www.thelancet.com Vol 366 September 24, 2005
(Full text available on request)
The metabolic syndrome (visceral obesity, dyslipidaemia, hyperglycaemia, and hypertension), has become one of the major public-health challenges worldwide.1 There has been growing interest in this constellation of closely
related cardiovascular risk factors. Although the association of several of these risk factors has been known for more than 80 years,2 the clustering received scant attention until 1988 when Reaven described syndrome X:
insulin resistance, hyperglycaemia, hypertension, low HDL-cholesterol, and raised VLDL-triglycerides. Surprisingly, he omitted obesity, now seen by many as an essential component, especially visceral obesity. Various names were subsequently proposed, the most popular being metabolic syndrome.
The cause of the syndrome remains obscure. Reaven proposed that insulin resistance played a causative role, but this remains uncertain. Lemieux et al suggested visceral obesity and the hypertriglyceridaemic waist phenotype as a central component,4 but this too has been contested. Several different factors are probably involved, many related to changes in lifestyle.
The ultimate importance of metabolic syndrome is that it helps identify individuals at high risk of both type 2 diabetes and cardiovascular disease (CVD). Several expert groups have therefore attempted to produce diagnostic criteria. The first attempt was by a WHO diabetes group in 1999, which proposed a definition that could be modified as more information became available.5 The criteria had insulin resistance or its surrogates, impaired glucose tolerance or diabetes, as essential components, together with at least two of: raised blood pressure, hypertriglyceridaemia and/or low HDL-cholesterol, obesity (as measured by waist/hip ratio or body-mass index), and microalbuminuria. The European Group for the Study of Insulin Resistance6 then produced a modification of the WHO criteria excluding people with diabetes and requiring hyperinsulinaemia to be present. Waist circumference was the measure of obesity, with different cutoffs for the other variables./.../
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