Open Access Research article

Urban and rural variation in clustering of metabolic syndrome components in the Thai population: results from the fourth National Health Examination Survey 2009

Wichai Aekplakorn15*, Pattapong Kessomboon2, Rassamee Sangthong3, Suwat Chariyalertsak4, Panwadee Putwatana1, Rungkarn Inthawong5, Wannee Nitiyanant6, Surasak Taneepanichskul7 and The NHES IV study group1

Author Affiliations

1 Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama VI Rd., Rajdevi, Bangkok 10400, Thailand

2 Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

3 Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand

4 Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

5 National Health Examination Survey Office, Health System Research Institute, Nonthaburi, Thailand

6 Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

7 College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand

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BMC Public Health 2011, 11:854  doi:10.1186/1471-2458-11-854

Published: 10 November 2011



Information on the distribution of Metabolic syndrome (MetS) and its combinations by urban/rural areas in lower-middle income countries has been limited. It is not clear how the various combinations of MetS components varied by urban/rural population and if particular combinations of MetS are more common. This study aimed to estimate the prevalence of MetS and combinations of MetS components according to sex and urban/rural areas from a nationally representative sample of Thai adults.


Data from the fourth National Health Examination Survey of 19,256 Thai adults aged 20 years and over were analyzed. MetS was defined using the harmonized criteria of six international expert groups with Asian-specific cut-point for waist circumference.


The prevalence of MetS was 23.2% among adults aged ≥ 20 years (19.5% in men and 26.8% in women). Among men, the prevalence of MetS in urban was higher than those in rural areas (23.1% vs 17.9%, P < 0.05), but among women, the prevalence was higher in rural areas (27.9% vs 24.5%, P < 0.05). Overall, an individual component of low high density lipoprotein (HDL) and hypertriglyceridemia were more common in rural areas, while obesity, high blood pressure and hyperglycemia were more common in urban areas. The most common combination of MetS components in men was the clustering of low HDL, hypertriglyceridemia, and high blood pressure (urban: 3.4% vs. rural: 3.9%, adjusted OR 0.9, 95%CI 0.7, 1.1). Among women, the most common combination was the clustering of obesity, low HDL, and hypertriglyceridemia (urban: 3.9% vs rural: 5.9%, adjusted OR 0.8, 95%CI 0.6, 0.9), followed by the clustering of these three components with high blood pressure (urban: 3.1% vs. rural 4.5%, adjusted OR 0.8, 95%CI 0.7, 0.9).


Metabolic syndrome affects both urban and rural population with different pattern of MetS combinations. Dyslipidemia and obesity were the most common components among women in rural areas, hence, interventions to prevent and control these factors should be strengthened.