Health Reports
Metabolic syndrome in Canadian adults, 2007 to 2019
DOI: https://www.doi.org/10.25318/82-003-x202500900001-eng
Abstract
Background
Metabolic syndrome (MetS) is a major cause of cardiovascular morbidity and mortality. This study provides an updated prevalence of MetS and its components among Canadian adults aged 18 to 79 years in the period from 2016 to 2019 by age group and sex. It also examines trends in the prevalence of MetS and its components over time in this population from 2007 to 2019.
Data and methods
This study used direct health measures data from cycles 1 to 6 (2007 to 2019) of the Canadian Health Measures Survey. MetS was defined as the presence of at least three of the following components: elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein (HDL) cholesterol, high blood pressure, and elevated fasting blood glucose.
Results
In the period from 2016 to 2019, 26.1% of Canadian adults aged 18 to 79 years had MetS. The prevalence of MetS was similar among females (25.2%) and males (27.0%) and increased with age, from 11.1% for those aged 18 to 39 years to 44.3% for those aged 60 to 79 years. The prevalence of MetS remained stable from the 2007-to-2011 period to the 2016-to-2019 period. Among individuals with MetS in the period from 2016 to 2019, high waist circumference was the most common component (90.0%), followed by high fasting blood glucose (70.6%) and low HDL cholesterol (65.8%). The prevalence of all components of MetS increased with age, except for low HDL cholesterol, which significantly decreased with age.
Interpretation
The prevalence of MetS among adults has remained stable over time in Canada. Low HDL cholesterol seems to be the leading component of MetS among young adults.
Keywords
Obesity, diabetes, hypertension, blood pressure, cholesterol, triglycerides
Authors
Hugues Sampasa-Kanyinga and Thomas Ferrao are with the Centre for Health Data Integration and Direct Measures at Statistics Canada.
What is already known on this subject?
- Metabolic syndrome (MetS) occurs when a person has at least three of the following conditions: high waist circumference, high triglycerides, reduced high-density lipoprotein cholesterol level, high blood pressure, and high fasting glucose. MetS greatly increases the risk of cardiovascular disease and type 2 diabetes.
- The global prevalence of MetS in the general population of adults varied from 12.5% to 31.4%, according to the definition considered, and is increasing, posing an important global public health concern.
- The data from the Canadian Health Measures Survey used in studies examining the prevalence of MetS among Canadian adults are outdated (2007 to 2011), highlighting the need to investigate the updated prevalence of MetS in the most recent available data from this survey (2016 to 2019).
What does this study add?
- In the period from 2016 to 2019, just over one in four Canadian adults aged 18 to 79 years had MetS based on the criteria from the 2009 joint interim statement.
- The prevalence of MetS increases with age and is similar among females and males.
- The prevalence of MetS among adults has remained stable over time in Canada.
- High waist circumference and high fasting blood glucose remain the most prevalent components among individuals with MetS.
Introduction
Metabolic syndrome (MetS) is a clustering of multiple risk factors, including abdominal obesity (or high waist circumference), elevated triglycerides, low high-density lipoprotein (HDL) cholesterol, high fasting blood glucose, and high blood pressure. MetS is an important contributor to cardiovascular disease and type 2 diabetes. Research indicates that MetS doubles the risk of cardiovascular disease and increases the risk of diabetes fivefold.Note 1, Note 2 The prevalence of MetS has been on the rise among adults, posing a global public health concern.Note 3, Note 4 A recent meta-analysis in the general population of adults has indicated that the global prevalence of MetS varied from 12.5% (95% confidence interval [CI]: 10.2% to 15.0%) to 31.4% (95% CI: 29.8% to 33.0%) according to the definition considered.Note 5
Several definitions of MetS have been proposed by different organizations over time,Note 6 including the World Health Organization (WHO) in 1998;Note 7 the European Group for the Study of Insulin Resistance in 1999;Note 8 the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) in 2001;Note 9 the American Heart Association and the National Heart, Lung, and Blood Institute (AHA/NHLBI) in 2004;Note 10 the International Diabetes Federation (IDF) in 2005;Note 10 and the joint interim statement by the AHA/NHLBI and IDF in 2009.Note 11
These variations make it difficult to compare the prevalence of MetS across studies. For example, among previous studies using the Canadian Health Measures Survey (CHMS), Riediger et al. (2011) applied the NCEP ATP III and the 2009 joint interim statement, using two sets of waist circumference cut-off points because they found limited evidence supporting either cut-off.Note 12 In contrast, Clarke and Janssen (2013) used the 2009 joint interim statement with waist circumference cut-offs aligned with Health Canada’s recommendations.Note 13 Finally, Rao et al. (2014) applied three definitions: the revised NCEP ATP III (which uses revised waist circumference criteria), the IDF, and the 2009 joint interim statement.Note 14 Regardless of the definition used, evidence has shown that individuals with MetS had an increased risk of cardiovascular disease and diabetes.Note 15, Note 16 Ongoing surveillance efforts are necessary to contribute to better prevention and management of MetS in Canada.
Apart from the challenges of defining MetS, WHO has recommended using ethno-specific waist measurement cut-off points. For adults with a predominant South Asian, Southeast Asian, or East Asian ethnicity, lower thresholds are advised—90 centimetres or more for men and 80 centimetres or more for women—as indicators of an increased risk of having visceral adiposity and developing cardiometabolic comorbidities. For adults from other ethnic backgrounds, higher thresholds are used: 102 centimetres or more for men and 88 centimetres or more for women.Note 11, Note 17 This is particularly important because Canada is a multicultural country, with 5.7 million people reporting South Asian, East Asian, or Southeast Asian ethnicity in the 2021 Census.Note 18
The CHMS is an ongoing, nationally representative survey that collects self-reported health information and direct physical measures, including blood samples and waist circumference. Previous studies have used data from Cycle 1 (2007 to 2009) or Cycle 2 (2009 to 2011) of the CHMS to examine the prevalence of MetS in relation to different outcomes in Canadian adults.Note 12, Note 13, Note 14 With sixcyclesof CHMS data spanning 12 years (2007 to 2019) now available, it is worthwhile to investigate the updated prevalence of MetS in adults based on the most recent MetS definition criteria—the 2009 joint interim statement, which accounts for ethno-specific abdominal obesity—in a representative sample of Canadian adults.Note 11 This approach facilitates comparisons across recent studies and enhances understanding of the population burden of MetS in Canada.
