Prevalence and determinants of metabolic syndrome: a cross-sectional survey of general medical outpatient clinics using National Cholesterol Education Program-Adult Treatment Panel III criteria in Botswana
Identifieur interne : 002337 ( Pmc/Corpus ); précédent : 002336; suivant : 002338Prevalence and determinants of metabolic syndrome: a cross-sectional survey of general medical outpatient clinics using National Cholesterol Education Program-Adult Treatment Panel III criteria in Botswana
Auteurs : Bernard Omech ; Jose-Gaby Tshikuka ; Julius C. Mwita ; Billy Tsima ; Oathokwa Nkomazana ; Kennedy Amone-P LakSource :
- Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy [ 1178-7007 ] ; 2016.
Abstract
Low- and middle-income countries, including Botswana, are facing rising prevalence of obesity and obesity-related cardiometabolic complications. Very little information is known about clustering of cardiovascular risk factors in the outpatient setting during routine visits. We aimed to assess the prevalence and identify the determinants of metabolic syndrome among the general outpatients’ attendances in Botswana.
A cross-sectional study was conducted from August to October 2014 involving outpatients aged ≥20 years without diagnosis of diabetes mellitus. A precoded questionnaire was used to collect data on participants’ sociodemographics, risk factors, and anthropometric indices. Fasting blood samples were drawn and analyzed for glucose and lipid profile. Metabolic syndrome was assessed using National Cholesterol Education Program-Adult Treatment Panel III criteria.
In total, 291 participants were analyzed, of whom 216 (74.2%) were females. The mean age of the total population was 50.1 (±11) years. The overall prevalence of metabolic syndrome was 27.1% (n=79), with no significant difference between the sexes (female =29.6%, males =20%,
Metabolic syndrome is highly prevalent in the general medical outpatients clinics. Proactive approaches are needed to screen and manage cases targeting its most important predictors.
Url:
DOI: 10.2147/DMSO.S109007
PubMed: 27616893
PubMed Central: 5008444
Links to Exploration step
PMC:5008444Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Prevalence and determinants of metabolic syndrome: a cross-sectional survey of general medical outpatient clinics using National Cholesterol Education Program-Adult Treatment Panel III criteria in Botswana</title><author><name sortKey="Omech, Bernard" sort="Omech, Bernard" uniqKey="Omech B" first="Bernard" last="Omech">Bernard Omech</name><affiliation><nlm:aff id="af1-dmso-9-273">Department of Internal Medicine</nlm:aff></affiliation></author><author><name sortKey="Tshikuka, Jose Gaby" sort="Tshikuka, Jose Gaby" uniqKey="Tshikuka J" first="Jose-Gaby" last="Tshikuka">Jose-Gaby Tshikuka</name><affiliation><nlm:aff id="af2-dmso-9-273">Department of Family Medicine and Public Health</nlm:aff></affiliation></author><author><name sortKey="Mwita, Julius C" sort="Mwita, Julius C" uniqKey="Mwita J" first="Julius C" last="Mwita">Julius C. Mwita</name><affiliation><nlm:aff id="af1-dmso-9-273">Department of Internal Medicine</nlm:aff></affiliation></author><author><name sortKey="Tsima, Billy" sort="Tsima, Billy" uniqKey="Tsima B" first="Billy" last="Tsima">Billy Tsima</name><affiliation><nlm:aff id="af2-dmso-9-273">Department of Family Medicine and Public Health</nlm:aff></affiliation></author><author><name sortKey="Nkomazana, Oathokwa" sort="Nkomazana, Oathokwa" uniqKey="Nkomazana O" first="Oathokwa" last="Nkomazana">Oathokwa Nkomazana</name><affiliation><nlm:aff id="af3-dmso-9-273">Department of Surgery</nlm:aff></affiliation></author><author><name sortKey="Amone P Lak, Kennedy" sort="Amone P Lak, Kennedy" uniqKey="Amone P Lak K" first="Kennedy" last="Amone-P Lak">Kennedy Amone-P Lak</name><affiliation><nlm:aff id="af4-dmso-9-273">Department of Psychology, University of Botswana, Gaborone, Botswana</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27616893</idno><idno type="pmc">5008444</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008444</idno><idno type="RBID">PMC:5008444</idno><idno type="doi">10.2147/DMSO.S109007</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">002337</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002337</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Prevalence and determinants of metabolic syndrome: a cross-sectional survey of general medical outpatient clinics using National Cholesterol Education Program-Adult Treatment Panel III criteria in Botswana</title><author><name sortKey="Omech, Bernard" sort="Omech, Bernard" uniqKey="Omech B" first="Bernard" last="Omech">Bernard Omech</name><affiliation><nlm:aff id="af1-dmso-9-273">Department of Internal Medicine</nlm:aff></affiliation></author><author><name sortKey="Tshikuka, Jose Gaby" sort="Tshikuka, Jose Gaby" uniqKey="Tshikuka J" first="Jose-Gaby" last="Tshikuka">Jose-Gaby Tshikuka</name><affiliation><nlm:aff id="af2-dmso-9-273">Department of Family Medicine and Public Health</nlm:aff></affiliation></author><author><name sortKey="Mwita, Julius C" sort="Mwita, Julius C" uniqKey="Mwita J" first="Julius C" last="Mwita">Julius C. Mwita</name><affiliation><nlm:aff id="af1-dmso-9-273">Department of Internal Medicine</nlm:aff></affiliation></author><author><name sortKey="Tsima, Billy" sort="Tsima, Billy" uniqKey="Tsima B" first="Billy" last="Tsima">Billy Tsima</name><affiliation><nlm:aff id="af2-dmso-9-273">Department of Family Medicine and Public Health</nlm:aff></affiliation></author><author><name sortKey="Nkomazana, Oathokwa" sort="Nkomazana, Oathokwa" uniqKey="Nkomazana O" first="Oathokwa" last="Nkomazana">Oathokwa Nkomazana</name><affiliation><nlm:aff id="af3-dmso-9-273">Department of Surgery</nlm:aff></affiliation></author><author><name sortKey="Amone P Lak, Kennedy" sort="Amone P Lak, Kennedy" uniqKey="Amone P Lak K" first="Kennedy" last="Amone-P Lak">Kennedy Amone-P Lak</name><affiliation><nlm:aff id="af4-dmso-9-273">Department of Psychology, University of Botswana, Gaborone, Botswana</nlm:aff></affiliation></author></analytic><series><title level="j">Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy</title><idno type="eISSN">1178-7007</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Low- and middle-income countries, including Botswana, are facing rising prevalence of obesity and obesity-related cardiometabolic complications. Very little information is known about clustering of cardiovascular risk factors in the outpatient setting during routine visits. We aimed to assess the prevalence and identify the determinants of metabolic syndrome among the general outpatients’ attendances in Botswana.</p></sec><sec><title>Methods</title><p>A cross-sectional study was conducted from August to October 2014 involving outpatients aged ≥20 years without diagnosis of diabetes mellitus. A precoded questionnaire was used to collect data on participants’ sociodemographics, risk factors, and anthropometric indices. Fasting blood samples were drawn and analyzed for glucose and lipid profile. Metabolic syndrome was assessed using National Cholesterol Education Program-Adult Treatment Panel III criteria.</p></sec><sec><title>Results</title><p>In total, 291 participants were analyzed, of whom 216 (74.2%) were females. The mean age of the total population was 50.1 (±11) years. The overall prevalence of metabolic syndrome was 27.1% (n=79), with no significant difference between the sexes (female =29.6%, males =20%, <italic>P</italic>=0.11). A triad of central obesity, low high-density lipoprotein-cholesterol, and elevated blood pressure constituted the largest proportion (38 [13.1%]) of cases of metabolic syndrome, followed by a combination of low high-density lipoprotein, elevated triglycerides, central obesity, and elevated blood pressure, with 17 (5.8%) cases. Independent determinants of metabolic syndrome were antihypertensive use and increased waist circumference.</p></sec><sec><title>Conclusion</title><p>Metabolic syndrome is highly prevalent in the general medical outpatients clinics. Proactive approaches are needed to screen and manage cases targeting its most important predictors.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Huang, Pl" uniqKey="Huang P">PL Huang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wilson, Pw" uniqKey="Wilson P">PW Wilson</name></author><author><name sortKey="D Gostino, Rb" uniqKey="D Gostino R">RB D’Agostino</name></author><author><name sortKey="Parise, H" uniqKey="Parise H">H Parise</name></author><author><name sortKey="Sullivan, L" uniqKey="Sullivan L">L Sullivan</name></author><author><name sortKey="Meigs, Jb" uniqKey="Meigs J">JB Meigs</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Angelico, F" uniqKey="Angelico F">F Angelico</name></author><author><name sortKey="Del Ben, M" uniqKey="Del Ben M">M del Ben</name></author><author><name sortKey="Augelletti, T" uniqKey="Augelletti T">T Augelletti</name></author><author><name sortKey="De Vita, R" uniqKey="De Vita R">R de Vita</name></author><author><name sortKey="Roma, R" uniqKey="Roma R">R Roma</name></author><author><name sortKey="Violi, F" uniqKey="Violi F">F Violi</name></author><author><name sortKey="Fabiani, M" uniqKey="Fabiani M">M Fabiani</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Byrne, Tj" uniqKey="Byrne T">TJ Byrne</name></author><author><name sortKey="Parish, Jm" uniqKey="Parish J">JM Parish</name></author><author><name sortKey="Somers, V" uniqKey="Somers V">V Somers</name></author><author><name sortKey="Aqel, Ba" uniqKey="Aqel B">BA Aqel</name></author><author><name sortKey="Rakela, J" uniqKey="Rakela J">J Rakela</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Misra, A" uniqKey="Misra A">A Misra</name></author><author><name sortKey="Khurana, L" uniqKey="Khurana L">L Khurana</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dalal, S" uniqKey="Dalal S">S Dalal</name></author><author><name sortKey="Beunza, Jj" uniqKey="Beunza J">JJ Beunza</name></author><author><name sortKey="Volmink, J" uniqKey="Volmink J">J Volmink</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Alberti, K" uniqKey="Alberti K">K