Capturing metabolic syndrome in low-resource settings: a case study in urban Haiti

Nour Mourra^1*Vanessa Rouzier^2,3Rodney Sufra³Reichling St Sauveur³Jodany Bernadin³Joseph Inddy³Alexandra Apollon³Rehana Rasul⁴Anju Ogyu²Lily Yan^2,5Jean William Pape³Margaret Mcnairy^2,5

• ¹Doctor of Medicine Program, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
• ²Weill Cornell Medicine Center for Global Health, New York, United States
• ³GHESKIO, Port-au-Prince, Haiti
• ⁴CUNY Graduate School of Public Health & Health Policy, New York, United States
• ⁵Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York City, United States

Local epidemiologic data on risk factors for heart disease are needed in low-income settings to guide targeted interventions for prevention and treatment. Metabolic syndrome (MetS) is a cluster of conditions (elevated blood pressure, blood sugar, waist circumference and cholesterol) that increases risk for cardiovascular disease (CVD), however the gold-standard MetS definition requires laboratory testing which are be limited in low-income countries like Haiti. The objective of this study was to estimate the prevalence of MetS in urban Haiti and compare it to alternative nonlaboratory MetS definitions. This study is a cross-sectional analysis of enrollment data from the population-based Haiti CVD Cohort Study which includes 3,005 participants ≥18 years, in Port-au-Prince. Demographic, health behavior, and clinical data including laboratory tests were collected. Gold standard, harmonized MetS (MetS-H) was defined as having three or more of the following: elevated blood pressure (eBP), elevated waist circumference (eWC), elevated fasting glucose, reduced HDL-C or elevated triglycerides. Three nonlaboratory alternatives were defined as: MetS-1 (eBP, and eWC), MetS-2 (three or more of: eBP, eWC, family or personal history of CVD), and MetS-3 (four or more of: eBP, eWC, family or personal history of CVD, high alcohol intake, current/former smoker, high fat intake). Sensitivity and specificity were calculated for each nonlaboratory MetS definition, compared to MetS-H. Associations between risk factors and MetS-H were assessed using multivariable log-binomial regressions. Among 2721 participants with a mean age of 42 years (SD 16), the prevalence of MetS-H was 21.2% (29.1% women, 10.4% men). Elevated blood pressure (82.9%), reduced HDL-C (81.7%) and elevated waist circumference (90.7%) were the most common components of MetS. The prevalence of nonlaboratory definitions were: MetS-1 22.5%, MetS-2 22.6%, and MetS-3 22.2%. Compared with MetS-H, MetS-1 had the highest sensitivity (74.4%, 95% CI: 70.6%, 77.9%) and the highest specificity (91.6%, 95% CI: 90.7%, 92.7%). Female sex and age >30 years were associated with MetS-H. The prevalence of MetS is high in urban Haiti and associated with older age and females. Simplified screening with nonlaboratory MetS definitions may be a pragmatic alternative to screening in low-income countries.