Using the most recent nationally representative data from the CHMS (2016 to 2019), this study provides an updated prevalence of MetS and its components among Canadian adults aged 18 to 79 years by age group and sex. It also examines trends in the prevalence of MetS and its components over time in this population from 2007 to 2019.
Methods
Data source
Data are from Cycle 1 (2007 to 2009) to Cycle 6 (2018 to 2019) of the CHMS, a cross-sectional survey of Canadians aged 3 to 79 years (except in Cycle 1, where participants were aged 6 to 79 years) that is conducted by Statistics Canada in partnership with Health Canada and the Public Health Agency of Canada.Note 19 Data from cycles 1 to 6 remain relevant, as data collection for Cycle 7 (2022 to 2024) has been completed but results are not yet available. Additionally, combining cycles enhances statistical power. The CHMS is designed to provide representative data of the Canadian population living in private dwellings across the 10 provinces over two-year cycles. The survey excludes people living in the territories, on First Nations reserves, or in institutional facilities, as well as full-time members of the Canadian Forces and residents of certain remote regions or areas with a low population. Sociodemographic data and information about health-related risk factors, health conditions, and medication use are collected at home via general health interviews, followed by a visit to a mobile examination centre, where blood and urine samples are collected and other direct physical measurements, such as height, weight, and blood pressure, are taken. Respondents provide a list of all prescription and over-the-counter products taken in the past month. All recorded medications were coded using the Anatomical Therapeutic Chemical (ATC) classification system. Additional information on survey methodology and data collection is described elsewhere.Note 19, Note 20
To increase statistical power, produce estimates by sex and age group, and compare data over time, the six cycles were combined into three pairs as follows: Cycle 1 (2007 to 2009) and Cycle 2 (2009 to 2011), Cycle 3 (2012 to 2013) and Cycle 4 (2014 to 2015), and Cycle 5 (2016 to 2017) and Cycle 6 (2018 to 2019). The most recent data from 2016 to 2019 were treated as the reference period. Analyses were restricted to respondents aged 18 to 79 years who fasted before the tests at the mobile examination clinic and were not pregnant at the time of data collection: n=3,734 for cycles 1 and 2, n=3,404 for cycles 3 and 4, and n=3,334 for cycles 5 and 6. Those with incomplete data on waist circumference, plasma triglycerides, blood glucose, HDL cholesterol, and blood pressure were excluded from the analysis. The final analytical sample sizes were as follows: cycles 1 and 2 (2007 to 2011), n=3,694; cycles 3 and 4 (2012 to 2015), n=3,366; and cycles 5 and 6 (2016 to 2019), n=3,296.
Measures and definitions
Detailed information on the measurement procedures for the MetS components is available online.Note 21, Note 22 Briefly, waist circumference was measured to the nearest 0.1 centimetre at the midpoint between the last floating rib and the top of the iliac crest, at the end of a normal expiration, using a Gulick tape measure. Abdominal obesity, as defined by a high waist circumference, indicates an increased risk of having visceral adiposity and developing cardiometabolic comorbidities. Resting blood pressure was measured electronically using a BpTRU BPM-200 device (BpTRU Medical Devices Ltd., Coquitlam, British Columbia). After resting quietly for five minutes, a minimum of six measurements were taken automatically, one minute apart, and the average systolic blood pressure and diastolic blood pressure were determined using the last five of the six measurements. High blood pressure was defined using the cut-off points presented in Table 1 or if respondents had been taking an antihypertensive medication in the month before the measurement. This included medications with ATC codes beginning with C02, C03, C07, C08, C09, C04AA02, or C04AB01, or a “yes” response to the question: “In the past month, did you take any medication for high blood pressure?”
| Criterion | Cut-off for men | Cut-off for women |
|---|---|---|
| Abdominal obesity (low thresholds for waist circumference)Table 1 Note 1 | Waist circumference of 90 cm or more | Waist circumference of 80 cm or more |
| Abdominal obesity (high thresholds for waist circumference)Table 1 Note 2 | Waist circumference of 102 cm or more | Waist circumference of 88 cm or more |
| High plasma triglycerides | 1.7 mmol/L or more | 1.7 mmol/L or more |
| High fasting blood glucose | 5.6 mmol/L or more | 5.6 mmol/L or more |
| Low HDL cholesterol | Less than 1.03 mmol/L | Less than 1.30 mmol/L |
| High blood pressure | 130/85 mmHg or more | 130/85 mmHg or more |
Source: Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640-1645. |
||
Venous blood samples were collected after a 10-hour fasting period. Glucose, triglycerides, and HDL cholesterol were measured in serum. Starting in Cycle 5, the reference laboratory for glucose, HDL cholesterol, and triglycerides changed, and glucose is now measured using the hexokinase ultraviolet assay on a Roche Cobas C501 analyzer. High fasting blood glucose was defined using the cut-off points outlined in Table 1, or if respondents used diabetes medications in the past month (ATC codes beginning with A10). HDL cholesterol and triglycerides are measured using the homogenous enzymatic colorimetric method on a Roche Cobas C501 analyzer.Note 22 High triglycerides and low HDL cholesterol were defined using the cut-off points outlined in Table 1. There is no question specific to lipid-lowering medications, but the following ATC codes were used to identify medication related to triglycerides: C04AC01, C04AC03, C10AB01, C10AB02, C10AB04, C10AB05, C10AC01, C10AC02, C10AX02, and C10AX06. For HDL, the following codes were used: C04AC01, C04AC03, C10AB01, C10AB02, C10AB04, C10AB05, C10AC01, C10AC02, and C10AX02.
