The Metabolic Syndrome: Is This a Useful Concept?
Professor Sir George Alberti
Affiliation : Senior Research Fellow, Imperial College London, UK
The Metabolic Syndrome has received increasing attention since the publication of Reaven in 1988 where he referred to Syndrome X. The original work stressed insulin resistance but over the intervening years other factors have taken on equal importance. These include central obesity, raised triglycerides, lowered HDL-cholesterol, raised blood pressure and raised plasma glucose levels. The first formal definition of the syndrome came from WHO in 1998 stressing the importance of insulin resistance and/or dysglycaemia, This was followed by a modified version from the European Study Group for Insulin Resistance and subsequently by the National Cholesterol Education Programme (ATP III). The three definitions all differed over cutpoints used and on the relative emphasis of different components. An IDF Consensus Group attempted to unify the definition and have recently published their findings. In this definition, central adiposity is a sine qua non. It is assessed by waist circumference and a big change from ATP III is that the waist circumference cutpoints are ethnic specific. In addition, two components are required of raised triglycerides, low HDL-cholesterol, raised blood pressure and raised glucose. The IDF criteria have the added advantage that measuring the waist can be used as a simple initial screening test. The value of the metabolic syndrome lies in its ability to identify those at high risk of developing cardiovascular disease (and diabetes). Many more long term studies are needed however to ensure that the correct components and cutpoints are being used.
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