Prevalence of metabolic syndrome in the Gulf Cooperation Council countries: meta-analysis of cross-sectional studies

Article information

J Exerc Rehabil Vol. 16, No. 1, 27-35, February, 2020

Publication date (electronic) : 2020 February 26

doi : https://doi.org/10.12965/jer.1938758.379

Seungmin Shin¹, Haemi Jee^2,

¹Physical Education Department, King Fahd University of Petroleum & Minerals, Dhahran, Saudi Arabia

²Department of Physical Therapy, Namseoul University, Cheonan, Korea

^*Corresponding author: Haemi Jee, https://orcid.org/0000-0002-9066-1472, Department of Physical Therapy, Namseoul University, 91 Daehak-ro, Seobuk-gu, Cheonan 31020, Korea, E-mail: wlgpal9@gmail.com

Received 2019 December 31; Accepted 2020 February 5.

Abstract

INTRODUCTION

The metabolic syndrome has been known to acquire by sedentary lifestyle and calorie rich eating habit. Various metabolic factors may lead to development of life strengthening diseases such as cardiovascular disease, type 2 diabetes, dyslipidemia, and hypertension (Ranasinghe et al., 2017). Although adult-onset diseases may solely occur without the metabolic factors, the risk for the co-occurrence has been known to increase by several folds with the existing metabolic factors (Mente et al., 2010). The most common definitions used to define metabolic syndrome were reported by the World Health Organization (WHO), European Group for Study of Insulin Resistance, National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), International Diabetes Federation (IDF), and Joint Interim Societies (JIS). The metabolic syndrome was defined by basically similar components that included terms. For example, WHO used components such as impaired fasting glucose, impaired glucose tolerance, homeostatic model assessment for insulin resistance, obesity, dyslipidemia, hypertension, waist circumference, and blood pressure as criteria. The NCEP ATP III used components such as fasting triglyceride, fasting high-density lipoprotein, fasting blood glucose as criteria for prevalence of metabolic syndrome (Huang, 2009).

The member states of the Gulf Cooperation Council (GCC) include Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. Recently, the prevalence of the type II diabetes mellitus and related adult-onset disorders have reported to be high in the GCC countries. Several publications reported that four out of six countries of the GCC countries are among the top 10 countries with the greatest prevalence rate for adult-onset type 2 diabetes and cardiovascular diseases (Al-Lawati et al., 2008; Kamran et al., 2007; Ranasinghe et al., 2017). The rapidly increasing rate of the adult-onset chronic complications such as type 2 diabetes and cardiovascular diseases have been related to the changes in the environment and lifestyle that lead to sedentary lifestyle and consumption of food high in calorie (Malik and Razig, 2008). Despite various studies on the prevalence of metabolic syndrome in the GCC countries, the overall report on the metabolic syndrome in the GCC countries is scarce. Therefore, this report was conducted to provide the evidence-based prevalence rate of metabolic syndrome in the GCC area through meta-analysis. Providing evidence- based prevalence rate of the metabolic syndrome in the GCC area could contribute fundamental foundation for developing scientifically supportive evidence for the metabolic syndrome prevention campaign.

MATERIALS AND METHODS

This study is a systemic review prepared by the meta-analysis based on the guidelines provided by the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis protocol) (Moher et al., 2010; Shamseer et al., 2015).

RESULTS

One hundred thirty-two articles were retrieved on the prevalence or metabolic syndrome in the GCC countries through extensive search process online. After through inclusion and exclusion procedures, duplications and irrelevant articles were excluded. After reviewing the title and abstracts, 56 articles were selected for full-text screening. After the full article reviewing, seven articles were excluded due to chronic diseases, three articles were excluded since they were conducted on the subjects that were not of the GCC countries, and five were excluded for being review articles. Therefore, among 132 articles, 37 articles were selected as the final articles for the systematic review. The selection processes for the articles are shown in Fig. 1.

Fig. 1

PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis protocol) diagram for the systematic review of the metabolic syndrome prevalence rates in the Gulf Cooperation Council counties population.

Within 37 articles, 53 different studies were identified and included for the review. Among 53 studies, 19 were published before the year 2009 and 35 were published in the year 2010 or later. Different criteria were used to diagnose metabolic syndrome in the selected studies. Fifteen studies used the criteria proposed by the NCEP ATP III for diagnosing the metabolic syndrome. Eight studies used the criteria by the IDF and 13 studies used the criteria by both NCEP ATP III and IDF. One study used the criteria by NCEP ATP III and WHO and another study used the criteria by NCEP ATP III, IDF, and JIS (Table 1). The metabolic syndrome prevalence rate is also shown as a forest plot for in Fig. 2.

Table 1

Characteristics of the reviewed studies

Fig. 2

Forest plot for the metabolic syndrome prevalence rate of Gulf Cooperation Council counties.

