the hyperglycemic condition in diabetics makes them prone to developing some complications , which contribute to the morbidity . the susceptibility of diabetics to complications is driven by both modifiable and nonmodifiable risk factors . currently , there is heightened interest in a cluster of some risk factors called metabolic syndrome ( mets ) that predicts cardiovascular disease and type 2 diabetes mellitus . it comprises the following major characteristics : hypertriglyceridemia , low levels of high - density lipoprotein - cholesterol ( hdl - c ) , central obesity ( abdominal ) obesity , hypertension and concomitant insulin resistance / glucose intolerance ( hyperinsulinemia ) . it is associated with a three to five fold increased risk for the development of type 2 diabetes mellitus which has now reached high proportions in many countries . the worldwide prevalence of mets is between 7.9% and 43% in males and 7% and 56% in females . the prevalence of diabetes mellitus worldwide in the adult population is assumed to be 4% . in urban ghana , according to the guidelines of the national cholesterol education program / adult treatment panel ( ncep / atp iii ) , the prevalence of the mets is between 23 and 38% , whereas type 2 diabetes mellitus affects at least 6% of the adult population in urban ghana . in 2008 , the prevalence of mets in type 2 diabetes patients at the komfo anokye teaching hospital was found to be 55.9% . the syndrome may progress to type 2 diabetes , a condition that is also becoming increasingly common . the mets is known to be caused by insulin resistance or insulin resistance - linked obesity , a condition whereby the body 's cells are incapable of taking up glucose from the blood . insulin resistance - linked obesity is caused by poor dieting and lack of regular exercise . other genetic or lifestyle risk factors / predictor variables equally lead to the metabolic mets . they are increasing age ( greater than 40 years ) , smoking of cigarette , alcohol intake , overweight , sedentary life - style and family history of type 2 diabetes . over the years locally , however , there is little information on its causes , due to few published data on the prevalence of mets and its association with type 2 diabetes mellitus . this study aims at identifying the most critical risk factors leading to mets which predispose these populations to prediabetes and type 2 diabetes mellitus , as well as the impact of mets on the progression of diabetes . one hundred and fifty ( 150 ) participants of the diabetic centre of the komfo anokye teaching hospital ( 50 males and 100 females ) were involved . the participants who were all indigenes of ghana consented to take part in the study after a thorough explanation of the aim of the study . this study was approved by the committee on human research , publication and ethics at the school of medical sciences of the kwame nkrumah university of science and technology and komfo anokye teaching hospital , kumasi . one hundred and fifty ( 150 ) participants of the diabetic centre of the komfo anokye teaching hospital ( 50 males and 100 females ) were involved . the participants who were all indigenes of ghana consented to take part in the study after a thorough explanation of the aim of the study . this study was approved by the committee on human research , publication and ethics at the school of medical sciences of the kwame nkrumah university of science and technology and komfo anokye teaching hospital , kumasi . about 5 ml venous blood samples were collected after an overnight fast ; 4 ml was dispensed into vacutainer plain tubes and 1 ml into fluoride - oxalate tubes . after centrifugation at 500 g for 15 min , the serum and plasma were stored at 80c until assayed . parameters that were determined included ; fasting blood glucose ( fbg ) , triglycerides ( tg ) and hdl - c . the protocol for the determination of the parameters was as indicated in the manufacturer 's instructions ( fortress diagnostics limited , unit 2c antrim technology park , antrim bt41 1qs , united kingdom ) . using a questionnaire and patients medical records , information on demographic and clinical characteristics , such as age , sex , age of onset of diabetes , family history of diabetes two readings were taken 5 min apart , and the mean of the two was taken as blood pressure . height was measured to the nearest 0.1 cm without shoes , using a stadiometer and weight to the nearest 0.1 kg in light clothing , using a bathroom scale ( zhongshan camry electronic co. ltd , guangdong , china ) . body mass index ( bmi ) was calculated by dividing weight ( kg ) by height squared ( m ) . waist circumference was measured to the nearest 0.1 cm , using a gulick ii spring - loaded measuring tape