METABOLIC SYNDROME AND ITS DETERMINANTS IN THE DALMATIAN POPULATION

Cilj istraživanja: Cilj istraživanja bio je ustanoviti prevalenciju metaboličkog sindroma u populaciji otoka Korčule i grada Splita te uz to ustanoviti koji čimbenici su povezani s prisutnošću metaboličkog sindroma, poglavito dob, spol, socioekonomski status, pušenje, tjelesna aktivnost i način prehrane. Materijali i metode: Presječnim istraživanjem obuhvaćeno je 3847 ispitanika koji su podijeljeni u 4 skupine s obzirom na mjesto stanovanja ispitanika. Prva skupina ispitanika dolazi s otoka Korčule, iz područja grada Korčule i okolnih naselja (uzorkovanje je provedeno 2007. godine; N=969). Druga skupina dolazi iz grada Splita (uzorkovanje je provedeno tijekom 2008/09. godine; N=1012). Treća skupina ispitanika dolazi također iz Korčule (naselje Smokvice i okolna naselja; uzorkovanje je provedeno 2012. godine; N=879). Četvrta skupina dolazi iz Blata na Korčuli (uzorkovanje je provedeno 2013/14. godine; N=987). Prikupljanje podataka provedeno je u okviru projekta „Pleitropija, genske mreže i putevi u izoliranim ljudskim populacijama: 10.001 Dalmatinac“ (HRZZ 8875). Za potrebe ovog istraživanja korišteni su podaci o spolu, dobi, zdravstvenom statusu (anamneza), socioekonomskom statusu i navikama, poput pušenja duhana, konzumacije alkohola i načinu prehrane. Uz to, provedena su i antropometrijska mjerenja i mjerenje krvnog tlaka. Za potrebe prikaza prevalencije metaboličkog sindroma korištena je gruba stopa prevalencije (engl. crude prevalence rate), kao i dobno standardizirana stopa prevalencije (engl. age-standardized prevalence rate), koja je izračunata korištenjem nove europske standardne populacije. U analizi podataka korišten je χ2 test, Kruskal-Wallis test i Spearmanov test rang korelacije. Također, korištena je i multivarijatna logistička regresija, za potrebu identifikacije čimbenika koji su povezani s prisutnošću metaboličkog sindroma. Rezultati: Gruba stopa prevalencije metaboličkog sindroma u ispitanom uzorku (N=3715) iznosila je 42,2%. U promatranim naseljima najviša gruba stopa prevalencije zabilježena je u podskupini ispitanika iz grada Korčule, čak 48,9%, a slijedili su ispitanici iz Smokvice s grubom stopom prevalencije od 46,3%, dok je u gradu Splitu bilo 36% ispitanika s postavljenom dijagnozom metaboličkog sindroma. Od pojedinačnih sastavnica, najučestalija je bila prisutnost povećanog opsega struka (između čak 72-80%), a slijedio je povišeni krvni tlak (između 45-68%), povišena koncentracija glukoze (između 36,7-42,7%), povišena koncentracija triglicerida (između 26,9-34,4%), dok je učestalost snižene koncentracije HDL kolesterola bila najmanje zastupljena od svih sastavnica (između 12,5-21,8%). Dobno standardizirana stopa prevalencije metaboličkog sindroma u ukupnom uzorku iznosila je 25%, u poduzorku žena iznosila je 22,8%, a u poduzorku muškaraca 28,5%. U odnosu na čimbenike rizika, statistički značajna povezanost s metaboličkim sindromom u modelu logističke regresije zabilježena je za stariju životnu dob (u dobnoj skupini od ≥65 godina OR=9,49; 95% CI 6,67-13,50, a u dobnoj skupini 35-65 godina OR=5,11; 95% CI 3,77-6,94, sve u odnosu na najmlađe ispitanike), muški spol (OR=1,38; 95% CI 1,14-1,68), mjesto stanovanja (samo Blato u odnosu na Split – OR=0,78; 95% CI 0,62-0,98), razinu obrazovanja (OR=0,92; 95% CI 0,89-0,94), status nepušača (OR=0,79; 95% CI 0,64-0,97) i umjerenu razinu tjelesne aktivnosti (OR=0,78; 95% CI 0,65-0,94), dok prehrambene navike nisu bile povezane s prisutnošću metaboličkog sindroma. Zaključak: Metabolički sindrom postao je golem javnozdravstveni problem, kako u svijetu tako i u Hrvatskoj. Potrebna su daljnja istraživanja za utvrđivanje povezanosti čimbenika rizika za razvoj metaboličkog sindroma, a sve u svrhu unaprjeđenja metaboličkog zdravlja populacije Dalmacije i cijele Republike Hrvatske.
