Criteria for the Metabolic Syndrome

The metabolic syndrome refers to the co-occurrence of several known cardiovascular risk factors, including insulin resistance, obesity, atherogenic dyslipidemia and hypertension. These conditions are interrelated and share underlying mediators, mechanisms and pathways.

ATP III Definition

Any three or more of the following criteria:

1. Waist circumference >102 cm (>40 in) in men and >88 cm (>35 in) in women

2. Serum triglycerides >/=150 mg/dL (>/=1.7 mmol/L)

3. Blood pressure >/=130/85 mm Hg

4. HDL-Cholesterol <40 mg/dL (<1.0 mmol/L) in men and <50 mg/dL (<1.3 mmol/L) in women

5. Fasting glucose 110 to 126 mg/dL (6.1 to 7.0 mmol/L) (100 mg/dL [>/=5.6 mmol/L] may be applicable)

WHO Definition

Diabetes, IFP, IGT or insulin resistance (assessed by clamp studies) and at least two of the following criteria:

1. Waist-to-hip ratio >0.90 in men or >0.85 in women.

2. Serum triglycerides 150 mg/dL (>/=1.7 mmol/l) or HDL cholesterol <36 mg/dL (<0.9 mmol/l) in men and <40 mg/dL (<1.0 mmol/l) in women.

3. Blood pressure >/= 140/90 mmHg

4. Urinary albumin excretion rate >20 mcg/min or albumin to creatinine ratio >/= 30 mg/g

IFG; Impaired Fasting Glucose
IGT; Impaired Glucose Tolerance

The new International Diabetes Federation (IDF) definition

According to the new IDF definition, for a person to be defined as having the metabolic syndrome they must have:

• Central obesity (defined as waist circumference >/= 94 cm for European men and >/= 80 cm for European women, with ethnicity specific values for other groups)

Plus any two of the following four factors:

1. Raised triglycerides (TG) level: >/=  150 mg/dL (1.7 mmol/L), or specific treatment for this lipid abnormality

2. Reduced HDL cholesterol: < 40 mg/dL (1.03 mmol/L) in males and < 50 mg/dL (1.29 mmol/L) in females, or specific treatment for this lipid abnormality

3. Raised blood pressure: systolic BP >/=  130 or diastolic BP >/=  85 mm Hg, or treatment of previously diagnosed hypertension

4. Raised fasting plasma glucose (FPG) >/=  100 mg/dL (5.6 mmol/L), or previously diagnosed type 2 diabetes. If above 5.6 mmol/L or 100 mg/dL, oral glucose tolerance test (OGTT) is strongly recommended but is not necessary to define presence of the syndrome.

 

References:

1. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The 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). JAMA. 2001 May 16;285(19):2486-97. [Medline]
2. Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C; American Heart Association; National Heart, Lung, and Blood Institute. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation. 2004 Jan 27;109(3):433-8. [Medline]
3. World Health Organization: Definition, Diagnosis, and Classification of Diabetes Mellitus and its Complications: Report of a WHO Consultation. Geneva, World Health Org., 1999
4. Alberti KG, Zimmet P, Shaw J; IDF Epidemiology Task Force Consensus Group. The metabolic syndrome–a new worldwide definition. Lancet. 2005 Sep 24-30;366(9491):1059-62. [Medline]
5. Pluta W, Dudzińska W, Lubkowska A. Metabolic Obesity in People with Normal Body Weight (MONW)-Review of Diagnostic Criteria. Int J Environ Res Public Health. 2022 Jan 6;19(2):624. [Medline]