midway between the inferior angle of the ribs and the suprailiac crest . using a questionnaire and patients medical records , information on demographic and clinical characteristics , such as age , sex , age of onset of diabetes , family history of diabetes were extracted . two readings were taken 5 min apart , and the mean of the two was taken as blood pressure . height was measured to the nearest 0.1 cm without shoes , using a stadiometer and weight to the nearest 0.1 kg in light clothing , using a bathroom scale ( zhongshan camry electronic co. ltd , guangdong , china ) . body mass index ( bmi ) was calculated by dividing weight ( kg ) by height squared ( m ) . waist circumference was measured to the nearest 0.1 cm , using a gulick ii spring - loaded measuring tape midway between the inferior angle of the ribs and the suprailiac crest . metabolic syndrome was defined according to the criteria of the ncep / atp iii to include individuals with any three or more of the following five components : abdominal obesity ( waist circumference > 102 cm for men or > 88 cm for women ) ; ( 2 ) high tg  1.7 mmol / l ( 150 mg / dl ) ; ( 3 ) low hdl - c : men < 0.9 mmol / l ( < 40 mg / dl ) or women < 1.0 mmol / l ( < 50 mg / dl ) ; ( 4 ) high blood pressure ( systolic bp  130 mm hg or diastolic bp  85 mm hg or treatment of hypertension ) and high fbg  6.1 mmol / l . the results are expressed as means  standard error of mean ( sem ) , using graphpad prism 5.01 for windows ( graphpad software , san diego california student 's t - test was used to ascertain the significance of the difference between two means of continuous variables and anova for difference in mean values of grouped data . a level of p < 0.05 was considered as statistically significant . using stata ( version 16.0 , inc . , chicago , il ) statistical software , multiple logistic regression was performed to estimate the relationship between mets and some risk factors , in order to find the most significant observed predictor of mets by estimating the odds ratio ( or ) of the predictors ( i.e. the measure of association between a predictor and an outcome , which in this case is mets ) . the coefficients or ors , give an estimate of the magnitude of each predictor . without adjusting for these predictors , next , the adjusted ors were calculated , using the variables that showed statistical significance , with p < 0.05 . the results are expressed as means  standard error of mean ( sem ) , using graphpad prism 5.01 for windows ( graphpad software , san diego california usa , www.graphpad.com ) . student 's t - test was used to ascertain the significance of the difference between two means of continuous variables and anova for difference in mean values of grouped data . a level of p < 0.05 was considered as statistically significant . using stata ( version 16.0 , inc . , chicago , il ) statistical software , multiple logistic regression was performed to estimate the relationship between mets and some risk factors , in order to find the most significant observed predictor of mets by estimating the odds ratio ( or ) of the predictors ( i.e. the measure of association between a predictor and an outcome , which in this case is mets ) . the coefficients or ors , give an estimate of the magnitude of each predictor . without adjusting for these predictors , next , the adjusted ors were calculated , using the variables that showed statistical significance , with p < 0.05 . the study population comprised 150 type 2 diabetes mellitus patients , made up of 50 males ( 33.3% ) and 100 females ( 66.67% ) . the overall mean age of the population was 51.31 ( sem = 0.97 ) years , whereas the ages of the males and females were 52.86 ( sem = 1.56 ) and 50.54 ( sem = 1.22 ) , respectively [ table 1 ] . the overall mean value of bmi was 26.43 kg / m , and the mean bmi of females was significantly higher ( p < 0.0244 ) than that of males [ table 1 ] . 46.7% of the subjects said they exercised , 56% being males and 42% being females while 12.7% of the subjects were still taking fast foods . with respect to the biochemical parameters , none showed statistical significance between the males and females . general characteristics of the studied population the overall percentage prevalence of mets was 58% [ table 2 ] . males had a lower percentage prevalence of 22.99% , compared to a higher percentage prevalence of 77.01% for the females . for the overall population , hypertension was the commonest component ( 60% ) of the mets , followed by high waist circumference , or central obesity . in females , central obesity was the most common component ( 87.67% ) , followed by lowered hdl ( 77.42% ) . in males , hypertension was the most common component ( 31.11% ) , followed by