Prevalence and sociodemographic determinants of the Gulliver syndrome in 395,660 Spanish workers

Abstract

Background: The Gulliver syndrome is a recently proposed conceptual framework intended to identify individuals with the simultaneous presence of multiple borderline cardiometabolic abnormalities that, when considered separately, may appear clinically unimportant. However, its epidemiological characteristics and sociodemographic distribution remain unknown. This study aimed to estimate, for the first time, the prevalence of Gulliver syndrome and to examine its association with sex, age, social class, and educational attainment in a large cohort of Spanish workers. Methods: A cross-sectional study was conducted among 395,660 Spanish workers undergoing routine occupational health examinations between 2019 and 2020. Gulliver syndrome was defined as the simultaneous presence of borderline abdominal adiposity, prehypertensive blood pressure, impaired fasting glucose, and elevated non-high-density lipoprotein cholesterol according to previously proposed criteria. Crude prevalence estimates and multivariable logistic regression analyses were performed to identify independent sociodemographic determinants associated with the syndrome. Results: A total of 10,920 workers fulfilled the diagnostic criteria for Gulliver syndrome, corresponding to an overall prevalence of 2.76% (95% confidence interval [CI]: 2.71–2.81). The prevalence was markedly higher in men than in women (3.83% vs. 1.11%, p<0.001) and increased with age, reaching its highest values among individuals aged 50–59 years. In multivariable analyses, women showed significantly lower odds of presenting the syndrome than men (odds ratio [OR]: 0.28; 95% CI: 0.26–0.29). Strong age gradients were observed, with adjusted ORs ranging from 2.98 (95% CI: 2.70–3.29) among individuals aged 30–39 years to 7.41 (95% CI: 6.72–8.16) among those aged 50–59 years. Lower educational attainment was independently associated with a higher probability of presenting the syndrome, whereas workers belonging to more advantaged occupational classes exhibited lower odds. Sensitivity analyses yielded similar results. Age-stratified analyses demonstrated distinct sex-specific trajectories, with a pronounced increase in prevalence among women aged 60–69 years. Conclusions: Approximately one in every 36 Spanish workers fulfilled the diagnostic criteria for Gulliver syndrome. The syndrome exhibited marked sociodemographic gradients according to sex, age, educational attainment, and socioeconomic status. These findings provide the first epidemiological characterization of this novel phenotype and support the hypothesis that the accumulation of multiple borderline cardiometabolic abnormalities may represent an intermediate stage between optimal cardiometabolic health and overt disease. Prospective studies are warranted to determine its prognostic significance and potential value for cardiovascular risk stratification and early prevention.