MetS was defined based on the criteria and definition published in the 2009 joint interim statement, as outlined in Table 1.11 MetS was considered present if any three of the following five criteria were met: abdominal obesity (defined by high waist circumference), high plasma triglycerides, high fasting blood glucose, low HDL cholesterol, and high blood pressure.
Statistical analyses
All statistical analyses were performed using SAS 9.4 (SAS Institute, Cary, North Carolina) and SUDAAN 11.0.3 (RTI International, Durham, North Carolina). The crude and age-standardized prevalence of MetS and all its components, including high waist circumference, high plasma triglycerides, high plasma triglycerides, high fasting blood glucose, low HDL cholesterol, and high blood pressure, were calculated. Estimates were age standardized to WHO’s world standard population using the direct method.Note 23 Age-standardization represent the potential prevalence of an outcome if the study population had the same age distribution as a given standard population. Cross-tabulation was used to assess the relationship of MetS with all its components by age group (18 to 39 years, 40 to 59 years, and 60 to 79 years), sex (males and females), and survey year (2007 to 2011, 2012 to 2015, and 2016 to 2019). A chi-square adjusted for the survey design was used to test for significant differences. Survey weights for the fasting subsample calculated by Statistics Canada were used to ensure that analyses for this restricted subpopulation remained representative of the Canadian population. Weights for the combined cycles and the appropriate denominator degrees of freedom were integrated into the analysis. To account for survey design effects, 500 bootstrap replicate weights were used to calculate variance estimation (95% CI) and conduct significance testing. The statistical threshold was set at p < 0.05.
Results
In the period from 2016 to 2019, 26.1% (95% CI: 22.5% to 30.0%) of Canadian adults aged 18 to 79 years had MetS (Chart 1). The crude prevalence of MetS was similar among females (25.2%) and males (27.0%) and increased with age, from 11.1% for those aged 18 to 39 years to 44.3% for those aged 60 to 79 years. The same age patterns were observed among females (from 11.0% for those aged 18 to 39 years to 38.0% for those aged 60 to 79 years) and males (from 11.1% to 51.0%), with significant differences between females and males among the oldest age group (i.e., 60 to 79 years). In this age group, MetS was more prevalent among males (51.0%) than among females (38.0%) (Chart 1).
Description of Chart 1
| Both sexes | Males | Females | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Number | Percent | 95% confidence interval | Number | Percent | 95% confidence interval | Number | Percent | 95% confidence interval | ||||
| from | to | from | to | from | to | |||||||
| All ages (crude prevalence) | 873 | 26.1 | 22.5 | 30.0 | 480 | 27.0 | 22.8 | 31.6 | 393 | 25.2 | 20.7 | 30.4 |
| All ages (age-standardized prevalence) | 873 | 22.5 | 19.1 | 26.4 | 485 | 23.1 | 18.7 | 28.2 | 395 | 22.0 | 17.9 | 26.8 |
| 18 to 39 years | 144 | 11.1Note ** Note E: Use with caution | 7.5 | 16.1 | 77 | 11.1Note ** Note E: Use with caution | 6.4 | 18.6 | 67 | 11.0Note ** Note E: Use with caution | 7.5 | 16.0 |
| 40 to 59 years | 254 | 29.5Note ** | 24.2 | 35.3 | 142 | 27.9Note ** | 21.5 | 35.2 | 112 | 31.1 | 23.3 | 40.2 |
| 60 to 79 years | 475 | 44.3 | 38.5 | 50.3 | 261 | 51.0 | 44.0 | 58.0 | 214 | 38.0Note * | 30.5 | 46.2 |
E use with caution
Source: Statistics Canada, Canadian Health Measures Survey, 2016 to 2019 (combined). |
||||||||||||
Abdominal obesity (90.0%) was the most common component of MetS in the period from 2016 to 2019, followed by high fasting blood glucose (70.6%), high blood pressure (66.7%), and low HDL cholesterol (65.8%) (Table 2). The prevalence of abdominal obesity was higher among females (97.7%) than males (86.6%) and did not vary across age groups. The prevalence of high blood pressure was higher among males (73.0%) than females (60.1%), while the prevalence of high plasma triglycerides, high fasting blood glucose, and low HDL cholesterol did not differ by sex. The prevalence of high fasting blood glucose significantly increased with age, from 57.2% among those aged 18 to 39 years to 76.3% among those aged 60 to 79 years. In contrast, the prevalence of low HDL cholesterol significantly decreased with age, from 90.3% for those aged 18 to 39 years to 51.4% for those aged 60 to 79 years. The same age patterns were observed among females and males for high fasting blood glucose and low HDL cholesterol. Among individuals aged 60 to 79 years, the three most common components of MetS were abdominal obesity (91.9%), followed by high blood pressure (83.0%) and high fasting blood glucose (76.3%).