hypertriglyceridemia ( 24.49% ) . central obesity and low hdl were the only components that showed statistically significant difference between males and females . prevalence of the individual components of mets individuals having three or more of the risk factors were reckoned as having the mets . with respect to age , individuals within the age group of 50 - 59 had the highest prevalence of the mets ( 39.08% ) , whereas individuals of age 70 years and above , had the lowest prevalence ( 4.60% ) [ table 3 ] . the prevalence of mets in the females was about 3 times higher ( 77.01% ) , compared to males . obese people had more of the metabolic components ( 40.23% ) , compared to normal weight individuals ( 21.84% ) . based on the level of education , majority of the junior high school or form four leavers had the highest prevalence of the mets ( 56.32% ) . factors like sex , bmi and educational status caused statistically significant differences , unlike the other independent variables . a comparative analysis of the influence of the risk factors on mets the predictive effects of the risk factors ( ie those that proved to be statistically significant in table 3 and their contribution to an individual 's increased chances or likelihood of meeting the criteria as defined by the ncep / atp iii definition are shown in table 4 . extent of influence of selected risk factors on mets ( multiple logistic regression ) with respect to sex , the likelihood for females to develop mets was 3 times ( 3.05 [ 1.51 - 6.15 ] ) that for males . obesity increased one 's probability of having mets , as obese individuals were almost 6 times [ 5.83 ( 1.1429.89 ) ] more likely to develop the mets , as compared with underweight and normal weight individuals . being a primary school leaver increased the odds of one having the mets , as it showed one to be 5 times [ 5.32 ( 0.9429.99 ) ] more likely to having the mets , as compared to the uneducated class . the study population comprised 150 type 2 diabetes mellitus patients , made up of 50 males ( 33.3% ) and 100 females ( 66.67% ) . the overall mean age of the population was 51.31 ( sem = 0.97 ) years , whereas the ages of the males and females were 52.86 ( sem = 1.56 ) and 50.54 ( sem = 1.22 ) , respectively [ table 1 ] . the overall mean value of bmi was 26.43 kg / m , and the mean bmi of females was significantly higher ( p < 0.0244 ) than that of males [ table 1 ] . 46.7% of the subjects said they exercised , 56% being males and 42% being females while 12.7% of the subjects were still taking fast foods . with respect to the biochemical parameters , none showed statistical significance between the males and females . males had a lower percentage prevalence of 22.99% , compared to a higher percentage prevalence of 77.01% for the females . for the overall population , hypertension was the commonest component ( 60% ) of the mets , followed by high waist circumference , or central obesity . in females , central obesity was the most common component ( 87.67% ) , followed by lowered hdl ( 77.42% ) . in males , hypertension was the most common component ( 31.11% ) , followed by hypertriglyceridemia ( 24.49% ) . central obesity and low hdl were the only components that showed statistically significant difference between males and females . individuals having three or more of the risk factors were reckoned as having the mets . with respect to age , individuals within the age group of 50 - 59 had the highest prevalence of the mets ( 39.08% ) , whereas individuals of age 70 years and above , had the lowest prevalence ( 4.60% ) [ table 3 ] . the prevalence of mets in the females was about 3 times higher ( 77.01% ) , compared to males . obese people had more of the metabolic components ( 40.23% ) , compared to normal weight individuals ( 21.84% ) . based on the level of education , majority of the junior high school or form four leavers had the highest prevalence of the mets ( 56.32% ) . factors like sex , bmi and educational status caused statistically significant differences , unlike the other independent variables . a comparative analysis of the influence of the risk factors on mets the predictive effects of the risk factors ( ie those that proved to be statistically significant in table 3 and their contribution to an individual 's increased chances or likelihood of meeting the criteria as defined by the ncep / atp iii definition are shown in table 4 . extent of influence of selected risk factors on mets ( multiple logistic regression ) with respect to sex , the likelihood for females to develop mets was 3 times ( 3.05 [ 1.51 - 6.15 ] ) that for males . obesity increased one 's probability of having mets , as obese individuals were almost 6 times [ 5.83 ( 1.1429.89 ) ] more likely to develop the