Alberti</name></author><author><name sortKey="Eckel, Rh" uniqKey="Eckel R">RH Eckel</name></author><author><name sortKey="Grundy, Sm" uniqKey="Grundy S">SM Grundy</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Alberti, Kg" uniqKey="Alberti K">KG Alberti</name></author><author><name sortKey="Zimmet, Pz" uniqKey="Zimmet P">PZ Zimmet</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kassi, E" uniqKey="Kassi E">E Kassi</name></author><author><name sortKey="Pervanidou, P" uniqKey="Pervanidou P">P Pervanidou</name></author><author><name sortKey="Kaltsas, G" uniqKey="Kaltsas G">G Kaltsas</name></author><author><name sortKey="Chrousos, G" uniqKey="Chrousos G">G Chrousos</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Grundy, Sm" uniqKey="Grundy S">SM Grundy</name></author><author><name sortKey="Hansen, B" uniqKey="Hansen B">B Hansen</name></author><author><name sortKey="Smith, Sc" uniqKey="Smith S">SC Smith</name></author><author><name sortKey="Cleeman, Ji" uniqKey="Cleeman J">JI Cleeman</name></author><author><name sortKey="Kahn, Ra" uniqKey="Kahn R">RA Kahn</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Malangu, N" uniqKey="Malangu N">N Malangu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Awotedu, K" uniqKey="Awotedu K">K Awotedu</name></author><author><name sortKey="Ekpebegh, C" uniqKey="Ekpebegh C">C Ekpebegh</name></author><author><name sortKey="Longo Mbenza, B" uniqKey="Longo Mbenza B">B Longo-Mbenza</name></author><author><name sortKey="Iputo, J" uniqKey="Iputo J">J Iputo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Garrido, Ra" uniqKey="Garrido R">RA Garrido</name></author><author><name sortKey="Semeraro, Mb" uniqKey="Semeraro M">MB Semeraro</name></author><author><name sortKey="Temesgen, Sm" uniqKey="Temesgen S">SM Temesgen</name></author><author><name sortKey="Simi, Mr" uniqKey="Simi M">MR Simi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gyakobo, M" uniqKey="Gyakobo M">M Gyakobo</name></author><author><name sortKey="Amoah, Ag" uniqKey="Amoah A">AG Amoah</name></author><author><name sortKey="Martey Marbell, Da" uniqKey="Martey Marbell D">DA Martey-Marbell</name></author><author><name sortKey="Snow, Rc" uniqKey="Snow R">RC Snow</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tran, A" uniqKey="Tran A">A Tran</name></author><author><name sortKey="Gelaye, B" uniqKey="Gelaye B">B Gelaye</name></author><author><name sortKey="Girma, B" uniqKey="Girma B">B Girma</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Poirier, P" uniqKey="Poirier P">P Poirier</name></author><author><name sortKey="Lemieux, I" uniqKey="Lemieux I">I Lemieux</name></author><author><name sortKey="Mauriege, P" uniqKey="Mauriege P">P Mauriège</name></author><author><name sortKey="Dewailly, E" uniqKey="Dewailly E">E Dewailly</name></author><author><name sortKey="Blanchet, C" uniqKey="Blanchet C">C Blanchet</name></author><author><name sortKey="Bergeron, J" uniqKey="Bergeron J">J Bergeron</name></author><author><name sortKey="Despres, Jp" uniqKey="Despres J">JP Després</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mittelman, Sd" uniqKey="Mittelman S">SD Mittelman</name></author><author><name sortKey="Van Citters, Gw" uniqKey="Van Citters G">GW Van Citters</name></author><author><name sortKey="Kim, Sp" uniqKey="Kim S">SP Kim</name></author><author><name sortKey="Davis, Da" uniqKey="Davis D">DA Davis</name></author><author><name sortKey="Dea, Mk" uniqKey="Dea M">MK Dea</name></author><author><name sortKey="Hamilton Wessler, M" uniqKey="Hamilton Wessler M">M Hamilton-Wessler</name></author><author><name sortKey="Bergman, Rn" uniqKey="Bergman R">RN Bergman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Barzilai, N" uniqKey="Barzilai N">N Barzilai</name></author><author><name sortKey="She, L" uniqKey="She L">L She</name></author><author><name sortKey="Liu, B Q" uniqKey="Liu B">B-Q Liu</name></author><author><name sortKey="Vuguin, P" uniqKey="Vuguin P">P Vuguin</name></author><author><name sortKey="Cohen, P" uniqKey="Cohen P">P Cohen</name></author><author><name sortKey="Wang, J" uniqKey="Wang J">J Wang</name></author><author><name sortKey="Rossetti, L" uniqKey="Rossetti L">L Rossetti</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pouliot, M C" uniqKey="Pouliot M">M-C Pouliot</name></author><author><name sortKey="Despres, J P" uniqKey="Despres J">J-P Després</name></author><author><name sortKey="Lemieux, S" uniqKey="Lemieux S">S Lemieux</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Janssen, I" uniqKey="Janssen I">I Janssen</name></author><author><name sortKey="Katzmarzyk, Pt" uniqKey="Katzmarzyk P">PT Katzmarzyk</name></author><author><name sortKey="Ross, R" uniqKey="Ross R">R Ross</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Peer, N" uniqKey="Peer N">N Peer</name></author><author><name sortKey="Lombard, C" uniqKey="Lombard C">C Lombard</name></author><author><name sortKey="Steyn, K" uniqKey="Steyn K">K Steyn</name></author><author><name sortKey="Levitt, N" uniqKey="Levitt N">N Levitt</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Schillaci, G" uniqKey="Schillaci G">G Schillaci</name></author><author><name sortKey="Pirro, M" uniqKey="Pirro M">M Pirro</name></author><author><name sortKey="Vaudo, G" uniqKey="Vaudo G">G Vaudo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mirmiran, P" uniqKey="Mirmiran P">P Mirmiran</name></author><author><name sortKey="Noori, N" uniqKey="Noori N">N Noori</name></author><author><name sortKey="Azizi, F" uniqKey="Azizi F">F Azizi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Abda, E" uniqKey="Abda E">E Abda</name></author><author><name sortKey="Hamza, L" uniqKey="Hamza L">L Hamza</name></author><author><name sortKey="Tessema, F" uniqKey="Tessema F">F Tessema</name></author><author><name sortKey="Cheneke, W" uniqKey="Cheneke W">W Cheneke</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Modesti, Pa" uniqKey="Modesti P">PA Modesti</name></author><author><name sortKey="Agostoni, P" uniqKey="Agostoni P">P Agostoni</name></author><author><name sortKey="Agyemang, C" uniqKey="Agyemang C">C Agyemang</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Diabetes Metab Syndr Obes</journal-id><journal-id journal-id-type="iso-abbrev">Diabetes Metab Syndr Obes</journal-id><journal-id journal-id-type="publisher-id">Diabetes, Metabolic Syndrome and Obesity</journal-id><journal-title-group><journal-title>Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy</journal-title></journal-title-group><issn pub-type="epub">1178-7007</issn><publisher><publisher-name>Dove Medical Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27616893</article-id><article-id pub-id-type="pmc">5008444</article-id><article-id pub-id-type="doi">10.2147/DMSO.S109007</article-id><article-id pub-id-type="publisher-id">dmso-9-273</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Research</subject></subj-group></article-categories><title-group><article-title>Prevalence and determinants of metabolic syndrome: a cross-sectional survey of general medical outpatient clinics using National Cholesterol Education Program-Adult Treatment Panel III criteria in Botswana</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Omech</surname><given-names>Bernard</given-names></name><xref ref-type="aff" rid="af1-dmso-9-273">1</xref><xref ref-type="corresp" rid="c1-dmso-9-273"></xref></contrib><contrib contrib-type="author"><name><surname>Tshikuka</surname><given-names>Jose-Gaby</given-names></name><xref ref-type="aff" rid="af2-dmso-9-273">2</xref></contrib><contrib contrib-type="author"><name><surname>Mwita</surname><given-names>Julius C</given-names></name><xref ref-type="aff" rid="af1-dmso-9-273">1</xref></contrib><contrib contrib-type="author"><name><surname>Tsima</surname><given-names>Billy</given-names></name><xref ref-type="aff" rid="af2-dmso-9-273">2</xref></contrib><contrib contrib-type="author"><name><surname>Nkomazana</surname><given-names>Oathokwa</given-names></name><xref ref-type="aff" rid="af3-dmso-9-273">3</xref></contrib><contrib contrib-type="author"><name><surname>Amone-P’Olak</surname><given-names>Kennedy</given-names></name><xref ref-type="aff" rid="af4-dmso-9-273">4</xref></contrib></contrib-group><aff id="af1-dmso-9-273"><label>1</label>Department of Internal Medicine</aff><aff id="af2-dmso-9-273"><label>2</label>Department of Family Medicine and Public Health</aff><aff id="af3-dmso-9-273"><label>3</label>Department of Surgery</aff><aff id="af4-dmso-9-273"><label>4</label>Department of Psychology, University of Botswana, Gaborone, Botswana</aff><author-notes><corresp id="c1-dmso-9-273">Correspondence: Bernard Omech, Department of Internal Medicine, University of Botswana, Private Bag UB 00713 Gaborone, Botswana, Tel +267 3 55 4915, Email <email>bgomech@gmail.com</email></corresp></author-notes><pub-date pub-type="collection"><year>2016</year></pub-date><pub-date pub-type="epub"><day>30</day><month>8</month><year>2016</year></pub-date><volume>9</volume><fpage>273</fpage><lpage>279</lpage><permissions><copyright-statement>© 2016 Omech et al. This work is published and licensed by Dove Medical Press Limited</copyright-statement><copyright-year>2016</copyright-year><license><license-p>The full terms of this license are available at <ext-link ext-link-type="uri" xlink:href="https://www.dovepress.com/terms.php">https://www.dovepress.com/terms.php</ext-link> and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.</license-p></license></permissions><abstract><sec><title>Background</title><p>Low- and middle-income countries, including Botswana, are facing rising prevalence of obesity and obesity-related cardiometabolic complications. Very little information is known about clustering of cardiovascular risk factors in the outpatient setting during routine visits. We aimed to assess the prevalence and identify the determinants of metabolic syndrome among the general outpatients’ attendances in Botswana.</p></sec><sec><title>Methods</title><p>A cross-sectional study was conducted from August to October 2014 involving outpatients aged ≥20 years without diagnosis of diabetes mellitus. A precoded questionnaire was used to collect data on participants’ sociodemographics, risk factors, and anthropometric indices. Fasting blood samples were drawn and analyzed for glucose and lipid profile. Metabolic syndrome was assessed using National Cholesterol Education Program-Adult Treatment Panel III criteria.