Prevalence and Diagnostic Concordance of Metabolic Syndrome amongst University Students in Navrongo Upper East Region of Ghana: A Cross-Sectional study

Background Metabolic syndrome (MetS) is a cluster of cardiometabolic abnormalities that significantly predisposes individuals to cardiovascular disease and type 2 diabetes mellitus. Although MetS has traditionally been associated with older adults, emerging evidence indicates an increasing burden amongst young adults, particularly university students. However, data on the prevalence and comparative diagnostic performance of MetS criteria amongst university populations in Ghana remain limited. Methods A cross-sectional study was conducted amongst 219 undergraduate students aged 18–36 years at the University of Technology and Applied Sciences (UTAS), Navrongo, Ghana. Anthropometric measurements, blood pressure, and fasting blood samples were collected following standard protocols. MetS was defined using four criteria, namely World Health Organization (WHO), National Cholesterol Education Programmed Adult Treatment Panel III (NCEP ATP III), International Diabetes Federation (IDF), and Harmonized (H_MS) definitions. Logistic regression analysis was applied to identify risk factors associated with MetS. Receiver operating characteristic (ROC) curve and Cohen’s kappa statistics were used to evaluate diagnostic performance and agreement between criteria. Results The prevalence of MetS varied across diagnostic criteria, with the highest prevalence observed using IDF (10.1%), followed by H_MS (8.2%), NCEP ATP III (7.3%), and WHO (5.5%). Females exhibited higher prevalence of MetS under IDF, NCEP ATP III, and H_MS criteria, while males showed slightly higher prevalence under WHO criteria. Low high-density lipoprotein cholesterol (HDL-C) was the most prevalent component (76.3%), followed by elevated fasting blood glucose (25.6–29.2%) and elevated blood pressure (18.7%). Logistic regression analysis identified fasting blood glucose as the strongest predictor of MetS across all definitions ( p < 0.001). ROC analysis showed that the H_MS definition demonstrated the highest discriminatory ability relative to the WHO definition (AUC = 0.677), followed by NCEP ATP III (AUC = 0.638), while IDF exhibited poor performance (AUC = 0.491). Kappa agreement analysis established fair concordance between WHO and NCEP ATP III (k = 0.238, p < 0.001) and between WHO and H_MS (k = 0.286, p < 0.001), but poor agreement between WHO and IDF (k=-0.013, p = 1.00). Conclusion Although the overall prevalence of MetS amongst UTAS students was relatively low, a substantial proportion exhibited one or more metabolic abnormalities, indicating early cardiometabolic risk. The harmonized definition demonstrated better alignment with the WHO-based classification and may be a useful screening approach in this population. These findings highlight the need for early screening and targeted lifestyle interventions amongst university students.