IJCS | Volume 31, Nº6, November / December 2018

607 Figure 2 - Prevalence of metabolic syndrome (MS) by nutritional state and gender. (*) indicates a significant difference in MS prevalence between genders (p < 0.05; chi-square test). (+) indicates an increased MS prevalence in the indicated gender compared with the previous nutritional status. Brajkovich et al. Metabolic syndrome inVenezuela Int J Cardiovasc Sci. 2018;31(6)603-609 Original Article Discussion In this study, 35.7% of the subjects met the criteria for MS, while the most prevalent abnormalities were low HDL-c, abdominal obesity, and elevated triglycerides levels. These abnormalities increased with age and were more prevalent in men and subjects with overweight or obesity. These results are consistent with those of other studies conducted in Venezuela, which reported a prevalence of MS ranging from 27.4%, in 274 subjects from Mérida city 14 in the Andes region to 45.4% in 321 subjects in the Junquito municipality 15 in the Capital District. Using the NCEP/ATP-III definition, the prevalence of MS in this study was similar to that observed in the Florez et al. study (31.2%), 10 conducted in the Zulia region, but higher than that observed in the CARMELA study, conducted in Barquisimeto (25.8%). 12 The prevalence observed in the present study is one of the highest reported in the American region. In a systematic review of MS in Latin American countries, the weighted prevalence of MS was 24.9% (range 18.8 – 43.3%). 16 A higher weighted mean for general MS prevalence has been reported in a Brazilian study (29.6%, range 14.9 – 65.3%). 17 The Central American Diabetes Initiative (CAMDI) study 18 included five major Central American populations and study data on 6,185 adults aged ≥ 20 years, with a survey response rate of 82.0%. This is higher than the data reported in the CARMELA study in Mexico City (27%). 12 The global prevalence of MS according to the NECP/ATP-III criteria was 30.3%, which is similar to the prevalence found in this study using the NECP/ATP-III definition. Compared with the population in the United States (US), the prevalence of MS in this report was similar to the one observed in Hispanics (35.4%) in the National Health and Nutrition Examination Survey (NHANES data 2003 – 2012); this population also showed an increasing prevalence of MS, from 34.3% in 2003 – 2004 to 38.6% in 2011 –2012. 19 The higher prevalence of MS observed in this study using the most recent definition of MS can be explained, in part, by the different cutoff values applied. The NCEP/ ATP-III definition 11 includes higher cutoff values for both elevated blood glucose (110 mg/dL) and abdominal obesity (using the cutoff values recommended for the US population). Therefore, the cutoff value to detect subjects with impaired fasting glucose was reduced to 100mg/dL, 20 while the International Diabetes Federation 19 recommended the adaptation of the waist circumference cutoff values to ethnic and regional differences. Thus, for Latin American subjects, the values proposed are