</p></sec><sec><title>Results</title><p>In total, 291 participants were analyzed, of whom 216 (74.2%) were females. The mean age of the total population was 50.1 (±11) years. The overall prevalence of metabolic syndrome was 27.1% (n=79), with no significant difference between the sexes (female =29.6%, males =20%, <italic>P</italic>=0.11). A triad of central obesity, low high-density lipoprotein-cholesterol, and elevated blood pressure constituted the largest proportion (38 [13.1%]) of cases of metabolic syndrome, followed by a combination of low high-density lipoprotein, elevated triglycerides, central obesity, and elevated blood pressure, with 17 (5.8%) cases. Independent determinants of metabolic syndrome were antihypertensive use and increased waist circumference.</p></sec><sec><title>Conclusion</title><p>Metabolic syndrome is highly prevalent in the general medical outpatients clinics. Proactive approaches are needed to screen and manage cases targeting its most important predictors.</p></sec></abstract><kwd-group><title>Keywords</title><kwd>metabolic syndrome</kwd><kwd>determinants</kwd><kwd>general medical outpatient clinics</kwd><kwd>Botswana</kwd></kwd-group></article-meta></front><body><sec sec-type="intro"><title>Introduction</title><p>Metabolic syndrome is commonly encountered in clinical practice worldwide and is defined by co-occurrence of known risk factors for cardiovascular diseases (CVDs), including insulin resistance, atherogenic lipid profile, obesity, and hypertension.<xref rid="b1-dmso-9-273" ref-type="bibr">1</xref> Metabolic syndrome is associated with an excess risk of atherosclerotic CVDs and type 2 diabetes mellitus<xref rid="b2-dmso-9-273" ref-type="bibr">2</xref> and variable complications of nonalcoholic fatty liver diseases and obstructive sleep apnea.<xref rid="b3-dmso-9-273" ref-type="bibr">3</xref>,<xref rid="b4-dmso-9-273" ref-type="bibr">4</xref> Although its pathogenesis is incompletely understood, behavioral and environmental factors such as diet, sedentary lifestyles, urbanization, industrialization, and underlying genetic predisposition are known to play a significant role in its development.<xref rid="b5-dmso-9-273" ref-type="bibr">5</xref> The current decline in HIV/AIDS mortality has tremendously improved life expectancy of populations in developing countries, including Botswana. Ironically, this improvement has been countered by an alarming rise of noncommunicable diseases, including CVDs and type 2 diabetes mellitus within the same populations.<xref rid="b6-dmso-9-273" ref-type="bibr">6</xref> A recent survey of noncommunicable disease risk factors in Botswana by the Ministry of Health has provided evidence of a high burden of obesity and hypertension in the community among adults aged 25–64 years, but its impact and related manifestations such as metabolic syndrome in clinical settings are not known.<xref rid="b7-dmso-9-273" ref-type="bibr">7</xref></p><p>Currently, several expert groups and institutions have proposed different criteria for the diagnosis of metabolic syndrome in clinical practice,<xref rid="b8-dmso-9-273" ref-type="bibr">8</xref>–<xref rid="b10-dmso-9-273" ref-type="bibr">10</xref> which include three or more of the five CVD risk factors. Although there are still no universally accepted diagnostic criteria,<xref rid="b11-dmso-9-273" ref-type="bibr">11</xref> the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII) criteria are considered simple and most practical in clinical practice and have been widely used in most parts of the world.<xref rid="b1-dmso-9-273" ref-type="bibr">1</xref> It is particularly useful for the health care providers to screen for metabolic syndrome and aggressively intervene to reduce patients’ cardiovascular risk.<xref rid="b12-dmso-9-273" ref-type="bibr">12</xref> In addition, individuals with metabolic syndrome should be aware of their risk status and the need to adhere to healthier lifestyle behaviors and medications. We aimed to determine the prevalence of metabolic syndrome among adults attending the general medical outpatient clinics and identify its major determinants among this population.</p></sec><sec sec-type="methods"><title>Methods</title><sec sec-type="methods"><title>Research design and settings</title><p>This is a cross-sectional study that used the quantitative analytical approach to address the research questions. The study was conducted between August and October 2014 in two general medical outpatient clinics of Princess Marina Hospital (PMH) and Letsholathebe II Memorial (LM) Hospital. PMH is the main referral hospital in Gaborone (south of Botswana), and LM is a district hospital in Maun (north of the country). The general medical outpatient clinics at PMH and LM receive on average 40 and 30 patients daily, respectively.</p></sec><sec sec-type="subjects"><title>Participants</title><p>All adults aged ≥20 years within the catchment area of the two hospitals who were attending the general medical outpatient clinics were eligible. Participants were excluded if they had any of the following: any type of diabetes mellitus, acutely ill, or unable to undergo anthropometric evaluation.</p></sec><sec sec-type="methods"><title>Procedures and outcome measures</title><p>All recruitments and evaluations were done by research nurses who had prior training on the study protocol, including anthropometric measurements and good clinical practice certification. We used a systematic random sampling to recruit five patients per day from an average of 30 patients from each clinic. On each study day, a sampling frame was made from a list of patients on scheduled visit. The first patient was picked randomly and evaluated for study eligibility. If eligible, then every sixth patient on the list was subsequently evaluated for study eligibility and enrollment after obtaining informed consent, until the sample size for the day was attained.</p><p>After obtaining written informed consent, data were obtained from the respondents through oral interview using a precoded questionnaire and included the following: age, sex, level of education, marital status, occupation, daily consumption of fruit, berries, or vegetables, daily physical activity (defined as having at least 30 minutes of daily physical activity during work or leisure), history of antihypertensive drug treatment, family history of diabetes mellitus in the first-degree or second-degree relatives, and HIV infection status.</p><p>Blood pressure (BP), height, weight, and waist circumference (WC) were measured during the physical examination. BP was measured by the research nurse after the subject had rested for at least 5 minutes by using the standard mercury sphygmomanometer, with the participant sitting in an upright position. BP was recorded to the nearest 2 mmHg. For each patient, two readings were recorded within a 2-minute interval and averaged. Weight was measured to the nearest 0.1 kg, and standing height was measured to the nearest 0.1 cm using a stadiometer attached to the same medical balance weighing scale (HiCare International, Kerala, India). Body mass index was calculated as weight per square meters (kg/m<sup>2</sup>). WC, to the nearest 0.1 cm, was taken using a nonstretchable tape measure at a level midway between the lowest rib and iliac crest. Waist–hip ratio was also calculated by dividing WC (cm) by hip circumference (cm) and categorized using WHO criteria.<xref rid="b13-dmso-9-273" ref-type="bibr">13</xref></p><p>After the interview and physical examination, overnight fasting blood samples (5 mL) were collected by the research nurse from each participant. After the blood was drawn into ethylenediaminetetraacetic acid-containing vacutainer tube, it was gently shaken; plasma and red blood cells were then separated and frozen at −20°C. All samples from the two hospitals were transported on dry ice to a central laboratory and stored at −70°C before analysis. Plasma serum lipid levels were analyzed by enzyme colorimetric methods using automatic chemistry analyzer machine (Abbott Architect; Abbott GmbH Diagnostika, Wiesbaden, Germany). Plasma glucose was analyzed by the research nurse at point of care using oxidase method (Betachek glucometer; National Diagnostic Products Pty Ltd, Sydney, NSW, Australia).</p></sec><sec><title>Operational definitions</title><p>Metabolic syndrome was diagnosed using NCEP-ATP III criteria, specifically when a subject had three or more of the following components: WC >102 cm (males) or >88 cm (females), triglycerides ≥1.7 mmol/L, high-density lipoprotein-cholesterol (HDL-C) <1.04 mmol/L (males) or <1.30 mmol/L (females), BP ≥130/≥85 mmHg, and fasting glucose ≥6.1 mmol/L.<xref rid="b8-dmso-9-273" ref-type="bibr">8</xref></p></sec><sec sec-type="methods"><title>Statistical analysis</title><p>Data were analyzed using IBM SPSS for Windows (Version 23.0; IBM Corporation, Armonk, NY, USA). Descriptive statistic was used to compute the demographic, clinical, and laboratory characteristics of participants. Continuous variables were expressed as mean value ± SD, and categorical variables as frequencies and proportions (%). For skewed variables, median ± interquatile ranges were computed and tabulated. Comparisons between groups or subgroups were carried out using Student’s <italic>t</italic>-test for continuous variables and the Pearson’s chi-squared test or Fisher’s exact test for categorical variables. The prevalence estimates of metabolic syndrome were categorized based on the NCEP-ATP III criteria for all possible combinations, and cumulative total was determined.