With rapid economic growth, the prevalence of metabolic diseases like central obesity, diabetes, and hyperlipidemia is rising rapidly, worldwide. This is attributable to aging populations, urbanization, lack of physical activity, and unhealthy diets3,13−14. Metabolic disorder may progress into disorders like atherosclerosis, coronary heart disease, and kidney diseases, which negatively impact physical and mental health, and social development. Thus, metabolic disorders are a major public health challenge in China. Data from the TIDE (Thyroid Disorders, Iodine Status and Diabetes, a national epidemiological cross-sectional study) program15, which involved 51795 adult participants in 31 provinces in 2015–2017 identified prediabetes (39.4%), central obesity (34.5%), hypertension (29.3%), MetS (28.6%), hypertriglyceridemia (28.5%), hypercholesterolemia (28.2%), high LDL-C (21.1%), low HDL-C (19.5%), and diabetes (8.7%) as the most prevalent metabolic disorders. The overall prevalence of metabolic disorders was 81.2%. In men and women, it was 85% and 76.7%, respectively.
Here, we investigated the association between sex and metabolic disorders in Hebei province, North China. Our data show that the overall prevalence of metabolic disorders in this region was 84.8% and that in men and women, it was 89.3 and 80%, respectively. The most prevalent metabolic disorders were prediabetes, central obesity, MetS, hypertriglyceridemia, hypertension, hypercholesterolemia, low HDL-C, high LDL-C, and diabetes at 42.5%, 41.9%, 36.8%, 32.4%, 31.5%, 27.1%, 22.8%, 15%, and 14.2%, respectively.
We find that prevalence of metabolic disorders is higher in Hebei province relative to national levels, except for hypercholesterolemia and high LDL-C. Additionally, the prevalence of all metabolic disorders were higher in men and women from Hebei province relative to national prevalence rates in men and women (Supplemental Table 3), indicating that without effective preventive measures, a large number of Hebei people are at risk of developing cardiovascular disorders.
Based on the 2017 national survey, diabetes and prediabetes rates rose with age in men and women and increased most sharply after 50 years of age16. Consistent with this, we found that metabolic disorder prevalence positively correlated with advancing age in men and women, except for low HDL-C. Men in age group 50–59 while women aged ≥ 60 had highest prevalence of one or more metabolic disorders (Table 2). Women's endocrine function changes at menopause, with estrogen level decreasing significantly. Estrogen deficiency is thought to cause central obesity17–18. Additionally, lipid deposits oxidation and resulting arterial walls stiffness and blockage aggravates development of metabolic diseases like hypertension and hyperglycemia19–20.
According to World Health Organization (WHO), diabetes prevalence increased from 9.7% in 2010, to 10.4% in 2013, and 11.2% in 2017 in mainland China16,21−22. Although Hebei lacks reliable data on the incidence of diabetes in earlier years, the 14.2% prevalence reported in 2017 is markedly higher than reported for mainland China. Prediabetes is of critical health concern in Hebei (42.5%) and in mainland China (39.4%) due to lack of effective lifestyle changes or treatments.
MetS refers to a set of physiological and biochemical disorders characterized by various pathological features like abdominal obesity, impaired glucose metabolism, and elevated blood pressure23. MetS prevalence in Hebei residents aged ≥ 20 was 36.8%. In men and women it was 43.6% and 29.7%, respectively, which is markedly higher than the national prevalence based on the 2017 national survey that reported a standardized overall MetS prevalence of 28.6% and 32.5% and 24.1% in men and women, respectively15. The difference in MetS prevalence in Hebei vs mainland China is attributable to geographic, economic, and lifestyle differences.
our data also suggest that aging people, overweight or obese people, urban residents, smokers, those with low education, manual workers, and those with family history of diabetes, are at higher risk of metabolic disorders. However, associations between independent variables and metabolic disorders vary in men vs women (Tables 3 and 4). While there was no significant association between BMI and hypercholesterolemia in men, high BMI increased ORs in hypercholesterolemic women. Living in rural areas was a risk factor for diabetes and hypertension in women, but not in men. Higher education negatively correlated with MetS and hypertension prevalence in men. In women, it negatively associated with the prevalence of MetS, prediabetes, and hypertriglyceridemia.
Age, gender, regional distribution, and educational level influence metabolic risks. Regarding intervention strategies, our data emphasize early intervention in middle-aged and elderly Hebei populations, while considering gender and regional characteristics of metabolic risk factor distribution in the population.