Metabolic syndrome pandemic

Arteriosclerosis, Thrombosis, and Vascular Biology

Volumn 28, Issue 4, 2008, Pages 629-636

  Grundy, Scott M ^a,b  

^a UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER   (United States)

^b UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER   (United States)

Author keywords

Acute coronary syndrome; Diabetes; Hypertension; Lipids; Obesity

Indexed keywords

GLUCOSE; LIPID;

AFRICAN AMERICAN; AGING; BLOOD PRESSURE MEASUREMENT; BODY FAT DISTRIBUTION; BODY WEIGHT; CANADA; CARDIOVASCULAR RISK; CAUCASIAN; CENTRAL AMERICA; DEVELOPING COUNTRY; DISEASE PREDISPOSITION; GENETIC SUSCEPTIBILITY; GLUCOSE BLOOD LEVEL; HISPANIC; HUMAN; INSULIN RESISTANCE; LIPID BLOOD LEVEL; METABOLIC SYNDROME X; NON INSULIN DEPENDENT DIABETES MELLITUS; OBESITY; PANDEMIC; POPULATION RESEARCH; POPULATION RISK; PREVALENCE; PRIORITY JOURNAL; RACE DIFFERENCE; SHORT SURVEY; SOUTH AMERICA; UNITED STATES; ADOLESCENT; ADULT; AGED; ATHEROSCLEROSIS; CARDIOVASCULAR DISEASE; CHILD; EPIDEMIC; FEMALE; MALE; MIDDLE AGED; REVIEW; RISK FACTOR;

ADOLESCENT; ADULT; AGED; ATHEROSCLEROSIS; CARDIOVASCULAR DISEASES; CHILD; DISEASE OUTBREAKS; FEMALE; HUMANS; MALE; METABOLIC SYNDROME X; MIDDLE AGED; RISK FACTORS;

EID: 42249093870     PISSN: 10795642     EISSN: None     Source Type: Journal    
DOI: 10.1161/ATVBAHA.107.151092     Document Type: Short Survey

References (90)

1. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr., Spertus JA, Costa F. American Heart Association; National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112:2735-2752.
2. Grundy SM. Metabolic syndrome: a multiplex cardiovascular risk factor. J Clin Endocrinol Metab. 2007;92:399-404.
3. Park YW, Zhu S, Palaniappan L, Heshka S, Carnethon MR, Heymsfield SB. The MetS: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988-1994. Arch Intern Med. 2003;163:427-436.
4. Gami AS, Witt BJ, Howard DE, Erwin PJ, Gami LA, Somers VK, Montori VM. Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies. J Am Coll Cardiol. 2007;49:403-414.
5. Despres JP, Lemieux I. Abdominal obesity and metabolic syndrome. Nature. 2006;444:881-887.
6. Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Final Report. Circulation. 2002;106:3143-3421.
7. Corti R, Hutter R, Badimon JJ, Fuster V. Evolving concepts in the triad of atherosclerosis, inflammation and thrombosis. J Thromb Thrombolysis. 2004;17:35-44.
8. Fuster V, Moreno PR, Fayad ZA, Corti R, Badimon JJ. Atherothrombosis and high-risk plaque: part I: evolving concepts. J Am Coll Cardiol. 2005;46:937-954.
9. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15:539-553.
10. Alberti KGMM, Zimmet P, Shaw J, and for the IDF Epidemiology Task Force Consensus Group. The Metabolic Syndrome-A New Worldwide Definition. Lancet. 2005;366:1059-1062.
11. Kahn R, Buse J, Ferrannini E, Stern M. American Diabetes Association; European Association for the Study of Diabetes. The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2005;28:2289-2304.
12. Goodman E. Pediatric metabolic syndrome: smoke and mirrors or true magic? J Pediatr. 2006;148:149-151.
13. Hossain P, Kawar B, El Nahas M. Obesity and diabetes in the developing world-a growing challenge. N Engl J Med. 2007;356:213-215.
14. Ogden CL, Carroll MD, Curtin LR, McDowell MA, TAbak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006;295:1649-1555.
15. Shields M, Tjepkema M. Trends in adult obesity. Health Rep. 2006;17:53-59.
16. Ford ES, Giles WH, Dietz WH. Prevalence of the MetS among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002;287:356-359.
17. Ford ES, Giles WH, Mokdad AH. Increasing prevalence of the metabolic syndrome among U.S. Adults. Diabetes Care. 2004;27:2444-2449.
18. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000. JAMA. 2002;288:1723-1727.
19. Alexander CM, Landsman PB, Grund SM. The influence of age and body mass index on the metabolic syndrome and its components. Diabetes Obes Metab. Epub Feb. 2, 2007.
20. Jain T, Peshock R, McGuire DK, Willett D, Yu Z, Vega GL, Guerra R, Hobbs HH, Grundy SM. Dallas Heart Study Investigators. African Americans and Caucasians have a similar prevalence of coronary calcium in the Dallas Heart Study. J Am Coll Cardiol. 2004;44:1011-1017.
21. Vega GL, Adams-Huet B, Peshock R, Willett D, Shah B, Grundy SM. Influence of body fat content and distribution on variation in metabolic risk. J Clin Endocrinol Metab. 2006;91:4459-4466.
22. Vega GL, Clark LT, Tang A, Marcovina S, Grundy SM, Cohen JC. Hepatic lipase activity is lower in African American men than in white American men: effects of 5′ flanking polymorphism in the hepatic lipase gene (LIPC). J Lipid Res. 1998;39:228-232.
23. Nie L, Niu S, Vega GL, Clark LT, Tang A, Grundy SM, Cohen JC. Three polymorphisms associated with low hepatic lipase activity are common in African Americans. J Lipid Res. 1998;39:1900-1903.
24. Haffner SM, D'Agostino R, Saad MF, Rewers M, Mykkanen L, Selby J, Howard G, Savage PJ, Hamman RF, Wagenknecht LE, et al. Increased insulin resistance and insulin secretion in nondiabetic African-Americans and Hispanics compared with non-Hispanic whites. The Insulin Resistance Atherosclerosis Study. Diabetes. 1996;45:742-748.
