Trajectories of Metabolic Syndrome Development in Young Adults

BackgroundMetabolic syndrome (MetS) is a constellation of metabolic aberrations that collectively increase the risk for cardiovascular disease and type 2 diabetes. Greater understanding of MetS developments may provide insight into targeted prevention strategies for individuals at greatest risk. The purpose of this study was to i) identify distinct patterns of longitudinal MetS development and; ii) develop a character profile that differentiates groups by level of MetS risk.Methods and ResultsData from the Coronary Artery Risk Development in Young Adults (CARDIA) study (n = 3 804; 18–30 y) was obtained by limited access application from the National Heart, Lung, and Blood Institute and used for this analysis. MetS, as defined by the Harmonized criteria, was assessed over a 20 year follow-up period. Group-level trajectory analysis identified 4 distinct groups with varying rates of component development [No (23.8% of sample); Low (33.5%); Moderate (35.3%); and High MetS (7.4%)]. After adjusting for covariates, individuals in the At-Risk groups (Low, Moderate and High MetS) were more likely to be of black ethnicity (1.37, 1.14–1.66), have a family history of cardiovascular disease (1.61, 1.31–1.97) and history of dieting (1.69, 1.20–2.39) when compared to the No Risk trajectory group (No MetS). Conversely, increasing baseline education (0.76, 0.65–0.89) and aerobic fitness (0.55, 0.47–0.64) was inversely associated with At-Risk group membership.ConclusionsResults suggest distinct profiles of MetS development that can be identified by baseline risk factors. Further research is necessary to understand the clinical implication of intermediate MetS development groups with respect to overall cardiometabolic risk.

研究背景
代谢综合征（Metabolic syndrome, MetS）是一组代谢异常症候群，可共同增加心血管疾病与2型糖尿病的发病风险。加深对MetS发生发展的认识，可为高危人群的针对性预防策略提供理论依据。本研究旨在实现两大目标：① 明确代谢综合征纵向发生发展的不同模式；② 构建可依据代谢综合征风险水平区分人群的特征画像。

研究方法与结果
本研究使用青年冠状动脉风险发展（Coronary Artery Risk Development in Young Adults, CARDIA）队列的研究数据（n=3804；受试者年龄18~30岁），该数据通过美国国家心脏、肺和血液研究所的受限访问申请获取，并用于本次分析。本研究采用统一标准（Harmonized criteria）定义代谢综合征，并对受试者开展了为期20年的随访评估。群体水平轨迹分析共识别出4组具有不同代谢异常组分进展速率的人群：无代谢综合征组（占样本的23.8%）、低风险组（33.5%）、中度风险组（35.3%）及高代谢综合征组（7.4%）。在校正混杂因素后，与无风险轨迹组（无代谢综合征）相比，各风险组（低、中、高代谢综合征组）个体更大概率为黑人种族（比值比1.37，95%置信区间1.14~1.66）、存在心血管疾病家族史（比值比1.61，95%置信区间1.31~1.97）及有节食史（比值比1.69，95%置信区间1.20~2.39）。与之相反，基线时较高的受教育程度（比值比0.76，95%置信区间0.65~0.89）与有氧适能水平（比值比0.55，95%置信区间0.47~0.64）与归入风险组呈负相关。

研究结论
本研究结果显示，代谢综合征的发生发展存在不同的特征画像，可通过基线风险因素进行识别。未来仍需开展进一步研究，以明确中间代谢综合征发生发展人群的临床意义及其对整体心代谢风险的影响。