Body Mass Index as a Dominant Risk Factor for Metabolic Syndrome among Indonesian Adults: A 6-year Prospective Cohort Study of Non-Communicable Diseases

Abstract

Abstract Background Non-communicable diseases (NCDs) are the leading cause of death globally. Metabolic syndrome (MetS) refers to a cluster of conditions that significantly increase the risk of some NCDs, in particular cardiovascular disease and type 2 diabetes mellitus. MetS risk factors have been extensively researched using cross-sectional and longitudinal study designs, however, few studies have tried to understand the course of the disease based on established risk factors. This study aimed to track changes in adult MetS risk in a cohort based in Bogor District, one of the most populated areas of Indonesia. Methods This prospective open cohort study analysed secondary data from the Special Research - Cohort Study of Non-Communicable Diseases by the Ministry of Health, Republic of Indonesia from 2011 to 2018. The final sample was 1,376 Indonesian adult participants, all residents of Bogor District. MetS outcome, dietary assessment, physical activity, and biomarkers were analysed every two consecutive years. Results The risk of overweight and obese participants developing MetS was 2.4 and 4.4 times higher, respectively (p < 0.001, 95% CI: 1.176–3.320 and 3.345–5.740) than those with body mass index (BMI) in the normal range. Participants who reported less intentional physical exercise had a MetS risk 1.5 times higher (p = 0.032, 95% CI: 1.034–2.109) than those with more intentional physical exercise. The role of diet is also significant, evidenced by a 30% reduction in MetS risk for people with fat intakes in the 2nd quartile compared to the 1st quartile (p-value = 0.033, 95% CI: 0.505–0.972). Meanwhile, a carbohydrate intake in the 2nd quartile increased the risk of MetS 1.5 times (p = 0.023, 95% CI: 1.063–2.241) in comparison with the 1st quartile. Conclusions After controlling for confounding factors, overweight and obesity, sedentary lifestyle, and a higher quartile of carbohydrate consumption were observed to increase MetS risk. The highest cumulative survival of MetS was recorded for participants with underweight BMI, and the lowest cumulative survival was recorded for participants with obese BMI. These findings indicate immediate strategic actions are required to improve an existing early detection and NCD monitoring programme that promotes a community-based healthy lifestyle in Bogor District, Indonesia.