25. Haffner SM, Howard G, Mayer E, Bergman RN, Savage PJ, Rewers M, Mykkanen L, Karter AJ, Hamman R, Saad MF. Insulin sensitivity and acute insulin response in African-Americans, non-Hispanic whites, and Hispanics with NIDDM: the Insulin Resistance Atherosclerosis Study. Diabetes. 1997;46:63-69.
26. Ferdinand KC, Saunders E. Hypertension-related morbidity and mortality in African Americans-why we need to do better. J Clin Hypertens (Greenwich). 2006;8(1 Suppl 1):21-30.
27. Egede LE, Dagogo-Jack S. Epidemiology of type 2 diabetes: focus on ethnic minorities. Med Clin North Am. 2005;89:949-975.
28. Carter JS, Pugh JA, Monterrosa A. Non-insulin-dependent diabetes mellitus in minorities in the United States. Ann Intern Med. 1996;125:221-232.
29. Li C, Ford ES, McGuire LC, Mokdad AH, Little RR, Reaven GM. Trends in hyperinsulinemia among nondiabetic adults in the U.S. Diabetes Care. 2006;29:2396-2402.
30. Baxter J, Hamman RF, Lopez TK, Marshall JA, Hoag S, Swenson CJ. Excess incidence of known non-insulin-dependent diabetes mellitus (NIDDM) in Hispanics compared with non-Hispanic whites in the San Luis Valley. Colorado Ethnicity & Disease. 1993;3:11-21.
31. Haffner SM, Hazuda HP, Mitchell BD, Patterson JK, Stern MP. Increased incidence of type II diabetes mellitus in Mexican Americans. Diabetes Care. 1991;14:102-108.
32. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006;295:1549-1555.
33. Flegal KM, Ogden CL, Carroll MD. Prevalence and trends in overweight in Mexican-American adults and children. Nutr Rev. 2004;62(7 Pt 2):S144-S148.
34. Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC, Grundy SM, Hobbs HH. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004;40:1387-1395.
35. Ong KL, Cheung BM, Man YB, Lau CP, Lam KS. Prevalence, awareness, treatment, and control of hypertension among United States adults 1999-2004. Hypertension. 2007;49:69-75.
36. Lillioja S, Mott diabetes, Spraul M, Ferraro R, Foley JE, Ravussin E, Knowler WC, Bennett PH, Bogardus C. Insulin resistance and insulin secretory dysfunction as precursors of non-insulin dependent diabetes mellitus: prospective studies of Pima Indians. N Engl J Med. 1993;329:1988-1992.
37. Resnick HE, Jones K, Ruotolo G, Jain AK, Henderson J, Lu W, Howard BV. Strong Heart Study. Insulin resistance, the metabolic syndrome, and risk of incident cardiovascular disease in nondiabetic american indians: the Strong Heart Study. Diabetes Care. 2003;26:861-867.
38. Kaler SN, Ralph-Campbell K, Pohar S, King M, Laboucan CR, Toth EL. High rates of the metabolic syndrome in a First Nations Community in western Canada: prevalence and determinants in adults and children. Int J Circumpolar Health. 2006;65:389-402.
39. Pollex RL, Hanley AJ, Zinman B, Harris SB, Khan HM, Hegele RA. Metabolic syndrome in aboriginal Canadians: prevalence and genetic associations. Atherosclerosis. 2006;184:121-129.
40. Jaber LA, Brown MB, Hammad A, Zhu Q, Herman WH. The prevalence of the metabolic syndrome among Arab-Americans. Diabetes Care. 2004;27:234-238.
41. Goodman E, Dolan LM, Morrison JA, Daniels SR. Factor analysis of clustered cardiovascular risks in adolescence: obesity is the predominant correlate of risk among youth. Circulation. 2005;111:1970-1977.
42. Daniels SR, Arnett DK, Eckel RH, Gidding SS, Hayman LL, Kumanyika S, Robinson TN, Scott BJ, St Jeor S, Williams CL. Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation. 2005;111:1999-2012.
43. Dallongeville J, Cottel D, Ferrieres J, Arveiler D, Bingham A, Ruidavets JB, Haas B, Ducimetiere P, Amouyel P. Household income is associated with the risk of metabolic syndrome in a sex-specific manner. Diabetes Care. 2005;28:409-415.
