuei-Man, L., Jeng-Yuan, C., Shu-Hua, K., Jung-Ying, T., Chien-Ning, H., & Weng-Chun, L.

(2015). Modifiable lifestyle behaviors are associated with metabolic syndrome in a

Taiwanese population. Journal of nursing scholarship, 47:6, 487-495.