Skip to main content

The effectiveness of IDF and ATP-III in identifying metabolic syndrome and the usefulness of these tools for health-promotion in older Taiwanese



The aim of this study was to compare the effectiveness of IDF (International Diabetes Federation) and ATP-III (National Cholesterol Education Program-Adult Treatment Panel III) for predicting metabolic syndrome, and to evaluate the usefulness of these definitions for health promotion.


A cross-sectional study.


A national random sample.


A population representative sample of 1021 54–91 year-old Taiwanese.


Subjects were measured for anthropometric and biochemical indicators and rated for the presence of metabolic syndrome using the two definitions. We evaluated the effectiveness of the two definitions in predicting MetS among those who had specific metabolic disorders. Results were analyzed with Student t-test and McNemar’s test.


Among the 918 subjects who had one or more MetS-item disorders, ATP-III rated greater proportions of subjects as having MetS than IDF, but both definitions predicted less than 50% (37.7% and 45.4%, respectively) as having MetS.


Compared to IDF, ATP-III rated a greater proportion of subjects as having MetS, but both definitions missed more than 50% of subjects who had metabolic disorder(s). Since those who are missed have as much need for lifestyle intervention, the definitions appear not appropriate for health promotion.

This is a preview of subscription content, access via your institution.


  1. 1.

    Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes. 1988;37(12):1595–1607.

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112(17):2735–2752.

    PubMed  Article  Google Scholar 

  3. 3.

    Alberti KG, Zimmet P, Shaw J. Metabolic syndrome—a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med. 2006;23(5):469–480.

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Hwang LC, Bai CH, Chen CJ. Prevalence of obesity and metabolic syndrome in Taiwan. J Formos Med Assoc. 2006;105(8):626–635.

    PubMed  Article  Google Scholar 

  5. 5.

    Hermalin AL, Liang J, Chang MC. 1989 survey of the health and living status of the elderly in Taiwan: questionnaire and survey design. Comparative study of the elderly in Asia research report 89-1. Ann Arbor: University of Michigan.; 1989.

    Google Scholar 

  6. 6.

    Seeman T, Glei D, Goldman N, Weinstein M, Singer B, Lin YH. Social relationships and allostatic load in Taiwanese elderly and near elderly. Soc Sci Med. 2004;59(11):2245–2257.

    PubMed  Article  Google Scholar 

  7. 7.

    Goldman N, Lin IF, Weinstein M, Lin YH. Evaluating the quality of self-reports of hypertension and diabetes. J Clin Epidemiol. 2003;56(2):148–154.

    PubMed  Article  Google Scholar 

  8. 8.

    Cheng TY, Wen SF, Astor BC, Tao XG, Samet JM, Wen CP. Mortality risks for all causes and cardiovascular diseases and reduced GFR in a middle-aged working population in Taiwan. Am J Kidney Dis. 2008;52(6):1051–1060.

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Lee J, Ma S, Heng D, Tan CE, Chew SK, Hughes K, et al. Should central obesity be an optional or essential component of the metabolic syndrome? Ischemic heart disease risk in the Singapore Cardiovascular Cohort Study. Diabetes Care. 2007;30(2):343–347.

    PubMed  Article  Google Scholar 

  10. 10.

    Moy FM, Bulgiba A. The modified NCEP ATP III criteria maybe better than the IDF criteria in diagnosing Metabolic Syndrome among Malays in Kuala Lumpur. BMC Public Health. 2010;10:678.

    PubMed  Article  Google Scholar 

  11. 11.

    Tong PC, Kong AP, So WY, Yang X, Ho CS, Ma RC, et al. The usefulness of the International Diabetes Federation and the National Cholesterol Education Program’s Adult Treatment Panel III definitions of the metabolic syndrome in predicting coronary heart disease in subjects with type 2 diabetes. Diabetes Care. 2007;30(5):1206–1211.

    PubMed  Article  Google Scholar 

  12. 12.