| Both sexes (N=3,296) | Males (N=1,690) | Females (N=1,606) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| n | % | 95% confidence interval |
n | % | 95% confidence interval |
n | % | 95% confidence interval |
||||
| from | to | from | to | from | to | |||||||
| Abdominal obesity | ||||||||||||
| Overall (crude prevalence) | 785 | 90.0 | 85.7 | 93.1 | 400 | 82.9 | 76.0 | 88.1 | 385 | 97.6Table 2 Note † | 78.3 | 92.2 |
| Overall (age-standardized prevalence) | 785 | 91.4 | 86.5 | 94.7 | 400 | 83.3 | 75.0 | 89.2 | 385 | 98.8 | 95.4 | 99.7 |
| 18 to 39 years | 131 | 94.3 | 88.6 | 97.2 | 65 | 88.9 | 73.0 | 96.0 | 66 | 99.7 | 95.3 | 100.0 |
| 40 to 59 years | 218 | 86.2 | 78.2 | 91.6 | 108 | 75.4 | 62.3 | 85.0 | 110 | 95.9Table 2 Note † | 77.6 | 99.4 |
| 60 to 79 years | 436 | 91.9 | 87.1 | 95.1 | 227 | 86.7 | 78.3 | 92.2 | 209 | 98.5Table 2 Note † | 94.9 | 99.6 |
| High plasma triglycerides | ||||||||||||
| Overall (crude prevalence) | 524 | 59.1 | 52.4 | 65.4 | 316 | 62.6 | 54.2 | 70.3 | 208 | 55.4 | 45.8 | 64.5 |
| Overall (age-standardized prevalence) | 524 | 63.8 | 55.7 | 71.3 | 316 | 71.6 | 59.4 | 81.4 | 208 | 64.5 | 55.4 | 72.7 |
| 18 to 39 years | 110 | 63.1 | 50.1 | 74.5 | 70 | 73.1Note E: Use with caution | 40.8 | 91.4 | 40 | 53.0Note E: Use with caution | 24.6 | 79.5 |
| 40 to 59 years | 173 | 62.5 | 48.0 | 75.1 | 103 | 66.4 | 47.7 | 81.1 | 70 | 59.0 | 42.4 | 73.8 |
| 60 to 79 years | 241 | 54.3 | 48.0 | 60.5 | 143 | 55.9 | 46.0 | 65.3 | 98 | 52.3 | 39.5 | 64.9 |
| High fasting blood glucose | ||||||||||||
| Overall (crude prevalence) | 652 | 70.6 | 64.3 | 76.3 | 376 | 73.7 | 64.7 | 81.2 | 276 | 67.3 | 57.3 | 76.0 |
| Overall (age-standardized prevalence) | 652 | 61.8 | 52.2 | 70.5 | 376 | 61.7 | 46.2 | 75.2 | 276 | 57.7 | 45.6 | 69.0 |
| 18 to 39 years | 80 | 57.2Table 2 Note ‡ | 42.3 | 70.9 | 44 | 48.0Note E: Use with caution Table 2 Note ‡ | 20.8 | 76.4 | 36 | 66.7Note E: Use with caution | 35.6 | 87.9 |
| 40 to 59 years | 181 | 70.0 | 61.5 | 77.4 | 105 | 74.9 | 61.4 | 84.9 | 76 | 65.7 | 52.5 | 76.8 |
| 60 to 79 years | 391 | 76.3 | 63.6 | 85.5 | 227 | 81.7 | 69.8 | 89.6 | 164 | 69.4 | 48.9 | 84.4 |
| Low high-density lipoprotein cholesterol | ||||||||||||
| Overall (crude prevalence) | 540 | 65.8 | 60.8 | 70.6 | 280 | 62.8 | 54.9 | 70.0 | 260 | 69.1 | 58.9 | 77.8 |
| Overall (age-standardized prevalence) | 540 | 80.4 | 76.0 | 84.1 | 280 | 78.6 | 72.5 | 83.6 | 260 | 81.6 | 72.9 | 88.0 |
| 18 to 39 years | 126 | 90.3Table 2 Note ‡ | 66.7 | 97.8 | 62 | 91.8Table 2 Note ‡ | 63.8 | 98.6 | 64 | 88.8Table 2 Note ‡ | 51.7 | 98.3 |
| 40 to 59 years | 183 | 71.2Table 2 Note ‡ | 60.7 | 79.9 | 99 | 69.3Table 2 Note ‡ | 55.5 | 80.3 | 84 | 73.0Table 2 Note ‡ | 57.9 | 84.1 |
| 60 to 79 years | 231 | 51.4 | 45.5 | 57.4 | 119 | 47.5 | 38.7 | 56.5 | 112 | 56.4 | 43.9 | 68.1 |
| High blood pressure | ||||||||||||
| Overall (crude prevalence) | 618 | 66.7 | 59.2 | 73.5 | 345 | 73.0 | 64.4 | 80.2 | 273 | 60.1Table 2 Note † | 50.8 | 68.8 |
| Overall (age-standardized prevalence) | 618 | 47.6 | 37.4 | 58.1 | 345 | 58.3 | 44.1 | 71.2 | 273 | 37.3 | 30.1 | 45.0 |
| 18 to 39 years | 39 | 16.0Note E: Use with caution Table 2 Note ‡ | 7.8 | 30.1 | 20 | Note F: too unreliable to be published | Note F: too unreliable to be published | Note F: too unreliable to be published | 19 | Note F: too unreliable to be published | Note F: too unreliable to be published | Note F: too unreliable to be published |
| 40 to 59 years | 161 | 70.0Table 2 Note ‡ | 60.4 | 78.1 | 94 | 77.4 | 60.8 | 88.3 | 67 | 63.4 | 52.2 | 73.3 |
| 60 to 79 years | 418 | 83.0 | 74.3 | 89.2 | 231 | 86.0 | 75.6 | 92.4 | 187 | 79.3 | 64.1 | 89.1 |
|
E use with caution F too unreliable to be published
|
||||||||||||
Chart 2 displays the crude and age-standardized prevalence of MetS in the Canadian adult population by sex and by paired survey cycle. Both the crude and the age-standardized prevalence of MetS remained fairly stable from the 2007-to-2011 period to the 2016-to-2019 period. For example, the crude prevalence of MetS increased slightly from 21.8% in the 2007-to-2011 period to 26.1% in the 2016-to-2019 period; however, the difference was not statistically significant. The trends among females (from 21.3% in the 2007-to-2011 period to 25.2% the 2016-to-2019 period) and males (from 22.3% to 27.0%) were comparable.
