Differences in prevalence and predictive value of metabolic syndrome

Metabolic syndrome (MetS) is common in Chinese adults, but evidence regarding its burden and cardiovascular relevance among young healthcare workers (HCWs) remains limited. Different MetS definitions can yield materially different prevalence estimates and risk classifications. This retrospective cross-sectional study included 420 HCWs aged 20 to 45 years who underwent mandatory annual health examinations at a tertiary hospital in China from 2022 to 2024. Demographic, occupational, anthropometric, and biochemical data were extracted from health examination and personnel records. MetS was defined using the International Diabetes Federation (IDF), revised National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), and Chinese Diabetes Society (CDS) criteria. Ten-year atherosclerotic cardiovascular disease risk was estimated using the China-PAR equations, with elevated estimated risk defined as ≥10%. We compared MetS prevalence, sex differences, agreement among definitions, diagnostic performance using NCEP ATP III. Participants had a mean age of 32.4 ± 5.8 years, and 30.0% were men. MetS prevalence was 15.5%, 18.6%, and 10.2% according to IDF, NCEP ATP III, and CDS criteria, respectively, and was consistently higher in men. Agreement was almost perfect between IDF and NCEP ATP III (κ = 0.82) and substantial between IDF and CDS (κ = 0.64) and between NCEP ATP III and CDS (κ = 0.61). Using an internally reconstructed 2 × 2 table that preserves the reported prevalence counts and pairwise κ values, IDF showed sensitivity 78.2%, specificity 98.8%, PPV 93.8%, and NPV 95.2%, whereas CDS showed sensitivity 51.3%, specificity 99.1%, PPV 93.0%, and NPV 89.9% relative to NCEP ATP III. These reconstructed diagnostic-performance values require verification against the original participant-level data before submission. MetS defined by any criterion was strongly associated with elevated China-PAR-estimated risk, with adjusted odds ratio of 6.5, 7.1, and 5.1 for IDF, NCEP ATP III, and CDS, respectively. atherosclerotic cardiovascular disease-risk AUCs were 0.80, 0.82, and 0.76, respectively. In this single-center cohort of young Chinese HCWs, estimated MetS prevalence differed substantially by diagnostic definition. IDF and NCEP ATP III identified more cases than CDS and showed stronger mutual agreement. The observed associations with China-PAR-estimated risk support the potential value of MetS assessment within occupational health screening.