    Moebus S, Hanisch JU, Aidelsburger P, Bramlage P, Wasem J, Jockel KH. Impact of 4 different definitions used for the assessment of the prevalence of the Metabolic Syndrome in primary healthcare: The German Metabolic and Cardiovascular Risk Project (GEMCAS). Cardiovasc Diabetol. 2007;6:22.

    PubMed  Article  Google Scholar 

  13. 13.

    Santos AC, Barros H. Impact of metabolic syndrome definitions on prevalence estimates: a study in a Portuguese community. Diab Vasc Dis Res. 2007;4(4):320–327.

    PubMed  Article  Google Scholar 

  14. 14.

    Wang J, Ruotsalainen S, Moilanen L, Lepisto P, Laakso M, Kuusisto J. The metabolic syndrome predicts cardiovascular mortality: a 13-year follow-up study in elderly non-diabetic Finns. Eur Heart J. 2007;28(7):857–864.

    PubMed  Article  Google Scholar 

  15. 15.

    Guembe MJ, Toledo E, Barba J, Martinez-Vila E, Gonzalez-Diego P, Irimia P, et al. Association between metabolic syndrome or its components and asymptomatic cardiovascular disease in the RIVANA-study. Atherosclerosis. 2010;211(2):612–617.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Thomas F, Pannier B, Benetos A, Vischer UM. The impact of the metabolic syndrome — but not of hypertension — on all-cause mortality disappears in the elderly. J Hypertens. 2011;29(4):663–668.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    He Y, Jiang B, Wang J, Feng K, Chang Q, Zhu S, et al. BMI versus the metabolic syndrome in relation to cardiovascular risk in elderly Chinese individuals. Diabetes Care. 2007;30(8):2128–2134.

    PubMed  Article  Google Scholar 

  18. 18.

    Hata J, Doi Y, Ninomiya T, Fukuhara M, Ikeda F, Mukai N, et al. Combined effects of smoking and hypercholesterolemia on the risk of stroke and coronary heart disease in Japanese: the Hisayama study. Cerebrovasc Dis. 2011;31(5):477–484.

    PubMed  Article  Google Scholar 

  19. 19.

    Arboix A, Garcia-Eroles L, Oliveres M, Targa C, Balcells M, Massons J. Pretreatment with statins improves early outcome in patients with first-ever ischaemic stroke: a pleiotropic effect of statins or a beneficial effect of hypercholesterolemia? BMC Neurol. 2010;10:47.

    PubMed  Article  Google Scholar 

  20. 20.

    Succurro E, Marini MA, Arturi F, Grembiale A, Fiorentino TV, Andreozzi F, et al. Usefulness of Hemoglobin A1c as a Criterion to Define the Metabolic Syndrome in a Cohort of Italian Nondiabetic White Subjects. Am J Cardiol. 2011(170):1650–1655.

    Google Scholar 

  21. 21.

    Ravikiran M, Bhansali A, Ravikumar P, Bhansali S, Dutta P, Thakur JS, et al. Prevalence and risk factors of metabolic syndrome among Asian Indians: a community survey. Diabetes Res Clin Pract. 2010;89(2):181–188.

    PubMed  Article  Google Scholar 

  22. 22.

    Simmons RK, Alberti KG, Gale EA, Colagiuri S, Tuomilehto J, Qiao Q, et al. The metabolic syndrome: useful concept or clinical tool? Report of a WHO Expert Consultation. Diabetologia. 2010;53(4):600–605.

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Lewis SJ, Rodbard HW, Fox KM, Grandy S. Self-reported prevalence and awareness of metabolic syndrome: findings from SHIELD. Int J Clin Pract. 2008;62(8):1168–1176.

    PubMed  Article  CAS  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Alan C. Tsai.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Chen, M.M., Tsai, A.C. The effectiveness of IDF and ATP-III in identifying metabolic syndrome and the usefulness of these tools for health-promotion in older Taiwanese. J Nutr Health Aging 17, 413–416 (2013).

Download citation

Key words

  • Metabolic syndrome
  • metabolic disorder
  • health promotion
  • Taiwan