Metabolic syndrome screening


 * Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [mailto:psingh@perfuse.org]

Overview
There are currently two major definitions for metabolic syndrome provided by 1) International Diabetes Federation and 2) the revised National Cholesterol Education Program, respectively. The revised NCEP and IDF definitions of metabolic syndrome are very similar and it can be expected that they will identify many of the same individuals as having metabolic syndrome. The two differences are that IDF excludes any subject without increased waist circumference, while in the NCEP definition metabolic syndrome can be diagnosed based on other criteria and the IDF uses geography-specific cut points for waist circumference, while NCEP uses only one set of cut points for waist circumference regardless of geography. These two definitions are much closer to each other than the original NCEP and WHO definitions.

American Heart Association/Updated NCEP, 2005
There is quite a bit of confusion about whether AHA/NHLBI intended to create another set of guidelines or simply update the NCEP ATP III definition. According to Scott Grundy, University of Texas Southwestern Medical School, Dallas, Texas, the intent was just to update the NCEP ATP III definition and not create a new definition. :
 * Elevated waist circumference: Men: ≥40 inches (102 cm), Women: ≥ 35 inches (88 cm); if Asian American, ≥ 35 inches (90 cm)in men or ≥ 32 inches (80 cm) in women.
 * Elevated triglycerides: ≥ 150 mg/dL
 * Reduced HDL (“good”) cholesterol: Men: ≤40 mg/dL Women: ≤Less than 50 mg/dL
 * Elevated blood pressure: ≥ 130/85 mm Hg or use of medication for hypertension
 * Elevated fasting glucose: ≥ 100 mg/dL (5.6 mmol/L) or use of medication for hyperglycemia

National Cholesterol Education Program (NCEP), 2001
The NCEP, Adult Treatment Panel III (2001) requires at least three of the following:
 * Central obesity: waist circumference ≥ 102 cm or 40 inches (male), ≥ 88 cm or 36 inches(female)
 * Dyslipidemia: TG ≥ 1.695 mmol/L (150 mg/dl)
 * Dyslipidemia: HDL-C < 40 mg/dL (male), < 50 mg/dL (female)
 * Blood pressure ≥ 130/85 mmHg
 * Fasting plasma glucose ≥ 6.1 mmol/L (110 mg/dl)

World Health Organization criteria (1999)
The WHO(1999) require presence of diabetes mellitus, impaired glucose tolerance, impaired fasting glucose or insulin resistance, AND two of the following:
 * blood pressure: ≥ 140/90 mmHg
 * dyslipidaemia: triglycerides (TG): ≥ 1.695 mmol/L and/or high-density lipoprotein cholesterol (HDL-C) ≤ 0.9 mmol/L (male), ≤ 1.0 mmol/L (female)
 * central obesity: waist:hip ratio > 0.90 (male), > 0.85 (female), and/or body mass index > 30 kg/m2
 * microalbuminuria: urinary albumin excretion ratio ≥ 20 mg/min or albumin:creatinine ratio ≥ 30 mg/g

European Group for the Study of Insulin Resistance (1999)
EGIR, 1999 requires insulin resistance defined as the top 25% of the fasting insulin values among non-diabetic individuals AND two or more of the following:


 * central obesity: waist circumference ≥ 94 cm (male), ≥ 80 cm (female)
 * dyslipidaemia: TG ≥ 2.0 mmol/L and/or HDL-C < 1.0 mg/dL or treated for dyslipidaemia
 * hypertension: blood pressure ≥ 140/90 mmHg or antihypertensive medication
 * fasting plasma glucose ≥ 6.1 mmol/L