Ibrahim Musa S, Pang Dong, Randhawa Gurch, Pappas Yannis
Institute for Health Research, University of Bedfordshire, Putteridge Bury Luton, Bedfordshire, LU2 8LE, England.
Diabetes Metab Syndr Obes. 2022 Apr 6;15:1051-1075. doi: 10.2147/DMSO.S336384. eCollection 2022.
To develop and validate a simple risk model for predicting metabolic syndrome in midlife using a prospective cohort data.
Prospective cohort study.
A total of 7626 members of the 1958 British birth cohort (individuals born in the first week of March 1958) participated in the biomedical survey at age 45 and have completed information on metabolic syndrome.
Variables utilised were obtained prospectively at birth, 7, 16, 23 and 45 years. Multivariable logistic regression was used to develop a total of ten (10) MetS risk prediction models taking the life course approach. Measures of discrimination and calibration were used to evaluate the performance of the models. A pragmatic criteria developed was used to select one model with the most potential to be useful. The internal validity (overfitting) of the selected model was assessed using bootstrap technique of Stata.
Metabolic syndrome was defined based on the NCEP-ATP III clinical criteria.
There is high prevalence of MetS among the cohort members (19.6%), with males having higher risk as compared to females (22.8% vs 16.4%, P < 0.001). Individuals with MetS are more likely to have higher levels of HbA1c and low HDL-cholesterol. Similarly, regarding the individual components of MetS, male cohort members are more likely to have higher levels of glycaemia (HbA1c), BP and serum triglycerides. In contrast, female cohort members have lower levels of HDL-cholesterol and higher levels of waist circumference. Furthermore, a total of ten (10) MetS risk prediction models were developed taking the life course approach. Of these, one model with the most potential to be applied in practical setting was selected. The model has good accuracy (AUROC 0.91 (0.90, 0.92)), is well calibrated (Hosmer-Lemeshow 6.47 (0.595)) and has good internal validity.
Early life factors could be included in a risk model to predict MetS in midlife. The developed model has been shown to be accurate and has good internal validity. Therefore, interventions targeting socioeconomic inequality could help in the wider prevention of MetS. However, the validity of the developed model needs to be further established in an external population.
利用前瞻性队列数据开发并验证一个用于预测中年人群代谢综合征的简单风险模型。
前瞻性队列研究。
1958年英国出生队列中的7626名成员（1958年3月第一周出生的个体）在45岁时参加了生物医学调查，并完成了关于代谢综合征的信息。
所使用的变量是在出生时、7岁、16岁、23岁和45岁时前瞻性获取的。采用多变量逻辑回归，采用生命历程方法开发了总共十个代谢综合征风险预测模型。使用区分度和校准度指标来评估模型的性能。采用制定的实用标准选择一个最具实用潜力的模型。使用Stata的自抽样技术评估所选模型的内部有效性（过度拟合）。
代谢综合征根据美国国家胆固醇教育计划成人治疗组第三次报告（NCEP-ATP III）临床标准定义。
队列成员中代谢综合征的患病率很高（19.6%），男性的风险高于女性（22.8%对16.4%，P<0.001）。患有代谢综合征的个体更有可能具有较高水平的糖化血红蛋白（HbA1c）和较低水平的高密度脂蛋白胆固醇。同样，关于代谢综合征的各个组成部分，男性队列成员更有可能具有较高水平的血糖（HbA1c）、血压和血清甘油三酯。相比之下，女性队列成员的高密度脂蛋白胆固醇水平较低，腰围水平较高。此外，采用生命历程方法开发了总共十个代谢综合征风险预测模型。其中，选择了一个最具潜力应用于实际情况的模型。该模型具有良好的准确性（曲线下面积（AUROC）为0.91（0.90，0.92）），校准良好（Hosmer-Lemeshow检验值为6.47（0.595）），并且具有良好的内部有效性。
早期生活因素可纳入风险模型以预测中年人群的代谢综合征。所开发的模型已被证明是准确的，并且具有良好的内部有效性。因此，针对社会经济不平等的干预措施可能有助于更广泛地预防代谢综合征。然而，所开发模型的有效性需要在外部人群中进一步确立。