Tables 2 and 3 show the pooled estimates for the prevalence rates of the metabolic syndrome in each country and the overall pooled estimated, respectively. The prevalence rates of the metabolic syndrome in Oman was 0.25 (95% CI, 0.19–0.31), UAE was 0.39 (95% CI, 0.34–0.42), Saudi was 0.28 (95% CI, 0.24–0.33), Kuwait was 0.22 (95% CI, 0.17–0.27), and Qatar was 0.26 (95% CI, 0.18–0.37). Moreover, the pooled prevalence rates of the metabolic syndrome were estimated for the subgroups of studies (Table 4). The random pooled samples of the studies reported before 2009 and after 2010 showed the metabolic syndrome prevalence rates of 0.28 (95% CI, 0.24–0.32) and 0.27 (95% CI, 0.23–0.32), respectively.

Table 2

Pooled estimations of the metabolic syndrome prevalence rate by country

Table 3

Overall pooled estimation of the metabolic syndrome prevalence rate

Table 4

Summary of the main results of the reviewed articles

Twenty-nine studies used the ATP III definition and the prevalence rate in the random pooled estimate was 0.25 (95% CI, 0.22–0.28). Ninety studies used the IDF definition and prevalence rate in the random pooled estimate was 0.28 (95% CI, 0.21–0.36). Three studies used both the ATP III and IDF and their prevalence rate in the random pooled estimate was 0.38 (95% CI, 0.35–0.40). One study used the JIS definition and its prevalence rate in the random pooled estimate was 0.28 (95% CI, 0.22–0.36). Finally, the last one study used the WHO definition and the prevalence rate in the random pooled estimate was 0.39 (95% CI, 0.39–0.45).

Regarding the effects of the adjustment on the random pooled estimates, six adjusted studies showed pooled for prevalence rate by the random effect of 0.28 (95% CI, 0.16–0.32). Forty-seven nonadjusted studies showed pooled prevalence by the random effect of 0.28 (95% CI, 0.25–0.31).

DISCUSSION

This study was conducted to observe the prevalence rate of metabolic syndrome in the GCC countries. In this meta-analysis review, 54 studies and 99,599 subjects were analyzed for the prevalence of metabolic syndrome. Overall, the pooled estimate of the metabolic syndrome prevalence rate in GCC was 0.28 (95% CI, 0.25–0.31). Such metabolic syndrome prevalence rate in the GCC region was greater than that of the other regions such as Latin American, Europe, Africa, and Asia. That is, the observed prevalence rate of the metabolic syndrome in the GCC countries such as was observably higher than other countries worldwide. For example, a systematic review of the countries in the Latin America region showed the metabolic syndrome prevalence rate of 24.9% with the ATP III’s metabolic syndrome definition (Márquez-Sandoval et al., 2011). A combined prospective cohort study on the prevalence rate of the metabolic syndrome reported of 15.0% in Europe with the WHO’s metabolic syndrome definition (Hu et al., 2004).

The prevalence rates of metabolic syndrome in the Sub-Saharan African regions range from 0% to 7.3% (Fezeu et al., 2007). A systematic review that reported the prevalence rates in the Asia-pacific region was 11.9% and 49.0% according to the definitions by ATP III and modified ATP III, respectively (Ranasinghe et al., 2017). On the other hand, the prevalence rates reported by the national survey in the United States were 35% and 39% according to the definitions by the ATP III and IDF, respectively (Ford, 2005). Therefore, the prevalence rate for the metabolic syndrome was high in comparison to some of the regions such as Africa or Asia while still lower than the regions such as the United States.

Over the past few decades, many of the GCC countries have experienced rapid wealth and corresponding urbanization. Such changes have led to a sedentary lifestyle by the general population due to rapid increase in the usage of motored vehicles for commuting. In addition, the working environment and facilities have changed to promote reduction in physical activity. The dietary patterns also changed in association with the environmental changes to promote inactivity and corresponding adult-onset diseases (Alzeidan et al., 2018). Conditions such as the infrastructure of the urban areas with scarce sidewalks or parks, hot arid climate, and conservative social culture restrict physical activity in the Gulf region (Alzeidan et al., 2018).

Although a vast amount of databases and articles were reviewed with detailed inclusion and exclusion criteria for the final selection limitations exist. Since a significant amount of regional reports were prepared in the native language, non-English articles could not be included in this study. The local studies that represent the regional information may provide more detailed input on the prevalence rate.

However, this is the first meta-analysis report on the prevalence ate of the metabolic syndrome in the GCC countries to our knowledge. This report may provide supportive information to prepare for the measures to intervene to prevent and control the onset of metabolic syndrome in the GCC region. It may assist to manage the morbidity and mortality rate related to adult-onset complications.

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