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Comparison Study of Metabolic Syndrome's Differences and Diagnostic Criteria's Applicability among Xingjiang Uighur, Kazak and Han Population

Our paper is a study about metabolism syndrome (MS) incidence situations of different nationalities, including Uighur, Kazak and Han nationality in Xinjiang by means of a cross-sectional survey and compare differences and adaptabilities of applications of the diagnostic criteria for MS recommended by Adult Treatment Protocol III of National Cholesterol Education Program of America (ATP III), International Diabetes Federation (IDF) and Chinese Diabetes Society (CDS) in three groups of populations. Conclusion tell us, for Uighur population and Kazak population, IDF criterion and ATPIII criterion had a better consistence, and CDS criterion was worst. For Han population, CDS criterion and IDF criterion had a better consistence, and ATPIII criterion was worst. For the screening of MS incidence rate of Uighur and Kazak adult populations in Xinjiang region, ATPIII criterion was optimal, while CDS criterion was optimal for Han population. However, as for screening of clustering of multiple risk factors of MS, IDF criterion was better than other criteria for the three nationalities.


Introduction
Metabolism syndrome (MS) mainly manifests the clustering of hypertension (HP), obesity, lipid abnormality, hyperglycemia, and insulin resistance (IR) in individuals and rapid increase of its incidence rate has become a global public health focus. However, the adaptabilities of different diagnostic criteria in different populations are always debatable [1]. According to the incidence rate indicated by MS related epidemiological data, it is well known that MS incidence rate is apparently different form different races and nationalities. For MS incidence rate in Xinjiang region, China, Uighur (Uighur nationality) is 35.2%, Han nationality is 9.21%, and Kazak (Kazak nationality) is 20.1%. There are significant differences [2]. Lu et al. reported that when MS was diagnosed for different nationalities of residents in Xinjiang region, there are differences for diagnosis tangency of waist circumference (WC), and it was different from the research result of inland Han population [3].
At present, there are at least 8 diagnostic criteria of MS in the world [4]. As various criteria themselves have some defects, even if differently defined criteria are used in the same population, it is obvious that different detection rates will be obtained. However, as different nationalities and races have different MS incidence rates, at present there is no still no unified judgment criterion for MS internationally [5]. Therefore, the differences for total incidence rate of MS detected by different diagnostic criteria are objectively existent among the same and different populations. For the detection rate of all components of MS among population detected by different criteria, such as obesity, hyperglycaemia, lipid abnormality, HP and IR, the differences of the results are greater. The main reasons for these differences lie in that various diagnostic criteria adopt different measurement indicators, and they highlight different parts for effects of 4 indicators in MS judgment. Also, used measurement methods and dividing values are also inconsistent [6], which causes chaos in this field to a certain extent. However, it is very difficult to prepare 2 International Journal of Endocrinology a globally unified criterion mainly because that there are apparent differences between races and between regions. Therefore, it is the most important in fact to prepare the most suitable criteria for different races and nationalities.
This study respectively adopted the diagnostic criteria of MS recommended by International Diabetes Federation (IDF), Adult Treatment Protocol III National Cholesterol Education Program of America (ATP III), and Chinese Diabetes Society (CDS) to analyze MS of Uighur, Kazak and Han populations in Xinjiang and incidence situations of various components and compare the consistence of 3 criteria diagnosing MS of 3 groups of populations in order to further understand the epidemiological situations of MS of Uighur, Kazak and Han populations in Xinjiang, investigate screening consistence and population suitability of currently used 3 diagnostic criteria and provide a basis for further conducting targeted health education and clinical intervention and provide the necessary based evidence for subsequently revising or preparing diagnostic criteria of MS for different nationalities.

Diagnostic Criteria of MS
In addition, SPSS17.0 statistics software was used for data analysis. Table 2 3.

Discussion
MS is the clustering status of a group of risk factors closely related to cardiovascular disease, and obesity or overweight, blood glucose increase, lipids disorder and HP are its main components. Its incidence rate rapidly increases in recent 20 years, and it has become a hot issue of common concern at home and abroad in recent years [9,10]. Also, MS is a clinical syndrome and a clustering status of multiple metabolism risk factors of cardiovascular and cerebrovascular diseases in the same body (metabolic disorder-related risk factors of cardiovascular and cerebrovascular disease) [11]. At present, MS has become a novel chronic disease and a public health problem. MS is an important risk factor causing increases of incidence rate and mortality rate of diabetes mellitus and cardiovascular disease. With caloric intake increase, physical activity decrease and obesity prevalence of global human, MS incidence rate will still rises [12,13]. Clinical studies show the incidence risk of chronic diseases of MS patients such as cardiovascular disease (CVD), diabetes mellitus and hypertension, is farther higher than that of normal people [14][15][16]. Therefore, it is very significant to timely and accurately judge MS and timely conduct intervention in clinic [17]. However, diagnostic criteria of MS and adaptabilities of diagnostic criteria in different regions and different populations have great differences and arguments. So, there is always no unified diagnostic criterion of MS [18]. Currently, more common diagnostic criteria in China are ATP III criterion, CDS criterion and IDF criterion. Xinjiang is the accumulation area of multiple nationalities, and Uighur nationality, Kazak nationality and Han nationality are main nationalities. Many clinical studies suggest that incidence rates of many chronic diseases such as hypertension, diabetes mellitus and MS are different among Uighur, Kazak and Han populations in Xinjiang region [19], which is possibly associated with the dietary habits, life styles and genetic factors of various nationalities and their interactions [20]. The study respectively used three common diagnostic criteria of MS, namely ATP III, IDF and CDS to carry out screening for the same population among Uighur, Kazak and Han populations. As a result, it was found that for Uighur nationality and Han nationality, MS incidence rates (standardized incidence rate) for ATP III criterion were highest, respectively 35.80% (29.64%) and 27.03% (27.18%), and both MS detection rates for CDS criterion were lowest; For Kazak population, the detection rate for IDF criterion was highest 23.88% (21.96%), and MS detection rate of CDS Comparisons of consistence of MS incidence rate of Uighur, Kazak, and Han populations diagnosed by the three criteria showed that for Uighur nationality and Kazak nationality, consistence rate, Youden's index and Kappa value between ATP III criterion and IDF criterion were highest, indicating that for Uighur and Kazak populations, ATP III criterion and IDF criterion had a better consistence, and the consistence rate between CDS criterion and the other two criteria (ATP III and IDF) wasn't high. For Han population, consistence rate, Kappa value, and Youden's index between CDS criterion and IDF criterion were highest, while consistence rate, Kappa value, and Youden's index between ATP III and IDF criterion were lowest. It is suggested that ATP III criterion and IDF criterion are relatively more suitable for Uighur and Kazak populations, rather than Han population. For Han population in Xinjiang region, CDS criterion adaptability was best, IDF criterion is second, and ATP III is the most unsuitable.
According to the analysis of this study, it is found that MS definition itself has some defects. For the judgment and treatment of risk factors of high-risk population, it is necessary to select the most suitable criterion for this population on the base of comprehensive consideration of existent generallyaccepted diagnostic criteria and treatment principle. For Uighur, Kazak, and Han populations in Xinjiang region, diagnostic criteria of MS shall be different due to their different genetic factors and life styles and differences for physical characteristics, and body metabolism. The study suggests that ATP III criterion is preferred for screening of MS incidence rate of adult Uighur and Kazak populations, while CDS criterion is preferred for Han population. For screening of clustering of MS multiple-risk factors, IDF criterion is better than the other criteria for the three nationalities.