Identifying people with metabolic syndrome in primary care by screening with a mailed tape measure: A survey of 14,000 people in the Netherlands
Introduction
Metabolic syndrome (MetS) refers to a cluster of cardiovascular (CV) risk factors (The European Group For The Study Of Insulin Resistance (EGIR), 2002, Kahn et al., 2005, Dekker et al., 2005). The definition of the Third Report of the National Cholesterol Education Program's Adult Treatment Panel (NCEP/ATP III), including waist circumference (WC) as a measure for central abdominal obesity, is most often used (Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, 2001). The inclusion of WC rather than body mass index in the NCEP/ATP III definition recognizes the important role of abdominal obesity in MetS (Després and Lemieux, 2006).
People with MetS have an up to 4-fold increased risk of mortality from CV disease (Kahn et al., 2005, Pladevall et al., 2006). Adequate treatment of the risk factors associated with MetS can prevent CV diseases (Wong et al., 2003), and lifestyle intervention may reduce the prevalence of MetS (Ilanne-Parikka et al., 2008). The Health Council of the Netherlands suggested targeted screening for various CV risk factors in a high-risk group of obese subjects, instead of a general population-based screening for type 2 diabetes (Health Council of the Netherlands, 2006). Such a screening may be more cost-effective in reducing morbidity and mortality and may easily be performed in primary care (Janssen et al., 2007). To estimate costs, the prevalence of MetS should be known. In the Netherlands, this prevalence was 14% in 1993–1999 (Bos et al., 2007), but more recent figures are lacking.
This study aims to investigate whether a primary care physician (PCP)-driven screening for central obesity can identify people with MetS, according to the NCEP/ATP III definition (Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, 2001), from the general population. Measurement of WC was chosen as the first screening step, as this is a simple step that may predict future coronary heart disease (Rexrode et al., 1998, Lakka et al., 2002). Furthermore, we want to assess the prevalence of MetS in a Dutch city.
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Study design
We performed a cross-sectional survey in five primary health care centers in IJsselstein, a small city (n = 33,000) in the middle of the Netherlands. In these centers, PCPs deliver health care to approximately 23,000 patients. The PCPs apply the same guidelines for management of diabetes and CV diseases (Nederlands Huisartsen Genootschap, 2006, Burgers et al., 2007).
The survey consisted of a mailed tape measure (Tailletest, Voedingscentrum, 2006) and a postage-paid return card, followed by a
Study population
We invited 11,862 subjects to participate in the screening (Fig. 1). Of these, 7336 (62%) returned the reply form and 6843 (58%) measured their WC. Of the latter, 5888 (86%) were interested in further examinations.
Of the respondents who were interested in further examinations, 2004 (34%) had a self-measured WC > 88/102 cm, and 1721 of these subjects (86%) underwent all study procedures. In 10% of the subjects who underwent all study procedures, no CV risk factor was detected, in 27% one risk
Discussion
This is to our knowledge the first study in which PCPs ask their patients to measure their WC as a method of targeted screening for MetS. The results of the screening indicate that it is feasible to identify especially unknown people aged 30–60 years with an elevated CV risk from the general population. As the number of MetS patients detected in people younger than 30 years was very low (n = 16), one might argue that screening is not efficient in this age group. On the other hand, the health gain
Conclusions
A PCP-driven population based screening for central obesity by mailing a tape measure as the first step is a cheap, simple, and feasible method, resulting in prior undiagnosed cases of MetS. Especially cases aged 30–60 years, who do not visit the PCP often, might be detected. This method may serve as an efficient screening for CV risk factors in the general population. Also a relatively large number of people without MetS will be invited for the medical examination. However, as most of them are
Conflict of interest statement
The authors have no conflict of interest to declare.
Acknowledgments
The authors express their special thanks to the primary care physicians, nurse practitioners, and assistants from primary care practices Ametisthof, Glennhof, De Poort, 't Steyn, and De Weegbree in IJsselstein.
Sponsored by a non-restricted grant from Merck Sharp & Dohme.
References (29)
- et al.
Self-reported and technician-measured waist circumferences differ in middle-aged men and women
J. Nutr.
(2005) - et al.
Screen-detected subjects with type 2 diabetes and impaired glucose tolerance have more adverse cardiovascular risk than subjects with impaired fasting glucose especially when they are obese: the ADDITION Netherlands study
Prim. Care Diabetes
(2007) - et al.
Preventing coronary events by optimal control of blood pressure and lipids in patients with the metabolic syndrome
Am. J. Cardiol.
(2003) - et al.
The prevalence of the metabolic syndrome in the Netherlands: increased risk of cardiovascular diseases and diabetes mellitus type 2 in one quarter of persons under 60
Ned. Tijdschr. Geneeskd.
(2007) - et al.
Richtlijn ‘Cardiovasculair risicomanagement’
Ned. Tijdschr. Geneeskd.
(2007) - Cardol, M., Van Dijk, L., De Jong, J.D., De Bakker, D.H., Westert, G.P., 2004. Tweede Nationale Studie naar ziekten en...
- et al.
Metabolic syndrome and 10-year cardiovascular disease risk in the Hoorn study
Circulation
(2005) - et al.
Abdominal obesity and metabolic syndrome
Nature
(2006) Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)
JAMA
(2001)- et al.
De kwaliteit van huisartsenzorg: burgers aan het woord in een zevenlandenonderzoek
Huisarts en Wetenschap
(2008)
Increasing prevalence of the metabolic syndrome among U.S. adults.
Diabetes Care
Overweight and obesity, Publication no. 2003/07
Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women
Arch. Int. Med.
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