THE METABOLIC SYNDROME

Abstract

Introduction
The metabolic syndrome - the clustering of
abdominal obesity, dyslipidemia, hyperglycemia and
hypertension - is a major public health challenge
worldwide.1,2 The metabolic syndrome is not benign;
it is associated with a substantially elevated risk of
type 2 diabetes (5-fold) and of cardiovascular disease
(CVD) (2-3-fold),1 and its increasing prevalence could
possibly reverse the gains made through recent
declining CVD mortality.
The metabolic syndrome is not a new condition. It
was first described in the 1920s by Kylin, a Swedish
physician, as the association of hypertension,
hyperglycemia and gout.3 In the 1940s, attention was
drawn to upper body adiposity (android or male-type
obesity) as the obesity phenotype commonly
associated with type 2 diabetes and CVD.4
This constellation of CVD risk factors has been given
a number of names, including "deadly quartet",
"syndrome X", and "insulin resistance syndrome",1
but "metabolic syndrome" is likely to hold sway for
the foreseeable future.
Just as the metabolic syndrome has borne a variety of
different names, numerous definitions have also
surfaced. The World Health Organization definition,5
and two others, developed by the European Group
for the Study of Insulin Resistance6 and the National
Cholesterol Education Program - Third Adult
Treatment Panel (ATP III),7 have been the main ones
in use. Each of these agreed on the core components
of obesity, hyperglycemia, dyslipidemia and
hypertension. However, the definitions differ in the
cut-points used for each component, and the way in
which the components are combined, leading to
considerable confusion.1 The confusion has been
particularly apparent in attempts to compare the
burden in different populations, where the use of
different definitions has seriously hampered the
ability to make comparisons between and within
communities.1,2