Description of Chart 2
| Both sexes | Males | Females | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Number | Percent | 95% confidence interval | Number | Percent | 95% confidence interval | Number | Percent | 95% confidence interval | ||||
| Lower | Upper | Lower | Upper | Lower | Upper | |||||||
| 2007 to 2011 (crude prevalence) | 853 | 21.8 | 19.1 | 24.7 | 432 | 22.3 | 19.2 | 25.7 | 421 | 21.3 | 17.6 | 25.5 |
| 2007 to 2011 (age-standardized prevalence) | 853 | 19.8 | 17.3 | 22.5 | 432 | 20.5 | 17.5 | 23.7 | 421 | 19.1 | 15.5 | 23.3 |
| 2012 to 2015 (crude prevalence) | 878 | 24.7 | 22.2 | 27.4 | 443 | 27.1 | 23.7 | 30.8 | 435 | 22.4 | 19.2 | 25.9 |
| 2012 to 2015 (age-standardized prevalence) | 878 | 22.2 | 19.9 | 24.7 | 443 | 24.4 | 21.2 | 27.9 | 435 | 19.8 | 16.7 | 23.3 |
| 2016 to 2019 (crude prevalence) | 873 | 26.1 | 22.5 | 30.0 | 480 | 27.0 | 22.8 | 31.6 | 393 | 25.2 | 20.7 | 30.4 |
| 2016 to 2019 (age-standardized prevalence) | 873 | 22.5 | 19.1 | 26.4 | 480 | 23.1 | 18.7 | 28.2 | 393 | 22.0 | 17.9 | 26.8 |
|
Notes: From 2007 to 2011, the total sample size for both sexes was 3,694 participants (1,751 males and 1,943 females); from 2012 to 2015, there were 3,366 participants (1689 males and 1677 females); and from 2016 to 2019, there were 3,296 participants (1,690 males and 1,606 females). Source: Statistics Canada, Canadian Health Measures Survey. |
||||||||||||
All MetS components remained stable from the 2007-to-2011 period to the 2016-to-2019 period, except for high plasma triglycerides (crude and age-standardized prevalence) and high fasting blood glucose (crude only) (Table 3). The crude prevalence of high plasma triglycerides significantly decreased over time, from 70.1% in the 2007-to-2011 period to 59.1% in the 2016-to-2019 period. In contrast, the prevalence of high fasting blood glucose significantly increased, from 58.6% in the 2007-to-2011 period to 70.6% in the 2016-to-2019 period. Similar patterns were observed among females and males, but the differences were not statistically significant in males. However, values for males and females did not change significantly from the 2007-to-2009 period to the 2012-to-2015 period for the remaining MetS components. Females were more likely than males to have a high waist circumference across all survey cycles and low HDL cholesterol in the period from 2007 to 2011. Males were more likely than females to have high fasting blood glucose in the 2007-to-2011 and the 2012-to-2015 periods, and high blood pressure in the period from 2016 to 2019.
| Both sexes | Males | Females | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| n | % | 95% confidence interval |
n | % | 95% confidence interval |
n | % | 95% confidence interval |
||||
| from | to | from | to | from | to | |||||||
| High waist circumference (crude prevalence) |
||||||||||||
| 2007 to 2011 | 769 | 93.1 | 90.4 | 95.1 | 371 | 89.1 | 84.3 | 92.6 | 398 | 97.2Table 3 Note † | 95.0 | 98.5 |
| 2012 to 2015 | 794 | 90.2 | 88.1 | 92.0 | 370 | 84.6 | 79.6 | 88.5 | 424 | 96.9Table 3 Note † | 90.5 | 99.0 |
| 2016 to 2019 | 785 | 90.0 | 85.7 | 93.1 | 400 | 82.9 | 76.0 | 88.1 | 385 | 97.6Table 3 Note † | 90.7 | 99.4 |
| High waist circumference (age-standardized prevalence) |
||||||||||||
| 2007 to 2011 | 769 | 94.2 | 88.8 | 97.1 | 371 | 91.4 | 83.3 | 95.8 | 398 | 98.1 | 94.9 | 99.3 |
| 2012 to 2015 | 794 | 92.9 | 88.9 | 95.6 | 370 | 88.8 | 83.2 | 92.7 | 424 | 98.8 | 94.6 | 99.7 |
| 2016 to 2019 | 785 | 91.4 | 86.5 | 94.7 | 400 | 83.3 | 75.0 | 89.2 | 385 | 98.8 | 95.4 | 99.7 |
| High plasma triglycerides (crude prevalence) |
||||||||||||
| 2007 to 2011 | 581 | 70.1 | 64.0 | 75.6 | 298 | 72.6 | 65.5 | 78.6 | 283 | 67.5 | 59.3 | 74.8 |
| 2012 to 2015 | 598 | 72.5 | 66.0 | 78.1 | 320 | 74.6 | 64.6 | 82.6 | 278 | 69.9 | 62.0 | 76.7 |
| 2016 to 2019 | 524 | 59.1Table 3 Note † | 52.4 | 65.4 | 316 | 62.6 | 54.2 | 70.3 | 208 | 55.4Table 3 Note ‡ | 45.8 | 64.5 |
| High plasma triglycerides (age-standardized prevalence) |
||||||||||||
| 2007 to 2011 | 581 | 77.8 | 71.2 | 83.3 | 298 | 76.1 | 69.6 | 81.6 | 283 | 78.0 | 68.3 | 85.3 |
| 2012 to 2015 | 598 | 83.5 | 78.9 | 87.2 | 320 | 85.3 | 75.8 | 91.5 | 278 | 79.6 | 73.4 | 84.7 |
| 2016 to 2019 | 524 | 63.8 | 55.7 | 71.3 | 316 | 71.6 | 59.4 | 81.4 | 208 | 64.5 | 55.4 | 72.7 |
| High fasting blood glucose (crude prevalence) |
||||||||||||
| 2007 to 2011 | 524 | 58.6 | 53.1 | 63.9 | 277 | 64.2 | 55.7 | 71.9 | 247 | 52.7Table 3 Note † | 46.5 | 58.9 |
| 2012 to 2015 | 529 | 60.1 | 52.3 | 67.5 | 295 | 69.1 | 60.5 | 76.5 | 234 | 49.4Table 3 Note † | 38.1 | 60.9 |
