Metabolic syndrome

WHO criteria (1999)[77]World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications: report of a WHO Consultation. Part 1: diagnosis and classification of diabetes mellitus. Geneva, Switzerland: World Health Organization; 1999. https://apps.who.int/iris/handle/10665/66040

Insulin resistance is defined as:

• Type 2 diabetes mellitus (DM) (i.e., fasting plasma glucose ≥7 mmol/L [≥126 mg/dL], or 2-hour postglucose load [oral glucose tolerance test] ≥11.1 mmol/L [ ≥200 mg/dL]), or

• Impaired fasting glucose (i.e., ≥5.6 mmol/L [>100 mg/dL]), or

• Impaired glucose tolerance (i.e., glucose <11.1 mmol/L [<200 mg/dL] and ≥7.8 mmol/L [>140 mg/dL] after oral glucose tolerance test), or

• For those with normal fasting glucose levels, glucose uptake below the lowest quartile for the background population under hyperinsulinaemic and euglycaemic conditions is used.

Plus two of the following:

• Abdominal obesity (waist-to-hip ratio >0.9 in men or >0.85 in women, or BMI >30 kg/m²)

• Triglycerides ≥1.7 mmol/L (≥150 mg/dL), and/or HDL-cholesterol <40 mg/dL (<1.04 mmol/L) in men and <50 mg/dL (<1.29 mmol/L) in women

• BP ≥140/90 mmHg

• Increased urinary albumin excretion (urinary albumin secretion rate ≥20 micrograms/minute or albumin-to-creatinine ratio ≥30 mg/g).

European Group for the Study of Insulin Resistance criteria (1999)[78]Balkau B, Charles MA. Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR). Diabet Med. 1999 May;16(5):442-3. http://www.ncbi.nlm.nih.gov/pubmed/10342346?tool=bestpractice.com

Plasma insulin above the 75th percentile of non-diabetic patients plus two of the following lead to a diagnosis of metabolic syndrome:

• Waist circumference 94 cm (37 inches) or greater in men, 80 cm (31 inches) or greater in women

• Triglycerides ≥1.7 mmol/L (≥150 mg/dL) and/or HDL-cholesterol <1.01 mmol/L (<39 mg/dL) in men or women

• BP ≥140/90 mmHg or taking antihypertensive drugs

• Fasting glucose ≥6.1 mmol/L (≥110 mg/dL).

National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) criteria (2001)[3]National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002 Dec 17;106(25):3143-421. https://circ.ahajournals.org/cgi/reprint/106/25/3143 http://www.ncbi.nlm.nih.gov/pubmed/12485966?tool=bestpractice.com

Any three of the following lead to a diagnosis of metabolic syndrome:

• Waist circumference >102 cm (40 inches) in men, >88 cm (35 inches) in women

• Triglycerides ≥150 mg/dL (≥1.7 mmol/L)

• HDL-cholesterol <1.04 mmol/L (<40 mg/dL) in men and <1.29 mmol/L (<50 mg/dL) in women

• BP ≥130/85 mmHg

• Fasting glucose 6.1 mmol/L (≥110 mg/dL).

American Association of Clinical Endocrinology criteria (2003)[79]Einhorn D, Reaven GM, Cobin RH, et al. American College of Endocrinology position statement on the insulin resistance syndrome. Endocr Pract. 2003 May-Jun;9(3):237-52. http://www.ncbi.nlm.nih.gov/pubmed/12924350?tool=bestpractice.com

Impaired glucose tolerance or impaired fasting glucose plus any of the following based on clinical judgement lead to a diagnosis of metabolic syndrome:

• BMI ≥25 kg/m²

• Triglycerides ≥1.7 mmol/L (≥150 mg/dL) and/or HDL-cholesterol <1.04 mmol/L (<40 mg/dL) in men and <1.29 mmol/L (<50 mg/dL) in women

• BP ≥130/85 mmHg.

International Diabetes Federation (IDF) criteria (2005)[80]Alberti KG, Zimmet P, Shaw J. Metabolic syndrome: a new world-wide definition. Diabet Med. 2006 May;23(5):469-80. http://www.ncbi.nlm.nih.gov/pubmed/16681555?tool=bestpractice.com

Central obesity (defined as waist circumference but can be assumed if BMI >30 kg/m²) with ethnicity-specific values* plus two of the following lead to a diagnosis of metabolic syndrome:

• Triglycerides ≥1.7 mmol/L (≥150 mg/dL)

• HDL-cholesterol <1.04 mmol/L (<40 mg/dL) in men and <1.29 mmol/L (<50 mg/dL) in women

• BP ≥130/85 mmHg

• Fasting glucose ≥5.6 mmol/L (≥100 mg/dL).

*To meet the criteria, waist circumference must be: for Europeans, >94 cm (>37 inches) in men and >80 cm (>31 inches) in women; and for South Asians, Chinese, and Japanese, >90 cm (>35 inches) in men and >80 cm (>31 inches) in women. For ethnic South and Central Americans, South Asian data are used, and for sub-Saharan Africans and Eastern Mediterranean and Middle East (Arab) populations, European data are used.

American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) criteria (2005)[81]Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005 Oct 25;112(17):2735-52. https://www.ahajournals.org/doi/10.1161/circulationaha.105.169404 http://www.ncbi.nlm.nih.gov/pubmed/16157765?tool=bestpractice.com

Any three of the following lead to a diagnosis of metabolic syndrome:

• Waist circumference ≥102 cm (≥40 inches) in men, ≥88 cm (≥35 inches) in women

• Triglycerides ≥1.7 mmol/L (≥150 mg/dL)

• HDL-cholesterol <1.04 mmol/L (<40 mg/dL) in men and <1.29 mmol/L (<50 mg/dL) in women

• BP ≥130/85 mmHg

• Fasting glucose ≥5.6 mmol/L (≥100 mg/dL).

Consensus definition (incorporating IDF and AHA/NHLBI definitions)[1]Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009 Oct 20;120(16):1640-5. https://circ.ahajournals.org/content/120/16/1640.full http://www.ncbi.nlm.nih.gov/pubmed/19805654?tool=bestpractice.com

Any three of the following lead to a diagnosis of metabolic syndrome:

• Elevated waist circumference (population- and country-specific definitions)

• Triglycerides ≥1.7 mmol/L (≥150 mg/dL)

• HDL-cholesterol <1.04 mmol/L (<40 mg/dL) in men and <1.29 mmol/L (<50 mg/dL) in women

• BP ≥130/85 mmHg

• Fasting glucose ≥5.6 mmol/L (≥100 mg/dL).

It is recommended that the IDF cut points be used for non-Europeans and either the IDF or AHA/NHLBI cut points used for people of European origin until more data are available.