X. The diagnostic parameters of the Metabolic syndrome
The definition of the MetS has gone through many changes.
The recommendations of the World Health Organization (WHO 1998), the European Group for the Study of Insulin Resistance (EGIR-1999), the National Cholesterol Education Program Adult Treatment Panel (NCEP/ATP-2001), the American Association of Clinical Endocrinologist (AACE -2003) and the International Diabetes Federation (IDF-2005) and the values of the consensus agreement (2009) are presented in Table 10.
The current parameters are recommended by the International Diabetes Federation (IDF), the National Heart, Lung, and Blood Institute (NHLBI), the World Heart Federation, The International Atherosclerosis Society and The American Heart Association (AHA).
Interestingly, insulin resistance and a high insulin level are not included in the criteria, but the literature indicates that these disorders form the molecular biological basis of MetS.
The Hungarian Diabetes Association lists among the criteria the abnormal HOMA level characteristic of insulin resistance (>4.4 HOMA.
In some cases, other criteria are taken into account:
LDL cholesterol >3.4 mmol/l
Serum total cholesterol >5.2 mmol/l
10-25% of the total population are believed to suffer from the MetS.
It is possible that 50% of T2DM patients and 25% of circulatory disorders are due to the MetS.
|
|
WHO 1998 |
EGIR 1999 |
ATP III |
NCEP
|
AACE |
IDF
|
Consensus agreement |
|
|
1998 |
1999 |
2001 |
(2001 2005) |
2003 |
2005 |
2009 |
|
|
IGT, IFG, T2DM, or low insulin resistance + 2 criteria from those listed below |
plasma insulin level >75% + 2 criteria from those listed below |
3 criteria from those listed below |
3 criteria from those listed below |
IGT or IFG + 1 criterion from those listed below |
central obesity + 2 criteria from those listed below |
|
|
Waist-hip ratio |
>0.9 in men >0.85 in women
|
|
|
|
BMI>25 |
|
|
|
Waist circumference |
|
>94 cm in men > 80 cm in women |
>102 cm in men > 88 cm in women |
>102 cm in men > 88 cm in women |
|
>94 cm in European men >90 cm in Asian men > 80 cm in women |
depends on population and region >102 cm in North American men > 88 cm in North American women >94 cm in men European >90 cm in Asian men > 80 cm in women |
|
Blood pressure |
>140/90 mmHg |
>140/90 mmHg |
>130/85 mmHg |
>130/85 mmHg or treated with hypertension |
>130/85 mmHg |
>130/85 mmHg or treated with hypertension |
>130/85 mmHg or treated with hypertension |
|
Triglycerides |
>1.7 mmol/l (150 mg/dl) |
>1.7 mmol/l (150 mg/dl) |
>1.7 mmol/l (150 mg/dl) |
>1.7 mmol/l (150 mg/dl) |
>1.7 mmol/l (150 mg/dl) |
>1.7 mmol/l (150 mg/dl) or treated |
>1.7 mmol/l or treated |
|
HDL cholesterol |
<35 mg/dl in men <39 mg/dl in women
|
<39 mg/dl |
<1.03 mmol/l (40 mg/dl) in men <1.29 mmol/l (50 mg/dl) in women
|
<1.03 mmol/l (40 mg/dl) in men <1.29 mmol/l (50 mg/dl) in women
|
<1.03 mmol/l (40 mg/dl) in men <1.29 mmol/l (50 mg/dl) in women
|
<1.03 mmol/l (40 mg/dl) in men <1.29 mmol/l (50 mg/dl) in women or treated |
<1.03 mmol/l (40 mg/dl) in men <1.29 mmol/l (50 mg/dl) in women or treated |
|
Fasting plasma glucose level |
IGT, IFG or T2DM |
IGT, IFG (no T2DM) |
>110 mg/dl (T2DM too) |
>6.1 mmol/l (2001) >5.6 mmol/l (2005) |
IGT, IFG (no T2DM) |
>5.6 mmol/l (100 mg/dl) or T2DM |
>5.6 mmol/l or T2DM or treated |
|
Micro-albuminuria |
urine albumin > 20 mg/min or albumin/creatinine ratio >30 mg/g |
|
|
|
|
|
|
Table 10. Criteria of the metabolic syndrome
(IFG: impaired fasting glucose; IGT: impaired glucose tolerance, HDL: high-density lipoprotein cholesterol, BMI: body mass index, T2DM type 2 diabetes mellitus)