The World Health Organization (WHO) has concluded that the metabolic syndrome should not be applied as a clinical diagnosis (Diabetologia. 2010;53:600-605).
The core components of metabolic syndrome usually are insulin resistance, elevated BP, low HDL cholesterol, high triglycerides, and central obesity. Typically, a person exhibiting any three of these risk factors is diagnosed with the syndrome, indicating a heightened risk for developing diabetes and cardiovascular disease (CVD).
The WHO panel pointed out that the diagnostic criteria for the metabolic syndrome is limited. For example, the definition fails to include other important predictors of diabetes or CVD, such as age, sex, and family history. In addition, thresholds used to define the metabolic abnormalities are artificial and discount crucial information about the magnitude of the risk factors.
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Although the concept of the metabolic syndrome has advantages in terms of professional and public education and awareness, the panel’s review found this constellation of risk factors to have limited practical utility as a diagnostic or management tool. The panel contends that further efforts to redefine the concept are “inappropriate in light of current knowledge and understanding,” adding that “there is limited utility in epidemiological studies in which different definitions” of the syndrome are compared. In fact, the experts pointed out, metabolic syndrome was never intended for use as an absolute risk predictor for diabetes or CVD but rather as an indicator of relative risk.
A separate report found that abandoning the behaviors that can help control the risk factors seen in the metabolic syndrome could reduce life expectancy by 4.9 years in men and 4.1 years in women. Smoking, high BP, elevated blood glucose, and high BMI accounted for a significant proportion of life-expectancy differences among various U.S. subgroups. The report is available online.