mets , as compared with underweight and normal weight individuals . being a primary school leaver increased the odds of one having the mets , as it showed one to be 5 times [ 5.32 ( 0.9429.99 ) ] more likely to having the mets , as compared to the uneducated class . metabolic syndrome has been on the rise , contributing to the increasing prevalence of noncommunicable disorders such as cardiovascular diseases and type 2 diabetes mellitus . despite the increasing prevalence , few studies have been done on the condition in ghana , in the west african sub - region . felix - val et al . undertook a study in the diabetes centre , and our study is a follow - up of that study . the ncep / atp iii criteria was chosen to assess mets prevalence because the indicators used are easily and readily measureable . in contrast to the study of felix - val et al . , the present study , apart from assessing the prevalence of mets in type 2 diabetic patients , also used logistic regression analysis to determine the most critical risk factors that need to be monitored in order to control , prevent and treat diabetes . the main finding of this study was a high prevalence ( 58% ) of mets in type 2 diabetics . females showed higher prevalence of mets ( 77.01% ) as they had more of the risk factors contributing to mets , compared to males ( 22.99% ) , which was consistent with a previous study by felix - val et al . and ford et al . from the logistic regression analysis , females were 3 times more likely to have mets than males [ table 4 ] . the reason may be due to a relatively sedentary lifestyle of women in this part of the world as most of them are traders or unemployed or it could be due to genetic factors . there was a high prevalence of obesity , contributing to 40.23% of the entire diabetes study population . obese persons were 5 times more likely to have mets , compared to normal weight persons [ table 4 ] . obesity worsens insulin resistance which then leads to increased hepatic production of very low density lipoprotein and the consequent release of high levels of tg in the bloodstream . persons with impaired glucose tolerance and type 2 diabetes , have hypertriglyceridemia as well as increased hdl catabolism , leading to lowered hdl levels . a number of potential mechanisms could explain the inverse relationship between the hypertriglyceridemia of insulin resistant states and increased hdl catabolism , leading to low plasma hdl concentrations . one possibility is a reduction in lipoprotein lipase ( lpl ) activity , which would have the effect of impairing the maturation of hdl particles . the normal insulin - mediated stimulation of lpl activity has been shown to be blunted in insulin resistance . in type 2 diabetes , particularly when glycemic control is poor and in patients who are relatively insulin deficient , lpl activity is reduced . thus , obesity is a major risk factor that really needs to be controlled in order to prevent type 2 diabetes mellitus or to stop or slow down the development of some complications . there was a significantly higher prevalence of mets amongst the diabetics with low educational status [ table 4 ] , a finding similar to a study by moebus et al . in 2007 . diabetics with primary school education ( 14.94% ) and those who were junior high school or form four leavers ( 56.32% ) had higher prevalence , compared to senior high school ( 3.45% ) diabetics with tertiary level education ( 12.64% ) . this could be due to their ignorance of good dietary habits , like eating too much saturated fatty foods , high carbohydrate diet , as well as irregular exercising and physical inactivity . in this study population , fast foods ( 12.79% ) and soft drinks ( 1.92% ) did not contribute significantly to the acquisition of mets as most of the diabetics avoided them prior to developing the disease and also during their diseased state . family history has been reported to contribute to the speeding up of the acquisition of mets . in this study , 79.31% of the respondents who had a family history of diabetes , had three or more components of the mets . in the present study , hypertension was found to be the commonest component in the entire type 2 diabetes study population , followed by central obesity and lowered hdl - c . in the males , the most prevalent component was hypertension , followed by hypertriglyceridemia and then lowered hdl [ table 2 ] . this result is in fair agreement with felix - val et al . in 2008 , who , using the ncep / atp iii , found hypertension to be the commonest in males , followed by hypertriglyceridemia . most of the men ( 76% ) were involved in heavy alcohol drinking prior to being diagnosed of diabetes [ table 1 ] and alcohol is known to induce hypertension . hypertensive