A brief history of definition of the Metabolic Syndrome

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The Metabolic Syndrome concept progressively emerged from the works of pioneers such as J. Vague, who established in 1947 a correlation between body fat distribution and the risk of diabetes and cardiovascular disease. Twenty years later, G. Crepaldi et al. identified a state of insulin resistance in moderately obese patients with impaired fasting glucose and high triglyceride levels. In 1987, Ferrannini et al. proposed that essential hypertension is an insulin resistance state.

The concept of a constellation of abnormalities (including impaired fasting glucose, dyslipidemia, and hypertension) related to a state of insulin resistance was developed during the next decades. Epidemiological studies showed that this cluster was frequently associated with overweight or obesity. Because such abnormalities are associated with a high risk of future diabetes and cardiovascular events, several groups developed their own set of criteria to identify affected individuals in clinical practice. Although the cluster itself was given different names (G. Reaven proposed the “syndrome X” concept in 1988, Kaplan described the “deadly quartet” in 1989, and E. Ferrannini and Haffner identified the “insulin resistance syndrome” in 1991-1992), the term Metabolic Syndrome coined in 1998 by the World Health Organization has become the most popular.

The definition proposed by ATP III has been the most clinician-friendly, as it does not require that insulin resistance be documented and relies on a simple measurement of waist circumference to detect intra-abdominal obesity.

THREE SETS OF CLINICAL CRITERIA TO IDENTIFY PEOPLE WITH THE METABOLIC SYNDROME

1998 Word Heath Organization (WHO)

Insulin resistance (identified by the clamp technique, or defined as the presence of impaired fasting glucose, glucose intolerance or type 2 diabetes)

+ any two of the following :

Blood pressure ≥ 140/90 mmHg or antihypertensive medication
Plasma triglycerides ≥ 1.7 mmol/l
HDL-cholesterol < 0.9 mmol/l (men) or < 1.0 mmol/l (women)
Body mass index > 30 kg/m2 or waist/hip ratio > 0.9 (men) or 0.85 (women)
Urinary albumin > 20 mg/min or albumin/creatinine > 30 mg/g

1999
European Group for the study of Insulin Resistance (EGIR)

Hyperinsulinemia (> 95th percentile)

+ any two of the following:

Waist circumference >94 cm (men) or 80 cm (women)
Plasma triglycerides ≥ 2.0 mmol/l or HDL-cholesterol < 1.0 mmol/l
Blood pressure ≥ 140/90 mmHg
Fasting glucose > 6.1 mmol/l

2001
National Cholesterol Education Program – Adult Treatment Panel III (NCEP-ATP III)

Any three of five:

Abdominal obesity (waist circumference >102 cm (men) or 88 cm (women)
Plasma triglycerides ≥ 150 mg/dl
HDL-cholesterol < 40 mg/dl (men) or < 50 mg/dl (women)
Blood pressure ≥ 130/80 mmHg
Blood glucose ≥ 100 mg/dl

CLINICAL CRITERIA FOR THE INSULIN RESISTANCE SYNDROME

2002
American Association of Clinical Endocrinologists (AACE)

Diagnosis depends on clinical judgment

Impaired fasting glucose (100 -126 mg/dl) or 2-h post oral glucose (≥ 140 mg/dl)
Blood pressure ≥ 130/85 mmHg
Abdominal obesity (waist circumference >102 cm (men) or 88 cm (women)
HDL-cholesterol < 40 mg/dl (men) or < 50 mg/dl (women)
Body mass index ≥ 25 kg/m2
Other risk factors: family history of type 2 diabetes, hypertension or cardiovascular disease; PCOS, aging, physical inactivity, ethnic susceptibility to type 2 diabetes or cardiovascular disease

The IDF definition of the Metabolic Syndrome (2005) can be seen as a further refinement of the ATP III set of criteria, with the ambition of being more universally accepted as it takes into account anthropometric variations between diverse populations across the world.

In 2007, the IDF proposed a clinical definition of the metabolisme syndrome applicable in children and adolescents