44. Bataille V, Perret B, Dallongeville J, Arveiler D, Yarnell J, Ducimetiere P, Ferrieres J. Metabolic syndrome and coronary heart disease risk in a population-based study of middle-aged men from France and Northern Ireland. A nested case-control study from the PRIME cohort. Diabetes Metab. 2006;32(5 Pt 1):475-479.
45. Assmann G, Guerra R, Fox G, Cullen P, Schulte H, Willett D, Grundy SM. Harmonizing the definition of the metabolic syndrome: comparison of the criteria of the Adult Treatment Panel III and the International Diabetes Federation in United States American and European populations. Am J Cardiol. 2007;99:541-548.
46. Dekker JM, Girman C, Rhodes T, Nijpels G, Stehouwer CD, Bouter LM, Heine RJ. Metabolic syndrome and 10-year cardiovascular disease risk in the Hoorn Study. Circulation. 2005;112:666-673.
47. Bo S, Gentile L, Ciccone G, Baldi C, Benini L, Dusio F, Lucia C, Forastiere G, Nuti C, Cassader M, Franco Pagano G. The metabolic syndrome and high C-reactive protein: prevalence and differences by sex in a southern-European population-based cohort. Diabetes Metab Res Rev. 2005;21:515-524.
48. Bonora E, Kiechl S, Willeit J, Oberhollenzer F, Egger G, Bonadonna RC, Muggeo M. Bruneck Study. Metabolic syndrome: epidemiology and more extensive phenotypic description. Cross-sectional data from the Bruneck Study. Int J Obes Relat Metab Disord. 2003;27:1283-1289.
49. Miccoli R, Bianchi C, Odoguardi L, Penno G, Caricato F, Giovannitti MG, Pucci L, Del Prato S. Prevalence of the metabolic syndrome among Italian adults according to ATP III definition. Nutr Metab Cardiovasc Dis. 2005;15:250-254.
50. Maggi S, Noale M, Gallina P, Bianchi D, Marzari C, Limongi F, Crepaldi G; ILSA Working Group. Metabolic syndrome, diabetes, and cardiovascular disease in an elderly Caucasian cohort: the Italian Longitudinal Study on Aging. J Gerontol A Biol Sci Med Sci. 2006;61:505-510.
51. Lorenzo C, Serrano-Rios M, Martinez-Larrad MT, Gonzalez-Sanchez JL, Seclen S, Villena A, Gonzalez-Villalpando C, Williams K, Haffner SM. Geographic variations of the International Diabetes Federation and the National Cholesterol Education Program-Adult Treatment Panel III definitions of the metabolic syndrome in nondiabetic subjects. Diabetes Care. 2006;29:685-691.
52. Santos AC, Barros H. Prevalence and determinants of obesity in an urban sample of Portuguese adults. Public Health. 2003;117:430-437.
53. Athyros VG, Ganotakis ES, Bathianaki M, Monedas I, Goudevenos IA, Papageorgiou AA, Papathanasiou A, Kakafika AI, Mikhailidis DP, Elisaf M. MetS-Greece Collaborative Group. Awareness, treatment and control of the metabolic syndrome and its components: a multicentre Greek study. Hellenic J Cardiol. 2005;46:380-386.
54. Kolcic I, Vorko-Jovic A, Salzer B, Smoljanovic M, Kern J, Vuletic S. Metabolic syndrome in a metapopulation of Croatian island isolates. Croat Med J. 2006;47:585-592.
55. Lawlor DA, Smith GD, Ebrahim S. Does the new International Diabetes Federation definition of the metabolic syndrome predict CHD any more strongly than older definitions? Findings from the British Women's Heart and Health Study. Diabetologia. 2006;49:41-48.
56. Tillin T, Forouhi N, Johnston DG, McKeigue PM, Chaturvedi N, Godsland IF. Metabolic syndrome and coronary heart disease in South Asians, African-Caribbeans and white Europeans: a UK population-based cross-sectional study. Diabetologia. 2005;48:649-656.
57. Boronat M, Chirino R, Varillas VF, Saavedra P, Marrero D, Fabregas M, Novoa FJ. Prevalence of the metabolic syndrome in the island of Gran Canaria: comparison of three major diagnostic proposals. Diabet Med. 2005;22:1751-1756.
