Kim Hoon Seok, Yoo Jaeeun
Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Department of Laboratory Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Medicina (Kaunas). 2025 Aug 21;61(8):1498. doi: 10.3390/medicina61081498.
: Metabolic syndrome (MetS) progresses gradually as individual components accumulate. However, there is limited understanding regarding whether the sequence of component appearance influences disease progression. This study sought to determine the most frequent initial MetS component and evaluate whether this component influences the subsequent risk of developing full MetS. : We examined data from 6137 participants in the Korean Genome and Epidemiology Study (KoGES), free of MetS at baseline (2001-2002), followed until 2011-2012. Participants were stratified by the first emerging MetS component: abdominal obesity, elevated blood pressure, high fasting glucose, high triglycerides, or low HDL cholesterol. The primary endpoint was progression to full MetS, defined as the development of three or more components. We also assessed transition probabilities between components and sex-specific sequence differences. : Abdominal obesity was the most frequent initial metabolic abnormality (31.0%), followed by elevated blood pressure (26.3%), low HDL cholesterol (15.3%), high triglycerides (13.7%), and high fasting glucose (4.9%). Over a median 8.2-year follow-up, participants with initial abdominal obesity exhibited the greatest progression rate to full MetS (44.4%), significantly higher than those with elevated blood pressure (24.8%), high triglycerides (23.0%), high fasting glucose (21.6%), or low HDL cholesterol (9.3%) (all < 0.001). After controlling for age, sex, smoking status, and baseline BMI, initial abdominal obesity was associated with a 4.77-fold increased risk (95% CI: 3.68-6.18) of developing full MetS compared to initial low HDL cholesterol. Distinct transition patterns were observed: high triglycerides frequently transitioned to low HDL cholesterol (78.1%), while abdominal obesity most often led to elevated blood pressure (52.1%). Marked sex-related differences were also found: abdominal obesity was more common initially among women (41.7% vs. 25.2%), whereas elevated blood pressure was predominant among men (37.6% vs. 21.2%). : The initial MetS component strongly predicts progression to full syndrome, with abdominal obesity conferring the highest risk. Early identification and targeted interventions addressing abdominal obesity may effectively prevent MetS and its subsequent complications.
代谢综合征（MetS）会随着各个组成部分的累积而逐渐发展。然而，对于各组成部分出现的顺序是否会影响疾病进展，人们的了解还很有限。本研究旨在确定最常见的初始MetS组成部分，并评估该组成部分是否会影响后续发展为完整MetS的风险。
我们分析了韩国基因组与流行病学研究（KoGES）中6137名参与者的数据，这些参与者在基线期（2001 - 2002年）无MetS，随访至2011 - 2012年。参与者按首个出现的MetS组成部分进行分层：腹型肥胖、血压升高、空腹血糖升高、甘油三酯升高或高密度脂蛋白胆固醇降低。主要终点是进展为完整的MetS，定义为出现三个或更多组成部分。我们还评估了各组成部分之间的转变概率以及性别特异性的顺序差异。
腹型肥胖是最常见的初始代谢异常（31.0%），其次是血压升高（26.3%）、高密度脂蛋白胆固醇降低（15.3%）、甘油三酯升高（13.7%）和空腹血糖升高（4.9%）。在中位8.2年的随访中，初始为腹型肥胖的参与者进展为完整MetS的比例最高（44.4%），显著高于血压升高（24.8%）、甘油三酯升高（23.0%）、空腹血糖升高（21.6%）或高密度脂蛋白胆固醇降低（9.3%）的参与者（均P < 0.001）。在控制了年龄、性别、吸烟状况和基线BMI后，与初始高密度脂蛋白胆固醇降低相比，初始腹型肥胖发展为完整MetS的风险增加4.77倍（95%CI：3.68 - 6.18）。观察到不同的转变模式：甘油三酯升高常转变为高密度脂蛋白胆固醇降低（78.1%），而腹型肥胖最常导致血压升高（52.1%）。还发现了明显的性别差异：腹型肥胖在女性中最初更为常见（41.7%对25.2%），而血压升高在男性中占主导（37.6%对21.2%）。
初始的MetS组成部分强烈预测进展为完整综合征，腹型肥胖的风险最高。早期识别并针对腹型肥胖进行有针对性的干预可能有效预防MetS及其后续并发症。