| 2016 to 2019 | 652 | 70.6Table 3 Note † | 64.3 | 76.3 | 376 | 73.7 | 64.7 | 81.2 | 276 | 67.3Table 3 Note ‡ | 57.3 | 76.0 |
| High fasting blood glucose (age-standardized prevalence) |
||||||||||||
| 2007 to 2011 | 524 | 50.7 | 40.6 | 60.8 | 277 | 54.8 | 41.9 | 67.2 | 247 | 47.6 | 34.5 | 61.1 |
| 2012 to 2015 | 529 | 47.8 | 37.1 | 58.7 | 295 | 56.7 | 43.8 | 68.7 | 234 | 35.4 | 22.4 | 51.0 |
| 2016 to 2019 | 652 | 61.8 | 52.2 | 70.5 | 376 | 61.7 | 46.2 | 75.2 | 276 | 57.7 | 45.6 | 69.0 |
| Low high-density lipoprotein cholesterol (crude prevalence) |
||||||||||||
| 2007 to 2011 | 541 | 66.5 | 60.7 | 71.8 | 253 | 61.0 | 52.3 | 69.0 | 288 | 72.1Table 3 Note † | 65.4 | 78.0 |
| 2012 to 2015 | 569 | 63.1 | 56.3 | 69.5 | 268 | 60.3 | 49.9 | 69.8 | 301 | 66.5 | 57.9 | 74.2 |
| 2016 to 2019 | 540 | 65.8 | 60.8 | 70.6 | 280 | 62.8 | 54.9 | 70.0 | 260 | 69.1 | 58.9 | 77.8 |
| Low high-density lipoprotein cholesterol (age-standardized prevalence) |
||||||||||||
| 2007 to 2011 | 541 | 76.6 | 70.2 | 81.9 | 253 | 69.3 | 59.0 | 77.9 | 288 | 81.6 | 72.0 | 88.5 |
| 2012 to 2015 | 569 | 70.7 | 59.6 | 79.9 | 268 | 62.2 | 46.4 | 75.7 | 301 | 81.5 | 73.5 | 87.5 |
| 2016 to 2019 | 540 | 80.4 | 76.0 | 84.1 | 280 | 78.6 | 72.5 | 83.6 | 260 | 81.6 | 72.9 | 88.0 |
| High blood pressure (crude prevalence) |
||||||||||||
| 2007 to 2011 | 572 | 59.9 | 53.9 | 65.6 | 295 | 62.2 | 53.1 | 70.6 | 277 | 57.4 | 48.2 | 66.1 |
| 2012 to 2015 | 624 | 64.1 | 58.0 | 69.8 | 319 | 63.1 | 55.6 | 69.9 | 305 | 65.4 | 58.2 | 72.0 |
| 2016 to 2019 | 618 | 66.7 | 59.2 | 73.5 | 345 | 73.0 | 64.4 | 80.2 | 273 | 60.1Table 3 Note † | 50.8 | 68.8 |
| High blood pressure (age-standardized prevalence) |
||||||||||||
| 2007 to 2011 | 572 | 39.6 | 34.4 | 44.2 | 295 | 46.9 | 39.3 | 54.7 | 277 | 35.1 | 26.0 | 45.4 |
| 2012 to 2015 | 624 | 42.3 | 36.6 | 47.3 | 319 | 46.3 | 36.4 | 56.5 | 305 | 36.7 | 31.0 | 42.9 |
| 2016 to 2019 | 618 | 47.6 | 36.7 | 58.7 | 345 | 58.3 | 44.1 | 71.2 | 273 | 37.3 | 30.1 | 45.0 |
|
||||||||||||
The distribution of the crude and age-standardized prevalence estimates by number of components of MetS among Canadian adults aged 18 to 79 in the period from 2016 to 2019 is summarized in Table 4. Nearly 32% of Canadian adults had none of the MetS components. Females were more likely than males to have none of the components, and the prevalence significantly decreased with age among females and males. In contrast, 10.5% of Canadian adults had four or five of the components. This prevalence significantly increased with age, from 1.7% for individuals aged 18 to 40 years to 19.1% for those aged 60 to 79 years. There were no sex differences in the proportion of participants with four or five of the MetS components.
| Both sexes (N=3,296) | Males (N=1,690) | Females (N=1,606) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| n | % | 95% confidence interval |
n | % | 95% confidence interval |
n | % | 95% confidence interval |
||||
| from | to | from | to | from | to | |||||||
| Zero risk factors | ||||||||||||
| Overall (crude prevalence) | 1,018 | 32.3 | 29.2 | 35.5 | 504 | 31.3 | 27.3 | 35.6 | 514 | 33.2 | 29.7 | 36.9 |
| Overall (age-standardized prevalence) | 1,018 | 36.1 | 32.7 | 39.7 | 504 | 35.5 | 30.6 | 40.6 | 514 | 36.6 | 32.4 | 41.0 |
| 18 to 39 years | 577 | 47.2Table 4 Note ‡ | 40.2 | 54.3 | 307 | 49.7Table 4 Note ‡ | 40.8 | 58.6 | 270 | 44.7Table 4 Note ‡ | 35.1 | 54.7 |
| 40 to 59 years | 301 | 29.8Table 4 Note ‡ | 24.2 | 36.1 | 138 | 26.6Table 4 Note ‡ | 20.0 | 34.3 | 163 | 33.0Table 4 Note ‡ | 26.1 | 40.7 |
| 60 to 79 years | 140 | 12.9 | 9.6 | 17.0 | 59 | 8.8 | 6.3 | 12.2 | 81 | 16.7Table 4 Note † | 12.0 | 22.7 |
| One risk factor | ||||||||||||
| Overall (crude prevalence) | 774 | 24.2 | 21.3 | 27.3 | 385 | 24.2 | 20.1 | 28.7 | 389 | 24.2 | 20.4 | 28.5 |
| Overall (age-standardized prevalence) | 774 | 25.5 | 22.3 | 29.1 | 385 | 25.4 | 20.8 | 30.6 | 389 | 25.8 | 21.4 | 30.7 |
| 18 to 39 years | 328 | 30.6Table 4 Note ‡ | 25.2 | 36.6 | 169 | 28.5Table 4 Note ‡ | 21.6 | 36.6 | 159 | 32.8Table 4 Note ‡ | 24.9 | 41.9 |
| 40 to 59 years | 247 | 21.1 | 16.8 | 26.2 | 125 | 25.8 | 18.0 | 35.5 | 122 | 16.5 | 12.4 | 21.7 |
| 60 to 79 years | 199 | 18.6 | 15.2 | 22.5 | 91 | 14.8 | 11.4 | 19.0 | 108 | 22.1 | 16.3 | 29.3 |
| Two risk factors | ||||||||||||
| Overall (crude prevalence) | 648 | 17.5 | 14.4 | 21.0 | 328 | 17.6 | 12.9 | 23.5 | 320 | 17.4 | 14.5 | 20.6 |
| Overall (age-standardized prevalence) | 648 | 16.1 | 13.3 | 19.4 | 328 | 16.3 | 11.4 | 22.8 | 320 | 15.9 | 13.5 | 18.7 |
| 18 to 39 years | 178 | 11.1 | 8.0 | 15.2 | 82 | 10.7Note E: Use with caution Table 4 Note ‡ | 5.6 | 19.4 | 96 | 11.5Note E: Use with caution Table 4 Note ‡ | 7.8 | 16.7 |