Objective: The aim of this study was to estimate the prevalence of metabolic syndrome in the population of the island of Korcula and the city of Split, and in addition establish which factors are associated with the presence of metabolic syndrome, particularly age, sex, socioeconomic status, smoking, physical activity and diet. Method: A cross-sectional study included 3847 patients who were divided into 4 groups according to the place of residence of the respondents. The first group of participants comes from the island of Korcula, area of the town of Korcula and surrounding villages (sampling was conducted in 2007; N = 969). Another group comes from the city of Split (sampling was carried out during 2008/09; N = 1012). A third group of subjects comes also from Korcula (town Smokvica and the surrounding villages, sampling was conducted in 2012; N = 879). A fourth group comes from Blato on Korcula (sampling was conducted in 2013/2014; N = 987). Data collection was conducted in the project "Pleitropy, gene networks and pathways in isolated human populations: 10 001 Dalmatians "(HRZZ 8875). For the purposes of this research we used data on gender, age, health status (health history), socioeconomic status and habits, such as smoking tobacco, alcohol consumption and diet. Additionally, there were conducted anthropometric measurements and blood pressure. To show the prevalence of metabolic syndrome it was used crude prevalence, as well as the age-standardized prevalence, which is calculated using the new European standard population. In analyzing the data, the χ2 test, Kruskal-Wallis test and Spearman's rank correlation test were used. Also, it was used multivariate logistic regression, to the purpose to identify factors that are associated with the presence of the metabolic syndrome. Results: Rough prevalence of metabolic syndrome in the sample (N = 3715) was 42.2%. In the observed settlements highest crude prevalence rates recorded a subset of patients from the town of Korcula, even 48.9%, followed by respondents from Smokvice with rough prevalence rate of 46.3%, while in the town of Split were 36% of respondents with a diagnosis of metabolic syndrome. Of the individual components, the most common is the presence of increased waist circumference (even between 72-80%), and was followed by high blood pressure (between 45-68%), elevated blood glucose (from 36.7 to 42.7%), elevated triglycerides (between 26.9 to 34.4%), while the incidence decreased HDL cholesterol was the least represented of all components (from 12.5 to 21.8%). Age-standardized prevalence of metabolic syndrome in the total sample was 25%, in the sub-sample of women was 22.8% and in the subsample of men 28.5%. With regard to risk factors, statistically significant correlation with the metabolic syndrome in the logistic regression model was recorded for, old age (in the age group of ≥65 years OR = 9.49; 95% CI 6.67 to 13.50, and in the age group 35-65 years OR = 5.11; 95% CI 3.77 to 6.94, as compared to the youngest respondents), male gender (OR = 1.38; 95% CI 1.14 to 1.68), place of residence (only mud compared to Split - OR = 0.78; 95% CI 0.62 to 0.98), educational level (OR = 0.92; 95% CI 0.89-0.94) the status of non-smokers (OR = 0.79; 95% CI 0.64 to 0.97) and a moderate level of physical activity (OR = 0.78; 95% CI from 0.65 to 0.94), while eating habits were not related with the presence of the metabolic syndrome. Conclusion: Metabolic syndrome has become a huge public health problem, both worldwide and in Croatia. Further research is needed to determine the relationship between risk factors for the development of the metabolic syndrome, with the purpose of improving metabolic health of the population of Dalmatia and all over the Croatian.