</p><p>Demographic and clinical CVD risk factors were investigated as potential predictors for the cumulative metabolic syndrome to compute unadjusted odd ratio (OR) and their 95% confidence interval (CI). All significant predictors were included in the multiple logistic regression analyses controlling for age and sex as possible confounders to compute for adjusted OR and their 95% CI as an approximation of the adjusted relative risk. How well the model fit the data was estimated using the Hosmer–Lemeshow test of goodness of fit. All reported <italic>P</italic>-values were two tailed, and the level of statistical significance was set at 0.05. The study was approved by the ethical committees of the PMH and LM Hospital, University of Botswana and Ministry of Health, and carried out in compliance with the Declaration of Helsinki.</p></sec></sec><sec sec-type="results"><title>Results</title><sec sec-type="intro|subjects"><title>Participants’ characteristics</title><p>A total of 704 outpatient attendees aged ≥20 years were sampled and screened for study eligibility. Two hundred forty-four (35%) patients were excluded because of documented history of diabetes or being acutely ill (<2 weeks) or were unable to undergo anthropometric evaluation. Fifty-two (7%) patients had not fasted and failed to return for phlebotomy. Sixty-seven (9.5%) declined consent. Only 291 participants (41%) who had complete interview and blood data were included in the final analyses.</p><p>The general characteristics of the participants are presented in <xref ref-type="table" rid="t1-dmso-9-273">Table 1</xref>. The mean age of the participants was 50.1 (±11) years, with no significant age differences between the sexes. Of the 291 participants analyzed, 216 (74.2%) were female. All participants were from the urban locations of Gaborone and Maun and were indigenous Batswana. A majority (71%) of the participants had either completed secondary education level or primary education levels, with only <7% having no formal schooling. Regarding employment status, 52% were formally employed and 23% were retired, while only 7% considered themselves unemployed. The most common reason for the visit was regular appointment for either one or more chronic disorders (197 [67.7%]), followed by new referrals (26.5%).</p><p>A majority of the participants (215 [73.9%]) had no symptom at presentation, and the common symptoms were headache, body pains, and shortness of breath. The most common chronic conditions were systemic hypertension (135 [46.4%]) and heart diseases (37 [12.7%]). However, 88 participants (26.9%) had no chronic disease. A total of 114 (39.2%) participants were HIV seropositive, 156 (53.6%) were seronegative negative, and 21 (7.2%) were unknown. Of those who were seropositive, 87 (76.3%) were on first-line antiretroviral therapy (ART; nucleoside/nucleotide analogues and nonnucleoside combinations). Only nine (7.9%) were on second-line ART (protease-based ART) and 18 (15.7%) were not on ART. Notably, there was very low prevalence of physical activity and consumption of vegetables, fruit, and berries in this population (<xref ref-type="table" rid="t1-dmso-9-273">Table 1</xref>). The prevalence of overweight and obesity was 93 (33%) and 98 (33.7%), respectively. Females had significantly higher prevalence of overweight and obesity.</p></sec><sec><title>Components and prevalence of metabolic syndrome</title><p>The most prevalent component of metabolic syndrome in this population was central obesity (162 [55.7%]), followed by hypertension (142 [48.8%]) and low HDL-C (65 [22.3%]). Hypertriglyceridemia was present in 58 (19.9%) participants. Only six (2.1%) had elevated fasting glucose. Females had significantly higher prevalence of central obesity (<italic>P</italic><0.001). The overall metabolic syndrome was present in 79 (27.1%) individuals among the total participants, there was no significance difference (<italic>P</italic>=0.11) between female (81%) and males (19%). A triad of central obesity, low HDL-C, and elevated BP was the most prevalent constituting 13.1% of the total cases, followed by a tetrad of central obesity, low HDL-C, hypertriglyceridemia, and elevated BP at 5.8% of cases. Only one participant had all the five components of the syndrome (<xref ref-type="table" rid="t2-dmso-9-273">Table 2</xref>).</p></sec><sec><title>Determinants</title><p>The results of both univariate and multivariate logistic regression analyses of risk factors for the overall metabolic syndrome are presented in <xref ref-type="table" rid="t3-dmso-9-273">Table 3</xref>. There were no significant associations between socioeconomic status (level of education and employment status), vital characteristics (pulse rate and pulse pressure) and metabolic syndrome. Although physical activity and consumption of vegetables, fruit, and berries showed a protective effect toward metabolic syndrome, it was not statistically significant and was not included in the multivariate analysis. There was no significant association between HIV serostatus or ART and metabolic syndrome in our sample.</p></sec></sec><sec sec-type="discussion"><title>Discussion</title><p>The result of this study indicates that metabolic syndrome is a common comorbidity among the general medical outpatient population in Botswana. The prevalence was 27.1% based on NCEP-ATP III criteria. A triad of central obesity, low HDL-C, and elevated BP was the most prevalent (13.1%) combination of CVD risk factors constituting the syndrome in this population. This was followed by a combination of four CVD risk factors, namely central obesity, low HDL-C, elevated triglycerides, and elevated BP found in 5.8% of the total participants. Despite the preponderance of the female population in our samples, the prevalence of metabolic syndrome was not statistically different between the sexes; however, individuals aged ≥45 years were at increased risk of developing the syndrome. Our findings also suggest that history of regular hypertensive medications use and increased WC were independently associated with the syndrome.</p><p>This is the first report of a systematic screening for metabolic syndrome among general medical outpatients in Botswana. Malangu in 2013 examined HIV population at PMH using the same criteria and found a lower rate of 11%.<xref rid="b14-dmso-9-273" ref-type="bibr">14</xref> Based on the same criteria in the Eastern Cape Province of South Africa, a comparable overall prevalence of 26.6%, with no significant variation among antiretroviral-naive individuals (15.7%) and HIV-negative groups (21.9%) were reported.<xref rid="b15-dmso-9-273" ref-type="bibr">15</xref></p><p>Reports from community survey of health care workers aged 22–65 years in Botswana using the same criteria found a higher prevalence of 34%.<xref rid="b16-dmso-9-273" ref-type="bibr">16</xref> Community surveys from other sub-Saharan African countries reported a lower prevalence, ranging from 12.5% to 15% among general workers in Ethiopia and palm oil workers in Ghana, respectively.<xref rid="b17-dmso-9-273" ref-type="bibr">17</xref>,<xref rid="b18-dmso-9-273" ref-type="bibr">18</xref> These findings are evidence of increasing burden of CVD risk factors and metabolic syndrome in sub-Saharan African urban populations being fueled by changes in lifestyle and nutrition factors against a backdrop of a high burden of chronic HIV infection in the region.</p><p>Our results also show that increased WC was independently predictive of the metabolic syndrome (adjusted OR 6.66, 95% CI 1.87–23.76). This finding is particularly important in resource-limited settings like sub-Saharan African countries where screening programs for CVD risk factors are not a priority due to the high burden of infectious diseases. WC correlates closely with both body mass index and waist–hip ratio and consistently predicts insulin resistance, CVD, hypertension, and stroke.<xref rid="b19-dmso-9-273" ref-type="bibr">19</xref>–<xref rid="b21-dmso-9-273" ref-type="bibr">21</xref> Although, the level of risk varies between population groups, recent data suggest that WC is a better correlate of abdominal visceral adipose tissue accumulation than waist–hip ratio<xref rid="b22-dmso-9-273" ref-type="bibr">22</xref> and body mass index.<xref rid="b23-dmso-9-273" ref-type="bibr">23</xref> In our findings, more than half of the participants had increased WC, of whom >90% were females, which mirrors the reports from similar settings in the South African region.<xref rid="b24-dmso-9-273" ref-type="bibr">24</xref> More than one-third of the participants were overweight, and a similar proportion of individuals were obese, with females being significantly affected. We found low rates of physical activity and daily consumptions of vegetables, fruit, and berries among the participants, which could explain the high burden of overweight and obesity. However, the reason for the sex differences in obesity apart from genetics might also be related to the positive attitudes and cultural values attached to being overweight in some African societies. Being overweight is culturally accepted as a sign of wealth and beauty and in some communities, young girls are specially fed to gain weight in preparations for marriage.<xref rid="b25-dmso-9-273" ref-type="bibr">25</xref> It is therefore imperative that culturally sensitive intervention programs are designed to prevent the rising epidemic of obesity in the region.</p><p>This study further indicates that a history of regular anti-hypertensive medications is independently associated with metabolic syndrome (adjusted OR 2.36, 95% CI 1.23–4.51). In hypertensive subjects, metabolic syndrome amplifies cardiovascular risk associated with high BP, independent of the effect of several traditional cardiovascular risk factors,<xref rid="b26-dmso-9-273" ref-type="bibr">26</xref> which requires targeted intervention by the treating physician.</p><p>Metabolic syndrome is a chronic heterogeneous disease and most of its risk factors are interrelated and share the underlying pathogenic factors, including genetic and dietary patterns. In addition, most of its risk factors are themselves considered components in the definition of the syndrome.