58. Gorter PM, Olijhoek JK, van der Graaf Y, Algra A, Rabelink TJ, Visseren FL. SMART Study Group. Prevalence of the metabolic syndrome in patients with coronary heart disease, cerebrovascular disease, peripheral arterial disease or abdominal aortic aneurysm. Atherosclerosis. 2004;173:363-369.
59. Jerico C, Knobel H, Montero M, Sorli ML, Guelar A, Gimeno JL, Saballs P, Lopez-Colomes JL, Pedro-Botet J. Hypertens in HIV-infected patients: prevalence and related factors. Am J Hypertens. 2005;18:1396-1401.
60. Skoumas J, Papadimitriou L, Pitsavos C, Masoura C, Giotsas N, Chrysohoou C, Toutouza M, Panagiotakos D, Stefanadis C. Metabolic syndrome prevalence and characteristics in Greek adults with familial combined hyperlipidemia. Metabolism. 2007;56:135-141.
61. Herva A, Rasanen P, Miettunen J, Timonen M, Laksy K, Veijola J, Laitinen J, Ruokonen A, Joukamaa M. Co-occurrence of metabolic syndrome with depression and anxiety in young adults: the Northern Finland 1966 Birth Cohort Study. Psychosom Med. 2006;68:213-216.
62. Deepa M, Farooq S, Datta M, Deepa R, Mohan V. Prevalence of metabolic syndrome using WHO, ATPIII and IDF definitions in Asian Indians: the Chennai Urban Rural Epidemiology Study (CURES-34). Diabetes Metab Res Rev. 2007;23:127-134.
63. Gupta R, Deedwania PC, Gupta A, Rastogi S, Panwar RB, Kothari K. Prevalence of metabolic syndrome in an Indian urban population. Int J Cardiol. 2004;97:257-261.
64. Ramachandran A, Snehalatha C, Satyavani K, Sivasankari S, Vijay V. Metabolic syndrome in urban Asian Indian adults-a population study using modified ATP III criteria. Diabetes Res Clin Pract. 2003;60:199-204.
65. Boonyavarakul A, Choosaeng C, Supasyndh O, Panichkul S. Prevalence of the metabolic syndrome, and its association factors between percentage body fat and body mass index in rural Thai population aged 35 years and older. J Med Assoc Thai. 2005;88 Suppl 3:S121-S130.
66. Lohsoonthorn V, Dhanamun B, Williams MA. Prevalence of metabolic syndrome and its relationship to white blood cell count in a population of Thai men and women receiving routine health examinations. Am J Hypertens. 2006;19:339-345.
67. Heng D, Ma S, Lee JJ, Tai BC, Mak KH, Hughes K, Chew SK, Chia KS, Tan CE, Tai ES. Modification of the NCEP ATP III definitions of the metabolic syndrome for use in Asians identifies individuals at risk of ischemic heart disease. Atherosclerosis. 2006;186:367-373.
68. Li ZY, Xu GB, Xia TA. Prevalence rate of metabolic syndrome and dyslipidemia in a large professional population in Beijing. Atherosclerosis. 2006;184:188-192.
69. Ko GT, Cockram CS, Chow CC, Yeung V, Chan WB, So WY, Chan NN, Chan JC. High prevalence of metabolic syndrome in Hong Kong Chinese-comparison of three diagnostic criteria. Diabetes Res Clin Pract. 2005;69:160-168.
70. Feng Y, Hong X, Li Z, Zhang W, Jin D, Liu X, Zhang Y, Hu FB, Wei LJ, Zang T, Xu X, Xu X. Prevalence of metabolic syndrome and its relation to body composition in a Chinese rural population. Obesity (Silver Spring). 2006;14:2089-2098.
71. Lao XQ, Thomas GN, Jiang CQ, Zhang WS, Yin P, Adab P, Lam TH, Cheng KK. Association of the metabolic syndrome with vascular disease in an older Chinese population: Guangzhou Biobank Cohort Study. J Endocrinol Invest. 2006;29:989-996.
72. Lu B, Yang Y, Song X, Dong X, Zhang Z, Zhou L, Li Y, Zhao N, Zhu X, Hu R. An evaluation of the International Diabetes Federation definition of metabolic syndrome in Chinese patients older than 30 years and diagnosed with type 2 diabetes mellitus. Metabolism. 2006;55:1088-1096.
73. Fan JG, Zhu J, Li XJ, Chen L, Lu YS, Li L, Dai F, Li F, Chen SY. Fatty liver and the metabolic syndrome among Shanghai adults. J Gastroenterol Hepatol. 2005;20:1825-1832.