| 40 to 59 years | 212 | 19.6 | 14.8 | 25.5 | 124 | 19.8Note E: Use with caution | 13.3 | 28.4 | 88 | 19.4Note E: Use with caution | 12.9 | 28.0 |
| 60 to 79 years | 258 | 24.3 | 19.8 | 29.4 | 122 | 25.4 | 19.0 | 33.1 | 136 | 23.2 | 18.3 | 28.9 |
| Three risk factors | ||||||||||||
| Overall (crude prevalence) | 479 | 15.6 | 12.8 | 18.8 | 254 | 15.6 | 12.4 | 19.5 | 225 | 15.5 | 12.1 | 19.6 |
| Overall (age-standardized prevalence) | 479 | 13.5 | 10.8 | 16.8 | 254 | 13.3 | 10.1 | 17.5 | 225 | 13.6 | 10.4 | 17.6 |
| 18 to 39 years | 98 | 9.3Note E: Use with caution Table 4 Note ‡ | 6.0 | 14.2 | 48 | 9.0Note E: Use with caution Table 4 Note ‡ | 4.9 | 16.1 | 50 | 9.7Note E: Use with caution Table 4 Note ‡ | 6.2 | 14.9 |
| 40 to 59 years | 127 | 15.5Table 4 Note ‡ | 12.4 | 19.3 | 69 | 13.5Table 4 Note ‡ | 9.6 | 18.8 | 58 | 17.5 | 13.2 | 22.8 |
| 60 to 79 years | 254 | 25.2 | 20.4 | 30.6 | 137 | 29.3 | 22.0 | 37.8 | 117 | 21.3 | 15.7 | 28.4 |
| Four or five risk factors | ||||||||||||
| Overall (crude prevalence) | 401 | 10.5 | 8.8 | 12.5 | 231 | 11.3 | 9.5 | 13.5 | 170 | 9.7 | 7.4 | 12.8 |
| Overall (age-standardized prevalence) | 401 | 8.8 | 7.2 | 10.6 | 231 | 9.5 | 7.7 | 11.7 | 170 | 8.1 | 5.9 | 10.9 |
| 18 to 39 years | 49 | 1.7Note E: Use with caution Table 4 Note ‡ | 1.0 | 2.9 | 31 | 2.1Note E: Use with caution Table 4 Note ‡ | 1.1 | 4.1 | 18 | 1.4Note E: Use with caution Table 4 Note ‡ | 0.7 | 2.6 |
| 40 to 59 years | 129 | 14.0Table 4 Note ‡ | 10.3 | 18.8 | 74 | 14.3 | 9.9 | 20.2 | 55 | 13.6Note E: Use with caution | 8.6 | 20.9 |
| 60 to 79 years | 223 | 19.1 | 15.4 | 23.4 | 126 | 21.7 | 16.8 | 27.6 | 97 | 16.7 | 12.6 | 21.8 |
E use with caution
|
||||||||||||
Results from sensitivity analyses using ethno-specific cut-off points for waist measurement recommended by the 2020 Canadian Adult Obesity Clinical Practice Guideline (i.e., 85 centimetres or more for men and 75 centimetres or more for women with a predominant South Asian, Southeast Asian, or East Asian ethnicity, and 102 centimetres or more for men and 88 centimetres or more for women of other ethnicities)Note 24 showed very small changes to the estimates (generally less than 1%).
Discussion
Previous studies have used data from the first two cycles of the CHMS (Cycle 1 [2007 to 2009] and Cycle 2 [2009 to 2011]) to examine the prevalence of MetS in relation to different outcomes.Note 12, Note 13, Note 14 With six cycles of CHMS data now available (2007 to 2019), this study provides an updated prevalence of MetS and its components among Canadian adults aged 18 to 79 years in the period from 2016 to 2019 by age group and sex. Results showed that nearly one in four Canadian males and females aged 18 to 79 had MetS. The prevalence of MetS was similar among females and males and increased with age, from 11.1% among those aged 18 to 39 years to 44.4% among those aged 60 to 79 years. Among individuals with MetS in the period from 2016 to 2019, high waist circumference was the most common component, followed by high fasting blood glucose and low HDL cholesterol. The prevalence of all MetS components increased with age, except for low HDL cholesterol, which significantly decreased with age.
Several definitions of MetS have been proposed by different organizations over time,6 making comparisons across studies difficult. Riediger et al. (2011) used data from Cycle 1 (2007 to 2009) of the CHMS to investigate the prevalence of MetS among Canadian adults aged 18 to 79 years using different criteria.Note 12 They found that the prevalence of MetS was about 17.7% based on ATP III criteria, 19.1% based on the unified criteria with high thresholds for waist circumference, and 23.2% based on the unified criteria with low thresholds for waist circumference.Note 12 Rao et al. (2014) also used Cycle 1 data to assess different criteria in adults aged 20 to 79 years.Note 14 They found that the crude prevalence of MetS was about 15.5% based on ATP III criteria, 23.1% based on the IDF criteria, and 19.6% based on the joint interim statement.Note 14 In another Canadian study, Clarke and Janssen (2014) combined data from cycles 1 and 2 (2007 to 2012) of the CHMS and documented a prevalence of 16.4% among Canadian adults aged 18 to 64 years, based on the joint interim statement.Note 13 The estimates reported in this study are different from those reported in previous studies using CHMS data because of differences in study methodology (e.g., age of the study population, combined cycles, exclusions) and definitions of MetS (e.g., the joint interim statement, ethno-specific cut-off points for waist measurement).