<xref rid="b27-dmso-9-273" ref-type="bibr">27</xref>,<xref rid="b28-dmso-9-273" ref-type="bibr">28</xref> It is hence not surprising that these components were the most significant in our multivariate analysis, and therefore these findings underscore the importance of history of hypertension and high WC as key determinants of prevalent metabolic syndrome and can be used to identify at-risk individuals in resource-limited settings. Moreover, according to the consensus document of the European Society of Hypertension working group on hypertension and cardiovascular risk in low resource settings, screening and treatments programs ought to be based on cardiovascular risk stratification, rather than focusing on the single risk factor such as untreated hypertension.<xref rid="b29-dmso-9-273" ref-type="bibr">29</xref> Thus in a clinical setting, the history of hypertension or being on treatment and increased WC are highly predictive of metabolic syndrome in this population and should prompt clinicians to assess for other related CVD risk factors in the same patient.</p><p>This study has several limitations. First, the cross-sectional nature of the study does not establish the causality between metabolic syndrome and the risk factors analyzed. Second, this was a clinic-based survey, and the fact that it was conducted in only two urban-based settings further limits its generalizability to the wider population. Third, the predominantly female population also limits its generalization. However, this is not unique to our study as most surveys in the medical outpatients in general and in this region in particular have also reported female predominance.<xref rid="b15-dmso-9-273" ref-type="bibr">15</xref></p></sec><sec><title>Conclusion</title><p>Our study clearly shows that metabolic syndromes are highly prevalent in the general outpatient populations in the urban settings of Botswana. These findings support the need to equip health care facilities to routinely assess anthropometric indices and identify the most important determinants of metabolic syndrome for case diagnosis and consider preventive intervention programs such as dietary advices and lifestyle changes as well as pharmacotherapy for specific elements of the syndrome.</p></sec></body><back><ack><title>Acknowledgments</title><p>The authors thank all the patients who agreed to participate in the study and the following research nurses who collected the data: Irene N Kebalefetse and Veronica O Makopo. The authors also thank Doctor Gerald-Michael Ssebunnya for his review and useful comments. The study was funded by the Office of Research and Development (ORD) of the University of Botswana.</p></ack><fn-group><fn><p><bold>Disclosure</bold></p><p>The authors report no conflicts of interest in this work.</p></fn></fn-group><ref-list><title>References</title><ref id="b1-dmso-9-273"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Huang</surname><given-names>PL</given-names></name></person-group><article-title>A comprehensive definition for metabolic syndrome</article-title><source>Dis Model Mech</source><year>2009</year><volume>2</volume><issue>5–6</issue><fpage>231</fpage><lpage>237</lpage><pub-id pub-id-type="pmid">19407331</pub-id></element-citation></ref><ref id="b2-dmso-9-273"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wilson</surname><given-names>PW</given-names></name><name><surname>D’Agostino</surname><given-names>RB</given-names></name><name><surname>Parise</surname><given-names>H</given-names></name><name><surname>Sullivan</surname><given-names>L</given-names></name><name><surname>Meigs</surname><given-names>JB</given-names></name></person-group><article-title>Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus</article-title><source>Circulation</source><year>2005</year><volume>112</volume><issue>20</issue><fpage>3066</fpage><lpage>3072</lpage><pub-id pub-id-type="pmid">16275870</pub-id></element-citation></ref><ref id="b3-dmso-9-273"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Angelico</surname><given-names>F</given-names></name><name><surname>del Ben</surname><given-names>M</given-names></name><name><surname>Augelletti</surname><given-names>T</given-names></name><name><surname>de Vita</surname><given-names>R</given-names></name><name><surname>Roma</surname><given-names>R</given-names></name><name><surname>Violi</surname><given-names>F</given-names></name><name><surname>Fabiani</surname><given-names>M</given-names></name></person-group><article-title>Obstructive sleep apnoea syndrome and the metabolic syndrome in an internal medicine setting</article-title><source>Eur J Intern Med</source><year>2010</year><volume>21</volume><issue>3</issue><fpage>191</fpage><lpage>195</lpage><pub-id pub-id-type="pmid">20493421</pub-id></element-citation></ref><ref id="b4-dmso-9-273"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Byrne</surname><given-names>TJ</given-names></name><name><surname>Parish</surname><given-names>JM</given-names></name><name><surname>Somers</surname><given-names>V</given-names></name><name><surname>Aqel</surname><given-names>BA</given-names></name><name><surname>Rakela</surname><given-names>J</given-names></name></person-group><article-title>Evidence for liver injury in the setting of obstructive sleep apnea</article-title><source>Ann Hepatol</source><year>2012</year><volume>11</volume><issue>2</issue><fpage>228</fpage><lpage>231</lpage><pub-id pub-id-type="pmid">22345340</pub-id></element-citation></ref><ref id="b5-dmso-9-273"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Misra</surname><given-names>A</given-names></name><name><surname>Khurana</surname><given-names>L</given-names></name></person-group><article-title>Obesity and the metabolic syndrome in developing countries</article-title><source>J Clin Endocrinol Metab</source><year>2008</year><volume>93</volume><issue>11 suppl 1</issue><fpage>S9</fpage><lpage>S30</lpage><pub-id pub-id-type="pmid">18987276</pub-id></element-citation></ref><ref id="b6-dmso-9-273"><label>6</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Dalal</surname><given-names>S</given-names></name><name><surname>Beunza</surname><given-names>JJ</given-names></name><name><surname>Volmink</surname><given-names>J</given-names></name><etal></etal></person-group><article-title>Non-communicable diseases in sub-Saharan Africa: what we know now</article-title><source>Int J Epidemiol</source><year>2011</year><volume>40</volume><issue>4</issue><fpage>885</fpage><lpage>901</lpage><pub-id pub-id-type="pmid">21527446</pub-id></element-citation></ref><ref id="b7-dmso-9-273"><label>7</label><element-citation publication-type="webpage"><person-group person-group-type="author"><collab>Ministry of Health Republic of Botswana World Health Organization [webpage on the Internet]</collab></person-group><source>Botswana STEPS Survey Chronic Disease Risk Factor Surveillance 2007</source><comment>Available from: <ext-link ext-link-type="uri" xlink:href="http://www.who.int/chp/steps/2007_STEPS_Report_Botswana.pdf">www.who.int/chp/steps/2007_STEPS_Report_Botswana.pdf</ext-link></comment><date-in-citation>Accessed June 21, 2016</date-in-citation></element-citation></ref><ref id="b8-dmso-9-273"><label>8</label><element-citation publication-type="journal"><person-group person-group-type="author"><collab>Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults</collab></person-group><article-title>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)</article-title><source>JAMA</source><year>2001</year><volume>285</volume><issue>19</issue><fpage>2486</fpage><lpage>2497</lpage><comment>Reprinted</comment><pub-id pub-id-type="pmid">11368702</pub-id></element-citation></ref><ref id="b9-dmso-9-273"><label>9</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Alberti</surname><given-names>K</given-names></name><name><surname>Eckel</surname><given-names>RH</given-names></name><name><surname>Grundy</surname><given-names>SM</given-names></name><etal></etal><collab>International Diabetes Federation Task Force on Epidemiology and Prevention</collab><collab>Hational Heart, Lung, and Blood Institute</collab><collab>American Heart Association</collab><collab>World Heart Federation</collab><collab>International Atherosclerosis Society</collab><collab>International Association for the Study of Obesity</collab></person-group><article-title>Harmonizing the metabolic syndrome a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity</article-title><source>Circulation</source><year>2009</year><volume>120</volume><issue>16</issue><fpage>1640</fpage><lpage>1645</lpage><pub-id pub-id-type="pmid">19805654</pub-id></element-citation></ref><ref id="b10-dmso-9-273"><label>10</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Alberti</surname><given-names>KG</given-names></name><name><surname>Zimmet</surname><given-names>PZ</given-names></name></person-group><article-title>Definition, diagnosis and classification of diabetes mellitus and its complications, part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation</article-title><source>Diabet Med</source><year>1998</year><volume>15</volume><issue>7</issue><fpage>539</fpage><lpage>553</lpage><pub-id pub-id-type="pmid">9686693</pub-id></element-citation></ref><ref id="b11-dmso-9-273"><label>11</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kassi</surname><given-names>E</given-names></name><name><surname>Pervanidou</surname><given-names>P</given-names></name><name><surname>Kaltsas</surname><given-names>G</given-names></name><name><surname>Chrousos</surname><given-names>G</given-names></name></person-group><article-title>Metabolic syndrome: definitions and controversies</article-title><source>BMC Med</source><year>2011</year><volume>9</volume><issue>1</issue><fpage>48</fpage><pub-id pub-id-type="pmid">21542944</pub-id></element-citation></ref><ref id="b12-dmso-9-273"><label>12</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Grundy</surname><given-names>SM</given-names></name><name><surname>Hansen</surname><given-names>B</given-names></name><name><surname>Smith</surname><given-names>SC</given-names></name><name><surname>Cleeman</surname><given-names>JI</given-names></name><name><surname>Kahn</surname><given-names>RA</given-names></name></person-group><article-title>Clinical management of metabolic syndrome report of the American Heart Association/National Heart, Lung, and Blood Institute/American Diabetes Association conference on scientific issues related to management</article-title><source>Arterioscler Thromb Vasc Biol</source><year>2004</year><volume>24</volume><issue>2</issue><fpage>e19</fpage><lpage>e24</lpage><pub-id pub-id-type="pmid">14766740</pub-id></element-citation></ref><ref id="b13-dmso-9-273"><label>13</label><element-citation publication-type="book"><person-group person-group-type="author"><collab>World Health Organisation</collab></person-group><source>Waist Circumference and Waist–Hip Ratio: Report of a WHO Expert Consultation, Geneva, 8–11 December 2008</source><publisher-loc>Geneva</publisher-loc><publisher-name>World Health Organisation</publisher-name><year>2011</year></element-citation></ref><ref id="b14-dmso-9-273"><label>14</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Malangu</surname><given-names>N</given-names></name></person-group><article-title>Factors associated with metabolic syndrome among HIV-positive patients at a health facility in Botswana</article-title><source>Br J Med Med Res</source><year>2014</year><volume>4</volume><issue>12</issue><fpage>2352</fpage><lpage>2361</lpage></element-citation></ref><ref id="b15-dmso-9-273"><label>15</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Awotedu</surname><given-names>K</given-names></name><name><surname>Ekpebegh</surname><given-names>C</given-names></name><name><surname>Longo-Mbenza</surname><given-names>B</given-names></name><name><surname>Iputo</surname><given-names>J</given-names></name></person-group><article-title>Prevalence of metabolic syndrome assessed by IDF and NCEP ATP 111 criteria and determinants of insulin resistance among HIV patients in the Eastern Cape Province of South Africa</article-title><source>Diabetes Metab Syndr</source><year>2010</year><volume>4</volume><issue>4</issue><fpage>210</fpage><lpage>214</lpage></element-citation></ref><ref id="b16-dmso-9-273"><label>16</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Garrido</surname><given-names>RA</given-names></name><name><surname>Semeraro</surname><given-names>MB</given-names></name><name><surname>Temesgen</surname><given-names>SM</given-names></name><name><surname>Simi</surname><given-names>MR</given-names></name></person-group><article-title>Metabolic syndrome and obesity among workers at Kanye Seventh-day Adventist Hospital, Botswana</article-title><source>S Afr Med J</source><year>2009</year><volume>99</volume><issue>5</issue><fpage>331</fpage><lpage>334</lpage><pub-id pub-id-type="pmid">19588794</pub-id></element-citation></ref><ref id="b17-dmso-9-273"><label>17</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Gyakobo</surname><given-names>M</given-names></name><name><surname>Amoah</surname><given-names>AG</given-names></name><name><surname>Martey-Marbell</surname><given-names>DA</given-names></name><name><surname>Snow</surname><given-names>RC</given-names></name></person-group><article-title>Prevalence of the metabolic syndrome in a rural population in Ghana</article-title><source>BMC Endocr Disord</source><year>2012</year><volume>12</volume><fpage>25</fpage><pub-id pub-id-type="pmid">23110418</pub-id></element-citation></ref><ref id="b18-dmso-9-273"><label>18</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Tran</surname><given-names>A</given-names></name><name><surname>Gelaye</surname><given-names>B</given-names></name><name><surname>Girma</surname><given-names>B</given-names></name><etal></etal></person-group><article-title>Prevalence of metabolic syndrome among working adults in Ethiopia</article-title><source>Int J Hypertens</source><year>2011</year><volume>2011</volume><fpage>8</fpage><comment>ID 193719</comment></element-citation></ref><ref id="b19-dmso-9-273"><label>19</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Poirier</surname><given-names>P</given-names></name><name><surname>Lemieux</surname><given-names>I</given-names></name><name><surname>Mauriège</surname><given-names>P</given-names></name><name><surname>Dewailly</surname><given-names>E</given-names></name><name><surname>Blanchet</surname><given-names>C</given-names></name><name><surname>Bergeron</surname><given-names>J</given-names></name><name><surname>Després</surname><given-names>JP</given-names></name></person-group><article-title>Impact of waist circumference on the relationship between blood pressure and insulin the Quebec Health Survey</article-title><source>Hypertension</source><year>2005</year><volume>45</volume><issue>3</issue><fpage>363</fpage><lpage>367</lpage><pub-id pub-id-type="pmid">15668356</pub-id></element-citation></ref><ref id="b20-dmso-9-273"><label>20</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mittelman</surname><given-names>SD</given-names></name><name><surname>Van Citters</surname><given-names>GW</given-names></name><name><surname>Kim</surname><given-names>SP</given-names></name><name><surname>Davis</surname><given-names>DA</given-names></name><name><surname>Dea</surname><given-names>MK</given-names></name><name><surname>Hamilton-Wessler</surname><given-names>M</given-names></name><name><surname>Bergman</surname><given-names>RN</given-names></name></person-group><article-title>Longitudinal compensation for fat-induced insulin resistance includes reduced insulin clearance and enhanced beta-cell response</article-title><source>Diabetes</source><year>2000</year><volume>49</volume><issue>12</issue><fpage>2116</fpage><lpage>2125</lpage><pub-id pub-id-type="pmid">11118015</pub-id></element-citation></ref><ref id="b21-dmso-9-273"><label>21</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Barzilai</surname><given-names>N</given-names></name><name><surname>She</surname><given-names>L</given-names></name><name><surname>Liu</surname><given-names>B-Q</given-names></name><name><surname>Vuguin</surname><given-names>P</given-names></name><name><surname>Cohen</surname><given-names>P</given-names></name><name><surname>Wang</surname><given-names>J</given-names></name><name><surname>Rossetti</surname><given-names>L</given-names></name></person-group><article-title>Surgical removal of visceral fat reverses hepatic insulin resistance</article-title><source>Diabetes</source><year>1999</year><volume>48</volume><issue>1</issue><fpage>94</fpage><lpage>98</lpage><pub-id pub-id-type="pmid">9892227</pub-id></element-citation></ref><ref id="b22-dmso-9-273"><label>22</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Pouliot</surname><given-names>M-C</given-names></name><name><surname>Després</surname><given-names>J-P</given-names></name><name><surname>Lemieux</surname><given-names>S</given-names></name><etal></etal></person-group><article-title>Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women</article-title><source>Am J Cardiol</source><year>1994</year><volume>73</volume><issue>7</issue><fpage>460</fpage><lpage>468</lpage><pub-id pub-id-type="pmid">8141087</pub-id></element-citation></ref><ref id="b23-dmso-9-273"><label>23</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Janssen</surname><given-names>I</given-names></name><name><surname>Katzmarzyk</surname><given-names>PT</given-names></name><name><surname>Ross</surname><given-names>R</given-names></name></person-group><article-title>Waist circumference and not body mass index explains obesity-related health risk</article-title><source>Am J Clin Nutr</source><year>2004</year><volume>79</volume><issue>3</issue><fpage>379</fpage><lpage>384</lpage><pub-id pub-id-type="pmid">14985210</pub-id></element-citation></ref><ref id="b24-dmso-9-273"><label>24</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Peer</surname><given-names>N</given-names></name><name><surname>Lombard</surname><given-names>C</given-names></name><name><surname>Steyn</surname><given-names>K</given-names></name><name><surname>Levitt</surname><given-names>N</given-names></name></person-group><article-title>High prevalence of metabolic syndrome in the Black population of Cape Town: the cardiovascular risk in Black South Africans (CRIBSA) study</article-title><source>Eur J Prev Cardiol</source><year>2014</year><volume>22</volume><issue>8</issue><fpage>1036</fpage><lpage>1042</lpage><pub-id pub-id-type="pmid">25208906</pub-id></element-citation></ref><ref id="b25-dmso-9-273"><label>25</label><element-citation publication-type="webpage"><person-group person-group-type="author"><collab>Mohamed AY [webpage on the Internet]</collab></person-group><article-title>Women fight Mauritania’s Fattening traddition</article-title><source>CNNcom</source><comment>[updated October 12, 2010]. Available from: <ext-link ext-link-type="uri" xlink:href="http://edition.cnn.com/2010/WORLD/africa/10/12/mauritania.force.feed/">http://edition.cnn.com/2010/WORLD/africa/10/12/mauritania.force.feed/</ext-link></comment><date-in-citation>Accessed October 23, 2015</date-in-citation></element-citation></ref><ref id="b26-dmso-9-273"><label>26</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Schillaci</surname><given-names>G</given-names></name><name><surname>Pirro</surname><given-names>M</given-names></name><name><surname>Vaudo</surname><given-names>G</given-names></name><etal></etal></person-group><article-title>Prognostic value of the metabolic syndrome in essential hypertension</article-title><source>J Am Coll Cardiol</source><year>2004</year><volume>43</volume><issue>10</issue><fpage>1817</fpage><lpage>1822</lpage><pub-id pub-id-type="pmid">15145106</pub-id></element-citation></ref><ref id="b27-dmso-9-273"><label>27</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mirmiran</surname><given-names>P</given-names></name><name><surname>Noori</surname><given-names>N</given-names></name><name><surname>Azizi</surname><given-names>F</given-names></name></person-group><article-title>A prospective study of determinants of the metabolic syndrome in adults</article-title><source>Nutr Metab Cardiovasc Dis</source><year>2008</year><volume>18</volume><issue>8</issue><fpage>567</fpage><lpage>573</lpage><pub-id pub-id-type="pmid">18068961</pub-id></element-citation></ref><ref id="b28-dmso-9-273"><label>28</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Abda</surname><given-names>E</given-names></name><name><surname>Hamza</surname><given-names>L</given-names></name><name><surname>Tessema</surname><given-names>F</given-names></name><name><surname>Cheneke</surname><given-names>W</given-names></name></person-group><article-title>Metabolic syndrome and associated factors among outpatients of Jimma University Teaching hospital</article-title><source>Diabetes Metab Syndr Obes</source><year>2016</year><volume>9</volume><fpage>47</fpage><lpage>53</lpage><pub-id pub-id-type="pmid">27019600</pub-id></element-citation></ref><ref id="b29-dmso-9-273"><label>29</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Modesti</surname><given-names>PA</given-names></name><name><surname>Agostoni</surname><given-names>P</given-names></name><name><surname>Agyemang</surname><given-names>C</given-names></name><etal></etal><collab>ESH Working Group on Hypertension and Cardiovascular Risk in Low Resource Settings</collab></person-group><article-title>Cardiovascular risk assessment in low-resource settings: a consensus document of the European Society of Hypertension Working Group on hypertension and cardiovascular risk in low resource settings</article-title><source>J Hypertens</source><year>2014</year><volume>32</volume><issue>5</issue><fpage>951</fpage><lpage>960</lpage><pub-id pub-id-type="pmid">24577410</pub-id></element-citation></ref></ref-list></back><floats-group><table-wrap id="t1-dmso-9-273" position="float"><label>Table 1</label><caption><p>Demographic and clinical characteristics of the study participants stratified by sex (N=291)</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="left" rowspan="1" colspan="1">General characteristics</th><th valign="top" align="left" rowspan="1" colspan="1">Total</th><th valign="top" align="left" rowspan="1" colspan="1">Females</th><th valign="top" align="left" rowspan="1" colspan="1">Males</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1">Participants, n (%)</td><td valign="top" align="left" rowspan="1" colspan="1">291 (100)</td><td valign="top" align="left" rowspan="1" colspan="1">216 (74.2)</td><td valign="top" align="left" rowspan="1" colspan="1">75 (25.8)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Mean age, years (±SD)</td><td valign="top" align="left" rowspan="1" colspan="1">50.06 (11)</td><td valign="top" align="left" rowspan="1" colspan="1">50.52 (12)</td><td valign="top" align="left" rowspan="1" colspan="1">49.90 (10)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Mean heart rate, beats per min (±SD)</td><td valign="top" align="left" rowspan="1" colspan="1">76.31 (13.8)</td><td valign="top" align="left" rowspan="1" colspan="1">77.67 (13.33)</td><td valign="top" align="left" rowspan="1" colspan="1">72.38 (14.68)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Mean pulse pressure (±SD)</td><td valign="top" align="left" rowspan="1" colspan="1">50.13 (15.85)</td><td valign="top" align="left" rowspan="1" colspan="1">49.75 (15.61)</td><td valign="top" align="left" rowspan="1" colspan="1">51 (16.56)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Daily physical activity, n (%)</td><td valign="top" align="left" rowspan="1" colspan="1">111 (38.1)</td><td valign="top" align="left" rowspan="1" colspan="1">85 (76.6)</td><td valign="top" align="left" rowspan="1" colspan="1">26 (23.4)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Daily consumption of vegetables, fruit, or berries, n (%)</td><td valign="top" align="left" rowspan="1" colspan="1">38 (13.1)</td><td valign="top" align="left" rowspan="1" colspan="1">29 (76.3))</td><td valign="top" align="left" rowspan="1" colspan="1">9 (23.7)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Regularly used antihypertensive, n (%)</td><td valign="top" align="left" rowspan="1" colspan="1">135 (46.4)</td><td valign="top" align="left" rowspan="1" colspan="1">105 (77.8)</td><td valign="top" align="left" rowspan="1" colspan="1">30 (22.2)</td></tr><tr><td colspan="4" valign="top" align="left" rowspan="1">Family history of diabetes mellitus, n (%)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">First-degree relatives</td><td valign="top" align="left" rowspan="1" colspan="1">51 (17.5)</td><td valign="top" align="left" rowspan="1" colspan="1">38 (74.5)</td><td valign="top" align="left" rowspan="1" colspan="1">13 (25.5)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Second-degree relatives</td><td valign="top" align="left" rowspan="1" colspan="1">42 (14.4)</td><td valign="top" align="left" rowspan="1" colspan="1">33 (78.6)</td><td valign="top" align="left" rowspan="1" colspan="1">9 (21.4)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">HIV positive</td><td valign="top" align="left" rowspan="1" colspan="1">114 (39.2)</td><td valign="top" align="left" rowspan="1" colspan="1">91 (79.8)</td><td valign="top" align="left" rowspan="1" colspan="1">23 (20.2)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">First-line ART</td><td valign="top" align="left" rowspan="1" colspan="1">87 (29.9)</td><td valign="top" align="left" rowspan="1" colspan="1">66 (75.9)</td><td valign="top" align="left" rowspan="1" colspan="1">21 (24.1)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Second-line ART</td><td valign="top" align="left" rowspan="1" colspan="1">9 (3.1)</td><td valign="top" align="left" rowspan="1" colspan="1">9 (100)</td><td valign="top" align="left" rowspan="1" colspan="1">0</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Overweight (BMI: 25–30 Kg/m<sup>2</sup>)</td><td valign="top" align="left" rowspan="1" colspan="1">93 (32)</td><td valign="top" align="left" rowspan="1" colspan="1">76 (81.7)</td><td valign="top" align="left" rowspan="1" colspan="1">17 (18.3)<xref ref-type="table-fn" rid="tfn1-dmso-9-273">a</xref></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Obesity (BMI: >30 kg/m<sup>2</sup>)</td><td valign="top" align="left" rowspan="1" colspan="1">98 (33.7)</td><td valign="top" align="left" rowspan="1" colspan="1">84 (85.7)</td><td valign="top" align="left" rowspan="1" colspan="1">14 (14.3)<xref ref-type="table-fn" rid="tfn1-dmso-9-273">a</xref></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Waist–hip ratio (females >0.85 and males >0.90)</td><td valign="top" align="left" rowspan="1" colspan="1">135 (48.8)</td><td valign="top" align="left" rowspan="1" colspan="1">112 (81.2)</td><td valign="top" align="left" rowspan="1" colspan="1">26 (18.8)<xref ref-type="table-fn" rid="tfn1-dmso-9-273">a</xref></td></tr><tr><td colspan="4" valign="top" align="left" rowspan="1">Components of metabolic syndrome, n (%)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Central obesity</td><td valign="top" align="left" rowspan="1" colspan="1">162 (55.7)</td><td valign="top" align="left" rowspan="1" colspan="1">146 (90.1)</td><td valign="top" align="left" rowspan="1" colspan="1">16 (9.9)<xref ref-type="table-fn" rid="tfn1-dmso-9-273">a</xref></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Elevated blood pressure (systolic BP: ≥130 mmHg; diastolic Bp: ≥85 mmHg)</td><td valign="top" align="left" rowspan="1" colspan="1">142 (48.8)</td><td valign="top" align="left" rowspan="1" colspan="1">107 (75.4)</td><td valign="top" align="left" rowspan="1" colspan="1">35 (24.6)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Fasting glucose ≥6.1 mmHg</td><td valign="top" align="left" rowspan="1" colspan="1">6 (2.1)</td><td valign="top" align="left" rowspan="1" colspan="1">5 (83.3)</td><td valign="top" align="left" rowspan="1" colspan="1">1 (16.7)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Triglycerides ≥1.7 mmHg</td><td valign="top" align="left" rowspan="1" colspan="1">58 (19.9)</td><td valign="top" align="left" rowspan="1" colspan="1">36 (62.1)</td><td valign="top" align="left" rowspan="1" colspan="1">22 (37.9)</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">HDL-cholesterol, mmol/L (females <1.3 and males <1.0)</td><td valign="top" align="left" rowspan="1" colspan="1">65 (22.3)</td><td valign="top" align="left" rowspan="1" colspan="1">45 (69.2)</td><td valign="top" align="left" rowspan="1" colspan="1">20 (30.8)</td></tr></tbody></table><table-wrap-foot><fn><p><bold>Note:</bold></p></fn><fn id="tfn1-dmso-9-273"><label>a</label><p><italic>P</italic>-value statistically significant.</p></fn><fn id="tfn2-dmso-9-273"><p><bold>Abbreviations:</bold> ART, antiretroviral therapy; HDL, high-density lipoprotein; HIV, human immunodeficiency virus; SD, standard deviation.</p></fn></table-wrap-foot></table-wrap><table-wrap id="t2-dmso-9-273" position="float"><label>Table 2</label><caption><p>Frequency distribution of various combinations of components of metabolic syndrome among the participants (N=291)</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="left" rowspan="1" colspan="1">Combinations of metabolic syndrome components</th><th valign="top" align="left" rowspan="1" colspan="1">n (%)</th><th valign="top" align="left" rowspan="1" colspan="1">Cumulative (%)</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1">0 or <3 components</td><td valign="top" align="left" rowspan="1" colspan="1">212 (72.9)</td><td valign="top" align="left" rowspan="1" colspan="1">72.9</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Low HDL + TRI + high BP</td><td valign="top" align="left" rowspan="1" colspan="1">4 (1.4)</td><td valign="top" align="left" rowspan="1" colspan="1">74.2</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Low HDL + TRI + central obesity</td><td valign="top" align="left" rowspan="1" colspan="1">9 (3.1)</td><td valign="top" align="left" rowspan="1" colspan="1">77.3</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Low HDL + TRI + central obesity + high BP</td><td valign="top" align="left" rowspan="1" colspan="1">17 (5.8)</td><td valign="top" align="left" rowspan="1" colspan="1">83.2</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Low HDL + TRI + central obesity + high BP + FG</td><td valign="top" align="left" rowspan="1" colspan="1">1 (0.3)</td><td valign="top" align="left" rowspan="1" colspan="1">83.5</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Low HDL + central obesity + high BP</td><td valign="top" align="left" rowspan="1" colspan="1">38 (13.1)</td><td valign="top" align="left" rowspan="1" colspan="1">96.6</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Low HDL + central obesity + FG</td><td valign="top" align="left" rowspan="1" colspan="1">1 (0.3)</td><td valign="top" align="left" rowspan="1" colspan="1">96.9</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">TRI + central obesity + high BP + FG</td><td valign="top" align="left" rowspan="1" colspan="1">1 (0.3)</td><td valign="top" align="left" rowspan="1" colspan="1">99.3</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Central obesity + FG + High BP</td><td valign="top" align="left" rowspan="1" colspan="1">1 (0.3)</td><td valign="top" align="left" rowspan="1" colspan="1">99.7</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Total</td><td valign="top" align="left" rowspan="1" colspan="1">291 (100)</td><td valign="top" align="left" rowspan="1" colspan="1">100</td></tr></tbody></table><table-wrap-foot><fn id="tfn3-dmso-9-273"><p><bold>Note:</bold> Central obesity, mean waist circumference >88 cm in females and >102 cm in males.