Diagnostic concordance of modified NCEP-ATP III and IDF criteria for screening metabolic syndrome among Yemeni medical students

Abstract Metabolic syndrome (MS) drives cardiovascular disease and type 2 diabetes. Conflict-affected, resource-limited environments like Yemen face rising non-communicable disease burdens, yet comparative data on screening tools remain scarce. This cross-sectional study compared MS prevalence using the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) versus the International Diabetes Federation (IDF) criteria, evaluating their diagnostic concordance among 300 apparently healthy medical students at Taiz University, Yemen. Demographic, clinical, anthropometric, and fasting biochemical profiles were systematically evaluated. The observed MS prevalence was 15.3% and 11.3% according to the modified NCEP-ATP III and the IDF criteria, respectively. Twelve participants (4.0% of the total cohort) were classified as NCEP-ATP III-positive but IDF-negative, representing 26.1% of all NCEP-ATP III-positive participants. Observed diagnostic agreement was 96.0% with almost perfect concordance (Cohen’s κ = 0.83; p < 0.001). Using NCEP-ATP III as the comparator definition, the IDF criteria demonstrated 73.9% sensitivity and 100.0% specificity. Reduced HDL-C, elevated triglycerides, and elevated waist circumference were the primary risk variables. While both criteria demonstrate high diagnostic agreement, the modified NCEP-ATP III offers broader clinical utility for early screening within disrupted settings by evaluating risk factors independently of an absolute obesity filter, capturing a subset of metabolically at-risk, non-obese individuals.