Criteria
WHO criteria (1999)[77]
Insulin resistance is defined as:
Type 2 diabetes mellitus (DM) (i.e., fasting plasma glucose ≥126 mg/dL or 2-hour postglucose load [oral glucose tolerance test] ≥200 mg/dL), or
Impaired fasting glucose (i.e., >100 mg/dL), or
Impaired glucose tolerance (i.e., glucose <200 mg/dL and >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 hyperinsulinemic and euglycemic conditions is used.
Plus 2 of the following:
Abdominal obesity (waist-to-hip ratio >0.9 in men or >0.85 in women, or BMI >30 kg/m²)
Triglycerides ≥150 mg/dL, and/or HDL-cholesterol <40 mg/dL in men and <50 mg/dL 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]
Plasma insulin above the 75th percentile of nondiabetic patients plus two of the following lead to a diagnosis of metabolic syndrome:
Waist circumference ≥94 cm (≥37 inches) in men, ≥80 cm (≥31 inches) in women
Triglycerides ≥150 mg/dL and/or HDL-cholesterol <39 mg/dL in men or women
BP ≥140/90 mmHg or taking antihypertensive drugs
Fasting glucose ≥110 mg/dL.
National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) criteria (2001)[3]
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
HDL-cholesterol <40 mg/dL in men and <50 mg/dL in women
BP ≥130/85 mmHg
Fasting glucose ≥110 mg/dL.
American Association of Clinical Endocrinology criteria (2003)[79]
Impaired glucose tolerance or impaired fasting glucose plus any of the following based on clinical judgment lead to a diagnosis of metabolic syndrome:
BMI ≥25 kg/m²
Triglycerides ≥150 mg/dL, and/or HDL-cholesterol <40 mg/dL in men and <50 mg/dL in women
BP ≥130/85 mmHg.
International Diabetes Federation (IDF) criteria (2005)[80]
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 ≥150 mg/dL
HDL-cholesterol <40 mg/dL in men and <50 mg/dL in women
BP ≥130/85 mmHg
Fasting glucose ≥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]
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
HDL-cholesterol <40 mg/dL in men and <50 mg/dL in women
BP ≥130/85 mmHg
Fasting glucose ≥100 mg/dL.
Consensus definition (incorporating IDF and AHA/NHLBI definitions)[1]
Any three of the following lead to a diagnosis of metabolic syndrome:
Elevated waist circumference (population- and country-specific definitions)
Triglycerides ≥150 mg/dL
HDL-cholesterol <40 mg/dL in men and <50 mg/dL in women
BP ≥130/85 mmHg
Fasting glucose ≥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.
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