Prediction of the development of metabolic syndrome by the Markov model based on a longitudinal study in Dalian City

Background: Metabolic syndrome (MetS) increases the incidence of cardiovascular disease and diabetes mellitus. It is essential to study the natural progression of MetS in the interest of prevention. Information on the dynamic changes in MetS in developing countries is limited. This study aimed to simulate the progression of each component of MetS and explore the potential role of these components in early prevention and intervention. Methods: This study involved 5881 individuals, aged 20 to 60 at study entry, who underwent at least two consecutive years of health check-ups in the seven-year study period at our institution's health check-up center. Participants were divided into four groups by age (a 20- to- 40-year-old group and a 40- to 60-year-old group) and gender. A Markov model containing 7 stages (no components, isolated hypertension, isolated obesity, isolated hyperglycemia, isolated dyslipidemia, a 2-component state, and the MetS state) was constructed for each group. Results: In women and young men (20- to 40-year-old men), dyslipidemia and obesity were the two most probable states for individuals who were transitioning from no components to one of the other six states. Among those who had no components and were 30 years old at study entry, MetS was estimated to develop within 10 years in 11.42% of men and 3.04% of women. Among those who had no components and were 50 years old at study entry, MetS was estimated to develop within 10 years in 25.04% of men and 7.09% of women. The estimated prevalence of MetS over the next 10 years was higher in individuals starting with the obesity component than in individuals starting with any other isolated component. In a comparison of interventions targeting single components, simulations showed that the obesity intervention produced the largest relative reduction in the prevalence of MetS. Conclusion: Markov models are suitable for describing and predicting the dynamic development of MetS. The occurrence of MetS most frequently began with dyslipidemia or obesity. Obesity played a predominant role in the development of MetS. Early obesity intervention was extremely important for MetS prevention.