Regardless of the diagnostic criteria used, several epidemiological studies have confirmed the increased risk of cardiovascular disease and diabetes for individuals with MetS.Note 25, Note 26, Note 27 The overall prevalence of MetS, documented at 26.2% in this study using the joint interim statement definition of MetS, is relatively lower than the prevalence documented among adults in the United States aged 18 and older in the 2007 to 2012 National Health and Nutrition Examination Survey (NHANES) (34.2%) using the same definition,Note 28 and in the 2011 to 2018 NHANES (37.6%) using the NCEP ATP III definition.Note 29 Moreover, the lack of sex differences in the prevalence of MetS over time observed in the total study sample is consistent with the findings from the 2011 to 2018 NHANESNote 29 and suggests that the prevalence of MetS is similar among males and females. However, differences between males and females became more apparent in the oldest age group (i.e., those aged 60 to 79 years), with females more likely to have MetS than males—an interesting observation that warrants further investigation. The findings that the prevalence of MetS increased with age are consistent with results observed in the United States and in other populations around the world.Note 30, Note 31, Note 32 It is well known that the prevalence of most chronic diseases and conditions increases with age.Note 33 As the Canadian population ages, an increase in the prevalence of MetS could be expected, increasing the burden of cardiovascular disease and diabetes.Note 10, Note 26, Note 27, Note 34 Heightened and ongoing efforts are needed, particularly to address diabetes as defined by high fasting blood glucose, which increased significantly over the study period.
This study also examines trends in the crude and age-standardized prevalence of MetS and its components over time in this population from 2007 to 2019. Results showed that the prevalence of MetS remained relatively stable from the 2007-to-2011 period to the 2016-to-2019 period. These findings contrast with those from the United States that showed an increase over time, from 37.6% in the 2011-to-2012 period to 41.8% in the 2017-to-2018 period.Note 29 However, the sample size of the present study may be insufficient to detect a significant difference. Trends for all the MetS components were also stable across the same period, except for high plasma triglycerides and high fasting blood glucose. The prevalence of high plasma triglycerides in individuals with MetS significantly decreased over time, while the prevalence of high fasting blood glucose showed an opposite trend. These findings are consistent with those from the United States indicating that among the MetS components, the prevalence of elevated glucose increased from 48.9% in the 2011-to-2012 period to 64.7% in the 2017-to-2018 period, while the prevalence of high plasma triglycerides decreased over time, from 26.7% to 21.1%, although the difference was not statistically significant.Note 29 The analyses in the present study provide further indication of the rising trend in hyperglycemia as one of the leading causes of MetS, highlighting the pressing need to strengthen ongoing efforts to prevent diabetes in Canada. In contrast, the prevalence of diabetes in the general population of Canadian adults based on the CHMS data remained relatively stable from the 2009-to-2011 period to the 2016-to-2019 period.Note 35 This finding is consistent with the self-reported data from the Canadian Community Health Survey,Note 36 indicating that the prevalence of diabetes among Canadian adults was fairly stable from 2015 to 2021. The observed increase in the prevalence of elevated fasting blood glucose over time could be explained by the change in the reference laboratory responsible for glucose test analysis in the CHMS during the period from 2016 to 2019 (i.e., cycles 5 and 6).
The finding that abdominal obesity (90.5%) was the most common component of MetS, followed by high fasting blood glucose (70.6%), was not surprising. Research has shown that the prevalence of MetS rises even more dramatically as body mass index increases. For example, in the 2003 to 2006 NHANES, overweight adult males and females aged 20 years or older were found to be over 6 and 5.5 times, respectively, as likely to meet the criteria for MetS than underweight and normal-weight individuals. However, among those with obesity, these figures spiked to 32 times higher in males and 17 times higher in females, compared with underweight and normal-weight individuals.Note 37
The strengths of the present study include the use of a large and nationally representative sample of Canadian adults and the use of direct measures data, which provide unbiased measures of MetS components. Age standardization allows for comparisons of estimates over time by removing the influence of changes in the population’s age distribution. The use of ethno-specific abdominal obesity cut-off points may help improve the accuracy of estimates, particularly for Asian participants.Note 37 Important limitations include the cross-sectional nature of the data, which does not allow for longitudinal follow-up or causal inferences, and the restriction of the present analyses to a smaller fasted subsample of the CHMS. This could be problematic because of reduced statistical power and a likely increased risk of bias.
In conclusion, this study provides an updated prevalence of MetS and its components among Canadian adults aged 18 to 79 years by age group and sex for the period from 2016 to 2019 using the most recent available data. While Cycle 7 data, which were collected from 2022 to 2024, will be available soon, waiting for data from Cycle 8 will allow for a more robust analysis and perhaps a better comparison of the periods before the COVID-19 pandemic and the period following it. In the period from 2016 to 2019, just over one in four Canadian adults had MetS. The prevalence of MetS increases with age and is similar among females and males, except in the oldest age group, where females were more likely than males to have MetS. Abdominal obesity and high fasting blood glucose were the most frequent components among individuals with MetS. The prevalence of MetS and its components remained relatively stable over the period from 2007 to 2011 to the period from 2016 to 2019, except for high plasma triglycerides and high fasting blood glucose, which decreased and increased over time, respectively. The rising trend in high fasting blood glucose highlights the pressing need for heightened efforts to prevent diabetes in Canada. The findings from this study also underscore the need to raise awareness and improve screening among this high-risk group while strengthening ongoing surveillance of obesity and diabetes in Canada to reduce the population burden of MetS.
Acknowledgments
The authors thank Janine Clarke and Tracey Bushnik for their input and support throughout the research process.
- Date modified: