PhilSPEN Online Journal of Parenteral and Enteral Nutrition

(Article 47 | POJ_0042)

Thesis Abstract

Risk Factors of Metabolic Syndrome using the World Health Organization and American Association of Clinical Endocrinologist Cut-Offs at the Nutrition Clinic of Philippine General Hospital

Introduction | Methodology | Results | Conclusion | Recommendation | Back to Total Names Codes

Submitted: June 2009

AUTHOR: Salome R. Santella, RND

INSTITUTION WHERE THESIS WAS DONE: Philippine Women's University, Metro-Manila, Philippines


This study sought to answer the following questions:

  1. What is the prevalence of patients with metabolic syndrome as defined by WHO and AACE?
  2. What are the risk factors associated with MetS using the WHO and AACE cut-offs?
  3. Which definition of MetS gives an early warning criterion so that an immediate nutrition therapy can be instituted to a susceptible MetS patient?

A retrospective cohort design was used in the study to analyze the readily available data at the PGH nutrition clinic for review and scrutiny.   In this study, two different definitions were used, particularly the WHO and AACE,  to identify who among the targeted patients have risk factors of MetS, simply because of  the limited information available from the data base of the clinic. Census data on daily visits of patients were reviewed to abstract and classify patients as possessing risk factors of MetS. Patients who were 20 years old and beyond and who had been seen at least twice in the nutrition clinic between 2006 to October 2008, were eligible for inclusion in the study. Subjects that were below the required age, pregnant, with edema or edematous tendency diseases such as in renal and liver, as well as those who did not have a follow- up consultation in Nutrition Clinic were excluded.

All 5,931 patients in the database were accounted for, but only those patients with available relevant variables were analyzed especially for identification and profiling of risk factor eligibility. From the records reviewed, 460 patients were included. 

The research data were quantitative in nature thus, the following tools were used in the analysis and interpretation of data: percentage   to analyze the distribution of participants according to profile variables and risk factors; Chi- square method to get the significance of the difference between two defined subjects. Pearson correlation (r)  to determine the relationship between management given and risk factors; while, a descriptive analysis was undertaken among patients identified with risk factors of MetS.  


Profile of the 460 patients seen at Nutrition Clinic within 2006 -2008

  • Gender - Majority of the patients (69%) are female while 30%  are male.
  • Age - The highest age range is from 50-60 years old with 40% followed by 28% composed of 60 up. The lowest and the youngest group is from 20-29 with 3%.
  • Physical Activity - Ninety four percent (94%) of the patient coming for consultation are sedentary.
  • Food Preferences - Prior to getting sick, majority of these patients consume fatty foods (76%) while sweets and salty foods are preferred almost at the same level  at 65% and 64%, respectively .
  • Lifestyle - Fifteen percent (15 %) of the patients, admitted they still  have their vices, such as 9%  from alcohol drinking, 4% cigarette smoking and 2% combination from alcohol drinking and cigarette smoking.

Prevalence of Patients with Metabolic Syndrome as Defined by WHO and AACE

  • More patients were identified by AACE (22% or 102) than WHO (6% or 29). Significantly seen using Chi square,  at 78%, AACE > WHO at 24%, p<0.001.
  • MetS components can be predominantly observed in this combination: DM, HPN,  and  High BMI  which are mostly identified by AACE (100%) compared with WHO (76%).
  • In both WHO AND AACE MetS definition, variables like increasing intake of HPN and DM medicine and increasing BMI were directly correlated with METS.

Prevalence of Risk Factors of  MetS

  • Hypertension at 65% using AACE or 58% using WHO definitions,  remains to be the top risk factor of MetS . Followed by High BMI at 60%  among AACE identified patients, unlike at WHO, where 17% of patients only are considered High BMI.  

Patients with Diabetes.      

  • Sixty nine percent (69%) female patients were identified with Diabetes, either using WHO and AACE definition for both have the same criteria. Majority of them belongs to 50 -59 years of age (43%).
  • At sedentary lifestyle (93%) and fond of fatty food(100%), followed by sweets (86%)  of which mostly are with high BMI at 25- below 30 BMI cut off (41%).

Patients with High cholesterolemia.  

  • Prominently female (67%) at age 50-59 yrs(40%), at sedentary lifestyle (80%), preferring fatty food (80%), followed by sweets( 60%) and considered obese at 25-below 30 BMI cut off (60%). More patients were identified by WHO definition than AACE.

Patients with Hypertension. 

  • Dominated by female(70%), at age 50-59 yrs (41%), mostly sedentary (95%), desires to eat fatty foods(46%) and with BMI ranging from 18.5 to 29 (36%), of which majority is  identified by AACE (297 OR 53 %) than WHO (266 OR 47 %).

Patients with High BMI.  

  • Two thirds of the sample we re female, with age range of 50-59 yrs old.
  • Majority have sedentary lifestyle (95%) and fond of fatty foods (100%), followed closely by those with this type of lifestyle and fond of sweets (90%) and salty foods(86%). 
  • More than half of  the sample was identified by AACE (277 OR 78 %) than WHO (77 OR 22 %), because of lower BMI cut off used.

Management given to risk factors of MetS.    

  • Diet was prominently the management given to  d iabetes (51%) and h igh cholesterolemia (74-80%). While with hypertensive patient, (60-70%) majority settled on a lifetime maintenance medication and diet. High BMI patients as well, (51-53%) settled on diet and medicine, because majority already have acquired other ailment that needs medication.

Variables correlated with risk factors.    

  • Patients with age ranging between 30 and above and increasing habit of  drinking HPN medication are likely to develop Diabetes M ellitus.
  • Because of too small subjects that fall under high cholesterolemia, data shows a very questionable findings. Such that additional prospective research studies are needed to further assess the relations among  variables and high cholesterolemia.
  • Patients with an increasing age and  increasing habit of eating sweet foods are likely to have HPN- WHO.  
  • Adding to the said variables, the increasing  habit of cigarette smoking,  taking of HPN medicine and  increasing  BMI are the ones likely to develop  HPN- AACE.
  • No variable was seen directly correlated with High BMI- WHO, but with  AACE , the variable of being male, with increasing habit of cigarette smoking, alcohol drinking  and preferring fatty foods are the ones likely  to develop h igh BMI.

Effect of MNT in Specific Risk Factors. 

  • For Diabetes, findings shows that there is an FBS improvement , significantly at 90% and majority of them  was because of diet, closely followed by medicine.
  • Among h igh cholesterolemia patients and due to a very small number of cases, no conclusive results was seen .        
  • Among WHO HPN patients, 32 % of them normalized in their BP, while 60%  of them improved.  
  • With regard to AACE, 34 % had normalized in BP while  59 % of them improve, s ignificantly at  92- 94% HPN change. Majority of them benefited from medicine and diet management. Specifically, among HPN-WHO patients, both systolic and diastolic changes were significantly affected both by medicine and diet at p < 0.00. While among HPN-AACE patients, the systolic and diastolic changes were significantly affected by diet only at p< 0.04.
  • Upon analyzing the weight  change  among High BMI-WHO patient, 70% improved, while at AACE   71 % improved . Majority of which is because of  diet and medicine ( for some have other illnesses aside from High BMI); c onsidering also the contributing effect of healthier lifestyle change.               


  • More patients were identified by AACE (22%) than WHO (6% ) w hich is statistically significant ( 78%, AACE > WHO at 24% ), p<0.001   b ecause generally criteria used in AACE have lower cut-offs than WHO.
  • The risk factors associated with MetS using WHO and AACE are similar, namely h ypertension, d iabetes and h igh BMI. Though for AACE, h igh BMI is more prominent as a risk factor  for MetS over diabetes.
  • AACE MetS definition gives an early warning criteria so that an immediate nutrition therapy can be instituted to a susceptible MetS patient.
  • Asian BMI cut off that is synonymously used by AACE is preferably to be use among Filipino patients in detecting High BMI as a risk factor.
  • This statement still holds true,  that as BMI of the patient increases, the   probability of developing  HPN and having MetS increases as well.


  • AACE MetS definition will be use for screening patients for early detection of risk factors or MetS and  for early MNT.
  • The creation of Hypertensive Club and Weight Management Club for PGH OPD, similar to presently existing Stroke, Renal and Diabetic club.
  • The revision of Nutrition Report Form (PGH Form No. P-510008), used for assessment to a more detailed demographic profile, that includes educational attainment, detailed food recall, medical history, lipid profile for future extensive research use.
  •  A formulation of a  structured  Follow- up program in Nutrition Clinic to ensure a more complete monitoring data .
  • To conduct a bigger prospective research for more conclusive MNT effect with risk factors of MetS.


Abstract | Introduction | Methodology | Results | Conclusion | Recommendation | Back to Total Names Codes