diabetic patients have a greater risk of micro and macrovascular complications than normotensive patients . in the females , the commonest component was central obesity , followed by lowered hdl , elevated triglyceride and hypertension [ table 2 ] . this could be due to less frequent participation of women in physical exercise , their sedentary lifestyle , probably attributable to their trading activity and regular intake of starchy foods , refined carbohydrates and late night eating . moreover , it was found out that central obesity and lowered hdl - c prevalence were markedly higher in females than in males . it is well documented that lowered hdl - c levels are associated with an increased risk of coronary heart diseases or cardiovascular diseases . from table 3 , 27 ( 31.03% ) of the 4049 age group and 34 ( 39.08% ) of the 5059 age group had three or more components of the mets . this indicates that between the ages of 40 and 59 , more people are likely to have a high prevalence of the mets components , irrespective of sex . thus , serious preventive and control measures should be taken as one nears these age groups since the prevalence of mets increases with age . individuals should be advised to exercise more , watch their diet by eating food containing little amounts of saturated fats and cholesterol , and foods containing refined sugars and rather take in more fiber - rich foods . high fiber diets have been shown to have good glycemic index , having the potential to lower fasting plasma glucose , total cholesterol and triglyceride , plasma concentrations . , there was a high prevalence of mets among the type 2 diabetics studied , similar to the study of felix - val et al . through logistic regression analysis , our study has shown that three factors ; sex , obesity and primary education have odd ratios of 3.05 , 5.83 and 5.32 , respectively in the causation of mets . the commonest component ( s ) or risk factor ( s ) will give a guide to prevention and treatment of type 2 diabetes mellitus . this study has shown an increased prevalence of mets ( 58% ) , and through logistic regression analysis , has delineated the key risk factors driving morbidity . most of the individual risk factors were more prevalent in women , compared to men ; women were 3 times more likely to have mets . the most prevalent component was hypertension , followed by central obesity , low hdl - c and hypertriglyceridemia . low educational status and obesity also have great predictive effects on mets in the type 2 diabetics . the small sample size , makes it less representative of the general diabetic population of the country . the cross - sectional nature would not allow the cause - effect relationship to be established , making generalization of the findings difficult . being the strengths of the study are the assessment of multiple parameters in one study , and the use of multiple logistic regression analyses to identify risk factors towards mets in type 2 diabetics , and the quantification of the contributions due to the selected risk factors .
background : the diabetic condition is influenced by several factors , some of which can accelerate the disease 's progression to various complications that aggravate the morbidity.aims:this study aimed at determining the prevalence of metabolic syndrome ( mets ) and its individual components and the most critical predictive risk factors of mets in type 2 diabetic patients.materials and methods : this cross - sectional study involved 150 type 2 diabetes mellitus patients and was conducted at the diabetes centre of the komfo anokye teaching hospital in kumasi , the ashanti region of ghana , from february , 2013 to april , 2013 . 
 the study involved the use of a questionnaire to obtain some information on the diabetics , undertaking anthropometric measurements , as well as collecting blood samples for the measurement of some biochemical parameters ; fasting blood glucose and lipid profile . 
 mets was defined according to the national cholesterol education program / adult treatment panel iii criteria.results:the prevalence of mets was 58% in the studied ghanaian population . 
 hypertension was the commonest risk factor ( 60% ) , followed by central obesity ( 48.67% ) and dyslipidemia ( 37% ) . 
 female type 2 diabetics had a higher prevalence of mets , and carried more components than their male counterparts . 
 regression analysis showed three factors ; femininity , high body mass index and low educational status were the most critical predictive risk factors of mets , according to this study.conclusion:with hypertension being the commonest component , future cardiovascular disease prevention strategies should focus attention on its management and prevention , through education .