PMID- 29410278 OWN - NLM STAT- MEDLINE DCOM- 20190128 LR - 20200306 IS - 1532-8600 (Electronic) IS - 0026-0495 (Print) IS - 0026-0495 (Linking) VI - 83 DP - 2018 Jun TI - Use of BMI as the marker of adiposity in a metabolic syndrome severity score: Derivation and validation in predicting long-term disease outcomes. PG - 68-74 LID - S0026-0495(18)30021-0 [pii] LID - 10.1016/j.metabol.2018.01.015 [doi] AB - BACKGROUND: Estimates of adiposity in evaluating the metabolic syndrome (MetS) have traditionally utilized measures of waist circumference (WC), whereas body mass index (BMI) is more commonly used clinically. Our objective was to determine if a MetS severity Z-score employing BMI as its measure of adiposity (MetS-Z-BMI) would perform similarly to a WC-based score (MetS-Z-WC) in predicting future disease. METHODS: To formulate the MetS-Z-BMI, we performed confirmatory factor analysis on a sex- and race/ethnicity-specific basis on MetS-related data for 6870 adult participants of the National Health and Nutrition Survey 1999-2010. We then validated this score and compared it to MetS-Z-WC in assessing correlations with future coronary heart disease (CHD) and Type 2 diabetes mellitus (T2DM) using Cox proportional hazard analysis of 13,094 participants of the Atherosclerosis Risk in Communities study and Jackson Heart Study. RESULTS: Loading factors, which represent the relative contribution of each component to the latent MetS factor, were lower for BMI than for WC in formulating the two respective scores (MetS-Z-BMI and MetS-Z-WC). Nevertheless, MetS-Z-BMI and MetS-Z-WC exhibited similar hazard ratios (HR) toward future disease. For each one standard-deviation-unit increase in MetS-Z-BMI, HR for CHD was 1.76 (95% confidence interval [CI]: 1.65, 1.88) and HR for T2DM was 3.39 (CI 3.16, 3.63) (both p < 0.0001). There were no meaningful differences between the MetS-Z-WC and MetS-Z-BMI scores in their associations with future CHD and T2DM. CONCLUSIONS: A MetS severity Z-score utilizing BMI as its measure of adiposity operated similarly to a WC-based score in predicting future CHD and T2DM, suggesting overall similarity in MetS-based risk as estimated by both measures of adiposity. This indicates potential clinical usefulness of MetS-Z-BMI in assessing and following MetS-related risk over time. CI - Copyright (c) 2018 Elsevier Inc. All rights reserved. FAU - Gurka, Matthew J AU - Gurka MJ AD - Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida 32608, United States. Electronic address: matthewgurka@ufl.edu. FAU - Filipp, Stephanie L AU - Filipp SL AD - Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida 32608, United States. FAU - Musani, Solomon K AU - Musani SK AD - Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39213, United States. FAU - Sims, Mario AU - Sims M AD - Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39213, United States. FAU - DeBoer, Mark D AU - DeBoer MD AD - Department of Pediatrics, Division of Pediatric Endocrinology, PO Box 800386, University of Virginia, Charlottesville, Virginia 22908, United States. LA - eng GR - HHSN268201100012C/HL/NHLBI NIH HHS/United States GR - HHSN268201100009I/HL/NHLBI NIH HHS/United States GR - HHSN268201100010C/HL/NHLBI NIH HHS/United States GR - HHSN268201100008C/HL/NHLBI NIH HHS/United States GR - HHSN268201100005G/HL/NHLBI NIH HHS/United States GR - HHSN268201100008I/HL/NHLBI NIH HHS/United States GR - HHSN268201100007C/HL/NHLBI NIH HHS/United States GR - HHSN268201100011I/HL/NHLBI NIH HHS/United States GR - HHSN268201100011C/HL/NHLBI NIH HHS/United States GR - HHSN268201300048C/HL/NHLBI NIH HHS/United States GR - HHSN268201100006C/HL/NHLBI NIH HHS/United States GR - HHSN268201300049C/HL/NHLBI NIH HHS/United States GR - HHSN268201100005I/HL/NHLBI NIH HHS/United States GR - HHSN268201300047C/HL/NHLBI NIH HHS/United States GR - HHSN268201300050C/HL/NHLBI NIH HHS/United States GR - R01 HL120960/HL/NHLBI NIH HHS/United States GR - HHSN268201100009C/HL/NHLBI NIH HHS/United States GR - HHSN268201100005C/HL/NHLBI NIH HHS/United States GR - HHSN268201100007I/HL/NHLBI NIH HHS/United States GR - HHSN268201300046C/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Validation Study DEP - 20180202 PL - United States TA - Metabolism JT - Metabolism: clinical and experimental JID - 0375267 RN - 0 (Biomarkers) SB - IM MH - Adiposity/*physiology MH - Adult MH - *Biomarkers/analysis MH - *Body Mass Index MH - Cardiovascular Diseases/diagnosis/etiology/metabolism MH - Disease Progression MH - Female MH - Humans MH - Male MH - Metabolic Syndrome/*diagnosis/etiology/pathology MH - Middle Aged MH - Obesity/complications/diagnosis/metabolism MH - Prognosis MH - Research Design MH - Risk Factors MH - Severity of Illness Index MH - Waist Circumference MH - Waist-Hip Ratio MH - Young Adult PMC - PMC5960618 MID - NIHMS937010 OTO - NOTNLM OT - Cardiovascular disease risk OT - Metabolic syndrome OT - Obesity OT - Type 2 diabetes COIS- Conflict of Interest Statement: None of the authors has any competing interests to declare. EDAT- 2018/02/08 06:00 MHDA- 2019/01/29 06:00 PMCR- 2019/06/01 CRDT- 2018/02/08 06:00 PHST- 2017/10/18 00:00 [received] PHST- 2017/12/14 00:00 [revised] PHST- 2018/01/17 00:00 [accepted] PHST- 2018/02/08 06:00 [pubmed] PHST- 2019/01/29 06:00 [medline] PHST- 2018/02/08 06:00 [entrez] PHST- 2019/06/01 00:00 [pmc-release] AID - S0026-0495(18)30021-0 [pii] AID - 10.1016/j.metabol.2018.01.015 [doi] PST - ppublish SO - Metabolism. 2018 Jun;83:68-74. doi: 10.1016/j.metabol.2018.01.015. Epub 2018 Feb 2.