Metabolic syndrome diagnostic criteria

There are currently two major definitions for metabolic syndrome provided by International Diabetes Federation (IDF) and the revised National Cholesterol Education Program (NECP), respectively. The revised National Cholesterol Education Program (NECP) and International Diabetes Federation (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 geographic-specific cut off points for waist circumference, while NCEP uses only one set of cut off points for waist circumference regardless of geography. These two definitions are much closer to each other than the original NCEP and WHO definitions.

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.^[1]

• 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: ≤ 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

The NCEP, Adult Treatment Panel III (2001) requires at least three of the following:^[2]

• 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) or drug treatment for elevated TGs
• Dyslipidemia: HDL-C < 40 mg/dL (male), < 50 mg/dL (female) or drug treatment for low HDL-C
• Blood pressure: ≥ 130/85 mmHg or drug treatment for elevated blood pressure
• Fasting plasma glucose: ≥ 5.6 mmol/L (100 mg/dl) or drug treatment for elevated blood glucose

The WHO (1999) requires the presence of diabetes mellitus, impaired glucose tolerance, impaired fasting glucose or insulin resistance, AND two or more of the following:

• Blood pressure: ≥ 140/90 mmHg
• Dyslipidaemia: triglycerides (TG): ≥ 150 mg/dL (1.695 mmol/L)
• High-density lipoprotein cholesterol (HDL-C): < 35 mg/dL (0.9 mmol/L) (male), < 40 mg/dL (< 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

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

In 2006 the International Diabetes Federation (IDF) updated their metabolic syndrome criteria. IDF requires abdominal obesity, defined as increased waist circumference as an essential criteria along with any two of the following:

• TGs > 150 mg/dL (1.7 mmol/L) or drug treatment for elevated TGs
• HDL-C < 40 mg/dL (1.03 mmol/L) in men or < 50 mg/dL (1.29 mmol/L) in women or treatment for low HDL
• Systolic BP > 130 mm Hg, diastolic BP > 85 mm Hg or treatment for hypertension
• Fasting blood sugar > 100 mg/dL (5.6 mmol/L) or previously diagnosed type II diabetes; an oral glucose tolerance test is recommended for patients with an elevated fasting plasma glucose but not required.

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