Boisvenue Jamie J, Oliva Carlo U, Manca Donna P, Johnson Jeffrey A, Yeung Roseanne O
School of Public Health (Boisvenue, Johnson, Yeung), and Department of Computing Science (Oliva), Faculty of Science, and Department of Family Medicine (Manca), Faculty of Medicine & Dentistry, University of Alberta; Northern Alberta Primary Care Research Network (Manca); Division of Endocrinology and Metabolism (Yeung), Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.
CMAJ Open. 2020 Nov 24;8(4):E779-E787. doi: 10.9778/cmajo.20200007. Print 2020 Oct-Dec.
The prevalence of metabolic syndrome is growing worldwide, yet remains underinvestigated in Canadian young adults. We sought to explore the use of a harmonized case definition specific to early-onset metabolic syndrome and determine its feasibility in assessing the prevalence of metabolic syndrome among electronic medical record (EMR) data of young adults in Northern Alberta.
We conducted a cross-sectional study using a sample of EMR data from young adult patients aged 18-40 years and residing in Northern Alberta, who had an encounter with a participating primary care clinic between June 29, 2015, and June 29, 2018. Physical examination, laboratory investigation and disease diagnosis data were collected. A case definition and algorithm were developed to assess the feasibility of identifying metabolic syndrome, including measures for body mass index (BMI), blood pressure (BP), dysglycemia, hypertriglyceridemia, high-density lipoprotein cholesterol, diabetes and hypertension.
Among 15 766 young adults, the case definition suggested the prevalence of metabolic syndrome was 4.4%, 95% confidence interval (CI) 4.1%-4.7%. The most frequent 3-factor combination (41.6%, 95% CI 37.9%-45.3%) of metabolic syndrome criteria consisted of being overweight or obese, having elevated BP and hypertriglyceridemia. Half of metabolic syndrome cases (51.3%, 95% CI 47.6%-55.0%) were missing measures for fasting blood glucose, and one-fifth were missing a hemoglobin A (HbA) level. Notably, most young adults with a BMI of 25 or greater were missing HbA (68.7%, 95% CI 67.6%-69.8%), fasting blood glucose (84.0%, 95% CI 83.2%-84.8%) and triglyceride testing (79.0%, 95% CI 78.1%-79.9%).
We have shown that our case definition is feasible in identifying early-onset metabolic syndrome using EMR data; however, the degree of missing data limits the feasibility in assessing prevalence. Further investigation is required to validate this case definition for metabolic syndrome in the EMR data, which may involve comparing this definition to other validated metabolic syndrome case definitions.
代谢综合征在全球的患病率呈上升趋势，但在加拿大年轻人中仍未得到充分研究。我们试图探索一种针对早发性代谢综合征的统一病例定义的应用，并确定其在评估阿尔伯塔省北部年轻人电子病历（EMR）数据中代谢综合征患病率方面的可行性。
我们进行了一项横断面研究，使用了2015年6月29日至2018年6月29日期间在阿尔伯塔省北部与参与研究的初级保健诊所接触过的18至40岁年轻成年患者的EMR数据样本。收集了体格检查、实验室检查和疾病诊断数据。制定了病例定义和算法，以评估识别代谢综合征的可行性，包括体重指数（BMI）、血压（BP）、血糖异常、高甘油三酯血症、高密度脂蛋白胆固醇、糖尿病和高血压的测量指标。
在15,766名年轻人中，病例定义显示代谢综合征的患病率为4.4%，95%置信区间（CI）为4.1%-4.7%。代谢综合征标准最常见的三因素组合（41.6%，95%CI 37.9%-45.3%）包括超重或肥胖、血压升高和高甘油三酯血症。一半（51.3%）的代谢综合征病例缺少空腹血糖测量值，五分之一的病例缺少糖化血红蛋白（HbA）水平。值得注意 的是，大多数BMI为25或更高的年轻人缺少HbA（68.7%，95%CI 67.6%-69.8%）、空腹血糖（84.0%，95%CI 83.2%-84.8%）和甘油三酯检测（79.0%，95%CI 78.1%-79.9%）。
我们已经表明，我们的病例定义在使用EMR数据识别早发性代谢综合征方面是可行的；然而，数据缺失的程度限制了评估患病率的可行性。需要进一步研究以验证EMR数据中这种代谢综合征病例定义，这可能涉及将此定义与其他经过验证的代谢综合征病例定义进行比较。
