How to best define the metabolic syndrome

The constellation of metabolic abnormalities including centrally distributed obesity, decreased high-density lipoprotein cholesterol (HDL-C), elevated triglycerides, elevated blood pressure (BP), and hyperglycaemia is known as the metabolic syndrome. Associated with increased risk of both type 2 diabetes and cardiovascular disease (CVD), the metabolic syndrome is thought to be a driver of the modern day epidemics of diabetes and CVD and has become a major public health challenge around the world 1. Since its initial description, several definitions of the syndrome have emerged. Each of these definitions used differing sets of criteria, the combination of which either reflected contrasting views on pathogenic mechanisms or clinical usefulness. The use of these definitions to conduct research into the metabolic syndrome in diverse populations resulted in wide ranging prevalence rates, inconsistencies and confusion, and spurred on the vigorous debate regarding how the metabolic syndrome should be defined. In response to this controversy, the International Diabetes Federation (IDF) has recently proposed a new definition, which is applicable to populations around the world 12. It is envisaged that the development of the new definition for the metabolic syndrome will help resolve the confusion caused by the number of earlier attempts to define this important entity.