74. Pei WD, Sun YH, Lu B, Liu Q, Zhang CY, Zhang J, Jia YH, Lu ZL, Hui RT, Liu LS, Yang YJ. Apolipoprotein B is associated with metabolic syndrome in Chinese families with familial combined hyperlipidemia, familial hypertriglyceridemia and familial hypercholesterolemia. Int J Cardiol. 2007;116:194-200.
75. Ishizaka N, Ishizaka Y, Toda E, Hashimoto H, Nagai R, Yamakado M. Hypertension is the most common component of metabolic syndrome and the greatest contributor to carotid arteriosclerosis in apparently healthy Japanese individuals. Hypertens Res. 2005;28:27-34.
76. Arai H, Yamamoto A, Matsuzawa Y, Saito Y, Yamada N, Oikawa S, Mabuchi H, Teramoto T, Sasaki J, Nakaya N, Itakura H, Ishikawa Y, Ouchi Y, Horibe H, Shirahashi N, Kita T. Prevalence of metabolic syndrome in the general Japanese population in 2000. J Atheroscler Thromb. 2006;13:202-208.
77. Tanaka H, Shimabukuro T, Shimabukuro M. High prevalence of metabolic syndrome among men in Okinawa. J Atheroscler Thromb. 2005;12:284-288.
78. Aizawa Y, Kamimura N, Watanabe H, Aizawa Y, Makiyama Y, Usuda Y, Watanabe T, Kurashina Y. Cardiovascular risk factors are really linked in the metabolic syndrome: this phenomenon suggests clustering rather than coincidence. Int J Cardiol. 2006;109: 213-218.
79. Aguilar-Salinas CA, Rojas R, Gomez-Perez FJ, Mehta R, Franco A, Olaiz G, Rull JA. The metabolic syndrome: a concept hard to define. Arch Med Res. 36:223-231, 2005. Review.
80. Alvarez MM, Vieira AC, Moura AS, da Veiga GV. Insulin resistance in Brazilian adolescent girls: association with overweight and metabolic disorders. Diabetes Res Clin Pract. 2006;74: 183-188.
81. Florez H, Silva E, Fernandez V, Ryder E, Sulbaran T, Campos G, Calmon G, Clavel E, Castillo-Florez S, Goldberg R. Prevalence and risk factors associated with the metabolic syndrome and dyslipidemia in White, Black, Amerindian and Mixed Hispanics in Zulia State, Venezuela. Diabetes Res Clin Pract. 2005l;69:63-77.
82. Hidalgo LA, Chedraui PA, Morocho N, Alvarado M, Chavez D, Huc A. The metabolic syndrome among postmenopausal women in Ecuador. Gynecol Endocrinol. 2006;22:447-454.
83. Sherry N, Hassoun A, Oberfield SE, Manibo AM, Chin D, Balachandar S, Pierorazio P, Levine LS, Fennoy I. Clinical and metabolic characteristics of an obese, Dominican, pediatric population. J Pediatr Endocrinol Metab. 2005;18:1063-1071.
84. Tull ES, Thurland A, LaPorte RE. Metabolic syndrome among Caribbean-born persons living in the U.S. Virgin Islands. Rev Panam Salud Publica. 2005;186:418-426.
85. Hashimoto SM, Gimeno SG, Matsumura L, Franco LJ, Miranda WL, Ferreira SR. Japanese Brazilian Diabetes Study Group. Autoimmunity does not contribute to the highly prevalent glucose metabolism disturbances in a Japanese Brazilian population. Ethn Dis. 2007 Winter;17(1):78-83.
86. Summary for patients in: Ethn Dis. 2007;17:169.
87. Damiao R, Castro TG, Cardoso MA, Gimeno SG, Ferreira SR. Japanese-Brazilian Diabetes Study Group. Dietary intakes associated with metabolic syndrome in a cohort of Japanese ancestry. Br J Nutr. 2006;96:532-538.
88. Lanz JR, Pereira AC, Martinez E, Krieger JE. Metabolic syndrome and coronary artery disease: is there a gender specific effect? Int J Cardiol. 2006;107:317-321.
89. Freire RD, Cardoso MA, Gimeno SG, Ferreira SR. Japanese-Brazilian Diabetes Study Group. Dietary fat is associated with metabolic syndrome in Japanese Brazilians. Diabetes Care. 2005;28:1779-1785.
90. Pousada JM, Britto MM, Cruz T, Lima Mde L, Lessa I, Lemaire DC, Carvalho RH, Martinez-Larrad MT, Torres EC, Serrano-Rios M. The metabolic syndrome in Spanish migrants to Brazil: unexpected results. Diabetes Res Clin Pract. 2006;72:75-80.