The European Journal of Public Health Advance Access published online on July 4, 2008
The European Journal of Public Health, doi:10.1093/eurpub/ckn056
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Identifying metabolic syndrome without blood tests in young adults—The Terneuzen Birth Cohort
Marlou L. A. de Kroon1,2, Carry M. Renders1, Esther C. C. Kuipers1,2, Jacobus P. van Wouwe3, Stef van Buuren3, Guus A. de Jonge3 and Remy A. Hirasing1,3
1 Department of Public and Occupational Health, Institute for Research in Extramural Medicine, VU University Medical Centre, Amsterdam, The Netherlands
2 Municipal Health Service (OCW, GGD JGZ), The Hague, The Netherlands
3 Netherlands Organisation for applied Scientific Research, TNO Quality of Life, Prevention and Health Care, Leiden, The Netherlands
Correspondence: Marlou L.A. de Kroon, Department of Public and Occupational Health, Institute for Research in Extramural Medicine (room N° C574), VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands, tel: +31152611289, +31204441706, fax: +31204448387, e-mail: top{at}fms.demon.nl
Received December 16, 2007 , accepted June 3, 2008
Background: Within the context of the obesity epidemic identifying young adults at risk for type 2 diabetes and cardiovascular disease is important. A practical approach is based on the identification of metabolic syndrome (MetS). Our objective was to develop a simple and efficient stepwise strategy to identify MetS in young adults. Methods: Subjects were part of a birth cohort (n = 2599) in Terneuzen, The Netherlands, born in 1977–86. In 2004–05: 642 of these young adults participated in a physical examination and blood tests. Tree regression was used to determine the optimal decision strategy to identify MetS. Results: Overall prevalence of MetS, defined according to the NCEP ATPIII, was 7.5%. The tree regression yielded an optimal stepwise strategy that eliminated the need for blood tests for the diagnosis of MetS in 50–90% of the cases, depending on the accepted level of error. A large group (52% of the total) with BMI <35 had a normal waist circumference (WC) and normal blood pressure (BP). None of them had MetS. Subjects with BMI 
35 all had MetS. If BMI <30, 38% had an increased WC or increased BP with a risk of MetS of only 6%. So for them the omission of blood tests could also be considered. Conclusion: In most young adults MetS can be identified or excluded without blood tests by a simple and stepwise strategy, based on the measurement of BMI, WC and BP. This makes it possible to develop simple prevention strategies for young adults at risk for type 2 diabetes and cardiovascular disease.
Keywords: metabolic syndrome, tree regression, young adults