Metabolic Syndrome

The metabolic syndrome is defined as the co-occurrence of metabolic risk factors for both type 2 diabetes and cardiovascular disease. These risk factors include abdominal obesity, hyperglycemia, dyslipidemia, and hypertension. All of them are related to insulin resistance. Other names for this syndrome include the dysmetabolic Syndrome, Syndrome X, Insulin Resistance Syndrome , or the obesity dyslipidemia syndrome.

Several medical organizations have published definitions for the metabolic syndrome. The National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) is the most widely used in the United States. ATPIII criteria for diagnosis of the metabolic syndrome include the presence of any three of the parameters summarized in the following table.

Parameter AACE NCEP WHO IDF

Obesity

   Men

   Women

Waist

>102 cm

>80 cm

Waist

>102 cm

>80 cm

BMI

>30

>30

Waist

>94 cm

>80 cm

BP

   Men

   Women

 

>130/85

>130/85

 

>130/85

>130/85

 

>140/90

>140/90

 

>130/85

>130/85

Triglycerides >150 >150 >150 >150

HDL

   Men

   Women

<40

<50

<40

<50

<35

<40

<40

<50

Glucose

   Fasting

   2h OGTT

 

110-125

140-200

 

100

 

110-125

140-200

 

>100

Microalbumin    

20 ug/min

30 mg/g

 

NCEP: National Cholesterol Education Program; IDF: International Diabetes Federation;  WHO: World Health Organization; AACE: American Association of Clinical Endocrinologists

 

The major difference between these criteria is in the tests for glucose intolerance. Both the AACE and WHO recommend an oral glucose tolerance test (OGTT), even in patients without an elevated fasting glucose. ATP III does not recommend OGTT in such persons, because they believe that the increased sensitivity does not outweigh the increased cost and inconvenience. WHO includes elevated microalbumin in their diagnostic criteria, but the other 2 organizations do not.

NCEP requires 3 of 5 abnormalities for diagnosis of insulin resistance syndrome. WHO requires evidence of glucose intolerance plus 2 more abnormalities. AACE does not specify a defined number of abnormalities and leaves the diagnosis to clinical judgment. IDF requires increased waist circumference, with ethnic-specific waist circumference cut-points plus two of the other criteria.

Using NCEP criteria, data from the National Health and Nutrition Survey (NHANES) from 1999 to 2002 indicated that 34.5% of adults in the United States have the metabolic syndrome. Identification of the metabolic syndrome is important because it is a significant risk factor for diabetes and cardiovascular disease.

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