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Chapter 29: Metabolic Syndrome

Maida Taylor

METABOLIC SYNDROME: HOW TO DEFINE HEALTH RISKS

In 1988, at the Banting Lecture at the annual meeting of the American Diabetes Association,1 Dr. Gerald Reaven of Stanford University described a constellation of metabolic abnormalities associated with an increased risk for diabetes and atherosclerotic cardiovascular disease (CVD). This cluster of risk factors was designated “syndrome X,” or insulin resistance syndrome. Dr. Reaven stated that persons with syndrome X2 manifest glucose intolerance, dyslipidemia, abnormal uric acid metabolism, renal salt retention, increased sympathetic tone, and hypercoagulability due to increases in plasminogen activator inhibitor 1 (PAI-1).

As the defining features of syndrome X have evolved, researchers coined the term metabolic syndrome (metS) to describe the abnormalities that identify the segment of the population at risk for diabetes and atherosclerotic disease. But, there has been a lack of consensus on a precise definition of metS.

The World Health Organization, National Cholesterol Education Project, American Academy of Clinical Endocrinology, and International Diabetes Federation have published somewhat different diagnostic criteria (Table 29-1). Consequently, the National Heart, Lung, and Blood Institute and the American Heart Association in 2004 convened a conference to develop a meaningful definition of metabolic syndrome.3 Clinical features they agreed on include the following:

TABLE 29-1Metabolic Syndrome: Varying Definitions
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TABLE 29-1 Metabolic Syndrome: Varying Definitions
Blood Pressure Lipids Central Obesity Glucose Other Diagnostic Requirements
WHO On antihypertensive therapy or BP ≥ 140/90 mm Hg Plasma triglycerides over 150 dL/mL and/or HDL-C < 35 mg/dL (men), < 39 mg/dL for women BMI > 30 and/or waist-hip ratio > 0.9 (men), > 0.85 (women) IGT or as in type 2 diabetes Microalbuminuria (UAE ≥ 20 μg/min or albumin-creatinine ratio ≥ 30 mg/g) Type 2 diabetes or IGT and 2 additional abnormalities; if GT normal, 3 required
NCEP ATP III BP ≥ 130/85 mm Hg Plasma triglycerides over 150 dL/mL and/or HDL-C < 40 mg/dL (men), < 50 mg/dL for women Waist circumference > 102 cm (40 in.) (men), > 88 cm (35 in.) (women) FBG ≥ 110 mg/dL   3 or more of criteria listed
AACE Hypertension Plasma triglycerides over 150 dL/mL and/or HDL-C <35 mg/dL (men), <45 mg/dL for women Waist circumference > 102 cm (40 in.) (men), >88 cm (35 in.) (women) IFG or as in type 2 diabetes

Insulin resistance, acanthosis nigricans, hyperuricemia.

Minor criteria: hypercoagulability, coronary heart disease, polycystic ovarian disease, vascular endothelial dysfunction, microalbumenuria

 Not specified

Abbreviations: IGT, Impaired Glucose Tolerance; UAE, Urinary Albumin Excretion; IFG, Impaired Fasting Glucose; AACE, American Association of Clinical Endocrinologists; NCEP ATP III, National Cholesterol Education Program, Adult Treatment Panel III; WHO, World Health Organization.

  1. Abdominal obesity is the form of obesity most strongly associated with metS. It presents clinically as increased waist circumference.

  2. Atherogenic dyslipidemia manifests in routine lipoprotein analysis by raised triglycerides and low concentrations of high-density lipoprotein (HDL) cholesterol and many times other lipoprotein abnormalities ...

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