</p></fn><fn id="tfn4-dmso-9-273"><p><bold>Abbreviations:</bold> BP, blood pressure; FG, fasting glucose; HDL, high-density lipoprotein; TRI, hypertriglyceridemia.</p></fn></table-wrap-foot></table-wrap><table-wrap id="t3-dmso-9-273" position="float"><label>Table 3</label><caption><p>Univariate and multivariate analyses of demographic and clinical risk factors for metabolic syndrome</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="left" rowspan="1" colspan="1">Characteristics</th><th valign="top" align="left" rowspan="1" colspan="1">Proportions (%)</th><th valign="top" align="left" rowspan="1" colspan="1">Unadjusted OR<break></break>(95% CI)</th><th valign="top" align="left" rowspan="1" colspan="1"><italic>P</italic>-values</th><th valign="top" align="left" rowspan="1" colspan="1">Adjusted OR<break></break>(95% CI)</th><th valign="top" align="left" rowspan="1" colspan="1"><italic>P</italic>-values</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1">Female</td><td valign="top" align="left" rowspan="1" colspan="1">74.2</td><td valign="top" align="left" rowspan="1" colspan="1">1</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Male</td><td valign="top" align="left" rowspan="1" colspan="1">25.8</td><td valign="top" align="left" rowspan="1" colspan="1">1.67 (0.89–3.18)</td><td valign="top" align="left" rowspan="1" colspan="1">0.109</td><td valign="top" align="left" rowspan="1" colspan="1">2.38 (0.94–6.06)</td><td valign="top" align="left" rowspan="1" colspan="1">0.68</td></tr><tr><td colspan="6" valign="top" align="left" rowspan="1">Age groups, years</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"><45</td><td valign="top" align="left" rowspan="1" colspan="1">35.4</td><td valign="top" align="left" rowspan="1" colspan="1">1</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">1</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">45–54</td><td valign="top" align="left" rowspan="1" colspan="1">33</td><td valign="top" align="left" rowspan="1" colspan="1">2.26 (1.15–4.43)</td><td valign="top" align="left" rowspan="1" colspan="1">0.018</td><td valign="top" align="left" rowspan="1" colspan="1">1.26 (0.56–2.84)</td><td valign="top" align="left" rowspan="1" colspan="1">0.58</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">55–64</td><td valign="top" align="left" rowspan="1" colspan="1">19.2</td><td valign="top" align="left" rowspan="1" colspan="1">3.04 (1.41–6.56)</td><td valign="top" align="left" rowspan="1" colspan="1">0.005</td><td valign="top" align="left" rowspan="1" colspan="1">2.26 (0.89–5.72)</td><td valign="top" align="left" rowspan="1" colspan="1">0.09</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">>64</td><td valign="top" align="left" rowspan="1" colspan="1">12.4</td><td valign="top" align="left" rowspan="1" colspan="1">2.66 (1.14–6.21)</td><td valign="top" align="left" rowspan="1" colspan="1">0.024</td><td valign="top" align="left" rowspan="1" colspan="1">1.45 (0.52–4.05)</td><td valign="top" align="left" rowspan="1" colspan="1">0.48</td></tr><tr><td colspan="6" valign="top" align="left" rowspan="1">Body mass index, kg/m<sup>2</sup></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"><25</td><td valign="top" align="left" rowspan="1" colspan="1">36.4</td><td valign="top" align="left" rowspan="1" colspan="1">1</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">1</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">25–30</td><td valign="top" align="left" rowspan="1" colspan="1">28.2</td><td valign="top" align="left" rowspan="1" colspan="1">4.88 (1.20–11.95)</td><td valign="top" align="left" rowspan="1" colspan="1">0.01</td><td valign="top" align="left" rowspan="1" colspan="1">1.77 (0.58–5.43)</td><td valign="top" align="left" rowspan="1" colspan="1">0.32</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">>30</td><td valign="top" align="left" rowspan="1" colspan="1">35.4</td><td valign="top" align="left" rowspan="1" colspan="1">12.24 (5.16–29.06)</td><td valign="top" align="left" rowspan="1" colspan="1"><0.001</td><td valign="top" align="left" rowspan="1" colspan="1">2.62 (0.84–8.23)</td><td valign="top" align="left" rowspan="1" colspan="1">0.1</td></tr><tr><td colspan="6" valign="top" align="left" rowspan="1">Waist circumference (females), cm</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"><94 (<80)</td><td valign="top" align="left" rowspan="1" colspan="1">27.5</td><td valign="top" align="left" rowspan="1" colspan="1">1</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">1</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">94–102 (80–88)</td><td valign="top" align="left" rowspan="1" colspan="1">19.2</td><td valign="top" align="left" rowspan="1" colspan="1">0.88 (0.23–11.95)</td><td valign="top" align="left" rowspan="1" colspan="1">0.8</td><td valign="top" align="left" rowspan="1" colspan="1">0.73 (0.17–3.13)</td><td valign="top" align="left" rowspan="1" colspan="1">0.67</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">>102 (>88)</td><td valign="top" align="left" rowspan="1" colspan="1">53.3</td><td valign="top" align="left" rowspan="1" colspan="1">11.05 (4.53–26.99)</td><td valign="top" align="left" rowspan="1" colspan="1"><0.001</td><td valign="top" align="left" rowspan="1" colspan="1">6.66 (1.87–23.76)</td><td valign="top" align="left" rowspan="1" colspan="1">0.004<xref ref-type="table-fn" rid="tfn6-dmso-9-273">b</xref></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Abnormal waist to hip ratio<xref ref-type="table-fn" rid="tfn5-dmso-9-273">a</xref></td><td valign="top" align="left" rowspan="1" colspan="1">48.8</td><td valign="top" align="left" rowspan="1" colspan="1">3.33 (1.92–5.82)</td><td valign="top" align="left" rowspan="1" colspan="1"><0.001</td><td valign="top" align="left" rowspan="1" colspan="1">1.5 (0.75–2.97)</td><td valign="top" align="left" rowspan="1" colspan="1">0.25</td></tr><tr><td colspan="6" valign="top" align="left" rowspan="1">Family history of diabetes mellitus</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">First-degree family</td><td valign="top" align="left" rowspan="1" colspan="1">17.5</td><td valign="top" align="left" rowspan="1" colspan="1">1.96 (1.03–3.75</td><td valign="top" align="left" rowspan="1" colspan="1">0.042</td><td valign="top" align="left" rowspan="1" colspan="1">1.55 (0.70–3.43)</td><td valign="top" align="left" rowspan="1" colspan="1">0.28</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Second-degree family</td><td valign="top" align="left" rowspan="1" colspan="1">14.4</td><td valign="top" align="left" rowspan="1" colspan="1">0.95 (0.44–2.07)</td><td valign="top" align="left" rowspan="1" colspan="1">0.9</td><td valign="top" align="left" rowspan="1" colspan="1">0.67 (0.27–1.67)</td><td valign="top" align="left" rowspan="1" colspan="1">0.39</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Daily physical activity</td><td valign="top" align="left" rowspan="1" colspan="1">38.1</td><td valign="top" align="left" rowspan="1" colspan="1">0.7 (0.42–1.18)</td><td valign="top" align="left" rowspan="1" colspan="1">0.19</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Daily consumption of vegetables, fruits, or berries</td><td valign="top" align="left" rowspan="1" colspan="1">13.1</td><td valign="top" align="left" rowspan="1" colspan="1">0.59 (0.29–1.20)</td><td valign="top" align="left" rowspan="1" colspan="1">0.15</td><td valign="top" align="left" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Regular antihypertensive use</td><td valign="top" align="left" rowspan="1" colspan="1">46.4</td><td valign="top" align="left" rowspan="1" colspan="1">3.23 (1.88––5.57)</td><td valign="top" align="left" rowspan="1" colspan="1"><0.001</td><td valign="top" align="left" rowspan="1" colspan="1">2.36 (1.23–4.51)</td><td valign="top" align="left" rowspan="1" colspan="1">0.01<xref ref-type="table-fn" rid="tfn5-dmso-9-273">a</xref></td></tr></tbody></table><table-wrap-foot><fn><p><bold>Notes:</bold></p></fn><fn id="tfn5-dmso-9-273"><label>a</label><p>Waist to hip ratio defined abnormal if >0.94 for males and >0.8 for females.</p></fn><fn id="tfn6-dmso-9-273"><label>b</label><p><italic>P</italic>-value statistically significant.</p></fn><fn id="tfn7-dmso-9-273"><p><bold>Abbreviations:</bold> CI, confidence interval; OR, odds ratio.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/SidaSubSaharaV1/Data/Pmc/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 002337 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd -nk 002337 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Sante
|area= SidaSubSaharaV1
|flux= Pmc
|étape= Corpus
|type= RBID
|clé= PMC:5008444
|texte= Prevalence and determinants of metabolic syndrome: a cross-sectional survey of general medical outpatient clinics using National Cholesterol Education Program-Adult Treatment Panel III criteria in Botswana
}}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/RBID.i -Sk "pubmed:27616893" \
| HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd \
| NlmPubMed2Wicri -a SidaSubSaharaV1
| This area was generated with Dilib version V0.6.32. |  |