Validation of metabolic syndrome score by confirmatory factor analysis in children and adults and prediction of cardiometabolic outcomes in adults

Diabetologia. 2014 May;57(5):940-9. doi: 10.1007/s00125-014-3172-5. Epub 2014 Jan 24.


Aims/hypothesis: We validated the metabolic syndrome (MetS) score by confirmatory factor analysis (CFA) in children, middle-aged men, and older women and men and by investigating the relationships of the MetS score to incident type 2 diabetes, myocardial infarction, and cardiovascular and overall death in middle-aged men.

Methods: We assessed the core features of MetS, calculated the MetS score using z scores for waist circumference, insulin, glucose, triacylglycerols, HDL-cholesterol and blood pressure, and carried out CFA to investigate whether MetS represents a single entity in population samples of 491 children, 1,900 middle-aged men, 614 older women and 555 older men from Finland. We also followed-up incident type 2 diabetes for 11 years and other outcomes for 17-18 years in middle-aged men.

Results: We carried out second-order CFAs in which the MetS was represented by a second-order latent variable underlying four latent variables characterised by abdominal obesity, insulin resistance, dyslipidaemia and raised blood pressure in different age groups. These second-order factors and factors derived from first-order CFA using previously proposed models were strongly associated with a composite MetS score in all age groups (r = 0.84-0.94) and similarly predicted type 2 diabetes, cardiovascular outcomes and mortality in middle-aged men. The risk of type 2 diabetes, myocardial infarction, cardiovascular death and overall death increased 3.67-, 1.38-, 1.56- and 1.44-fold, respectively, for a 1 SD increase in the MetS score.

Conclusions: The MetS can be described as a single entity in all age groups. The MetS score is a valid tool for research evaluating cardiometabolic risk in different age groups. Further research is needed to define cut-off points for risk estimation in clinical practice.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adult
  • Blood Glucose / analysis
  • Blood Pressure
  • Cardiovascular Diseases / blood*
  • Cardiovascular Diseases / complications
  • Cardiovascular Diseases / diagnosis*
  • Child
  • Cholesterol, HDL / blood
  • Diabetes Mellitus, Type 2 / blood
  • Diet
  • Exercise
  • Factor Analysis, Statistical
  • Female
  • Finland
  • Humans
  • Insulin / blood
  • Insulin Resistance
  • Male
  • Metabolic Syndrome / blood*
  • Metabolic Syndrome / complications
  • Metabolic Syndrome / diagnosis*
  • Middle Aged
  • Myocardial Infarction / blood
  • Myocardial Infarction / complications
  • Risk Factors
  • Treatment Outcome
  • Triglycerides / blood
  • Waist Circumference


  • Blood Glucose
  • Cholesterol, HDL
  • Insulin
  • Triglycerides