Metabolic Syndrome Severity Calculator
Measuring Severity of the Metabolic Syndrome: A Sex and Race/Ethnicity-Specific Score
What is the Metabolic Syndrome?
The metabolic syndrome (MetS) is a cluster of interrelated risk factors that have been found to be associated with future cardiovascular disease and type 2 diabetes. (1)
How is the Metabolic Syndrome Defined?
One commonly used criteria is the ATP-III, where an adult is classified as having MetS if he/she has 3 or more of the following features (1):
- Waist circumference:
- > 102 cm in men
- > 88 cm in women
- Triglycerides > 150 mg/dL
- < 40 mg/dL in men
- < 50 mg/dL in women
- Blood pressure > 130/85 mm Hg
- Glucose > 100 mg/dL, or diagnosed diabetes
However, numerous proposed criteria exist, and even more definitions have been proposed for use in children.
Why a Severity Score?
Others (2) have recommended such a severity score to improve the ability to accurately predict disease. In forming a continuous score, an estimate of the individual components that commonly make up the classic definitions of MetS (obesity, lipids, blood pressure, and glucose) is summed up somehow to provide an estimate of overall MetS severity. This approach has two main benefits:
- Fewer “false negatives” – we would assign a severity score to an individual that just misses the above criteria but who is approaching MetS; this score would indicate this.
- Ability to track individuals over time – we would thus be able to monitor progression, and evaluate the effectiveness of any interventions designed to treat MetS.
This is not the first continuous score proposed; however, the methods used to develop the score allow for correlations among the MetS components, and allow for differences in how these components correlate with this underlying MetS factor by sex and race/ethnicity. This is important, as it has been shown repeatedly that the association between MetS and biomarkers of future disease differs by both sex and race/ethnicity (3, 4, 5). The weight given to the individual components of MetS (triglycerides, HDL cholesterol, systolic blood pressure) thus varies in this score by racial/ethnic group according to how closely the components cluster together in that group.
How is the Score Calculated and Interpreted?
We aimed at creating a score that was simply a continuous version of traditionally defined MetS while allowing for sex and racial/ethnic differences. Moreover, our primary motivation was a clinically accessible tool that could be easily calculated and interpreted. The resulting score is actually a z-score from the normal distribution, with a value of 0 indicating an "average" severity score. Percentiles associated with each score can be interpreted as one would interpret percentiles for growth in children.
Our severity score equations for adolescents (using BMI) as well as adults (using waist circumference) have been published. (6, 7) For ease of clinical use and due to substantial growth that occurs during adolescence, the score is based on BMI z-scores rather than waist circumference. The adult score uses waist circumference rather than BMI. Please click the button at the top of this page to access the calculator for both adolescents (12-19 years of age) and adults (20 years and older), and please refer to the adolescent publication to review the methods and the resulting formula (the adult information is forthcoming).
If you have questions, or if you need assistance in calculating the score for participants in your data set(s), please contact Matthew Gurka, PhD, Founding Chair of the Department of Biostatistics at West Virginia University.
- Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, Spertus JA, Costa F; American Heart Association; National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement [published corrections appear in Circulation. 2005;112:e297 and Circulation.2005;112:e298]. Circulation. 2005; 112: 2735–2752
- Kahn R, Buse J, Ferrannini E, Stern M. The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. Sep 2005;28(9):2289-2304
- Walker SE, Gurka MJ, Oliver MN, Johns DW, DeBoer MD. Racial/ethnic discrepancies in the metabolic syndrome begin in childhood and persist after adjustment for environmental factors. Nutrition, Metabolism and Cardiovascular Disease 22: 141-148, 2012.
- DeBoer MD, Gurka MJ, Sumner AE. A diagnosis of the metabolic syndrome is associated with a disproportionately high degree of inflammation demonstrated by high levels of hsCRP in non-Hispanic black adolescents: An analysis of NHANES 1999-2008. Diabetes Care 34: 734-740, 2011.
- DeBoer MD, Dong L, Gurka MJ. Racial/ethnic and sex differences in the relationship between uric acid and metabolic syndrome in adolescents: an analysis of NHANES 1999-2006. Metabolism 61: 554-561, 2012.
- Gurka MJ, Ice CL, Sun SS, DeBoer MD. A confirmatory factor analysis of the metabolic syndrome in adolescents: an examination of sex and racial/ethnic differences. Cardiovascular Diabetology 11: 128, 2012 (full text) (pdf)
- Gurka MJ, Lilly CL, Oliver MN, DeBoer MD. An examination of sex and racial/ethnic differences in the metabolic syndrome among adults: A confirmatory factor analysis and a resulting continuous severity score. Metabolism 63: 218-225 (2014) (full text).
This work was supported by NIH grants U54GM10492, R01HL120960, R21DK085363, and K08HD060739-03.
We wish to express our gratitude to the WVU Health Sciences Center Information Technology Services (ITS), particularly Travis Maynard, for assistance with the development of the calculator and the website.