Skip to Main Content

++

Over the last 60 years, there has been an impressive change in the human environment, behaviors, and lifestyle. These changes have resulted in an increase in both type 2 diabetes and macrovascular disease (myocardial infarction and cerebral ischemic disease). These rises must be attributed to the greater prevalence of obesity and consequent pathophysiologic condition, the so-called metabolic syndrome.1 It has been estimated that 190 million people worldwide have diabetes and it is likely that this will increase to 324 million by 2025.2 This epidemic is taking place both in developed and developing countries and the combination of obesity, diabetes, and metabolic syndrome is now recognized as one of the major threats to human health in the twenty-first century.

++

Considering the obesity epidemic as the major cause of increasing prevalence of metabolic syndrome, we assumed that obesity-related insulin resistance is the major cause of the metabolic derangement in this population. Insulin resistance is defined clinically as a state in which a given increase in plasma insulin in an individual causes less of an effect in lowering the plasma glucose than it does in a normal population.

++

The first description corresponding to the metabolic syndrome comes from a paper of Kylin, a Swedish physician who, in 1923, pointed out a clustering of hypertension, hyperglycemia, and gout.3 In 1947, Vague reported that obesity phenotype, android or male-type obesity, was associated with the metabolic abnormalities often seen with diabetes and with cardiovascular disease.4 The clinical importance of the syndrome was highlighted some years later by Reaven, who described the existence of a cluster of metabolic abnormalities, with insulin resistance as a central pathophysiological feature, and named it “Syndrome X.”5 The metabolic syndrome has several synonymous syndromes including the deadly quartet,6 insulin resistance syndrome,7 and dysmetabolic syndrome.8 More important than giving a name is providing a definition for the syndrome.

++

The first attempt at a global definition of the metabolic syndrome was in 1999 by the World Health Organization (WHO) Consultative Group9 (Table 16–1). Critics of the WHO definition identified several limitations, of which the most important related to the use of the euglycemic clamp to measure insulin sensitivity, making the definition virtually impossible to use either in clinical practice or epidemiological studies. Later, a new version of WHO definition had considered the fasting levels of insulin instead of the euglycemic clamp to measure insulin resistance.10 This definition also introduced waist circumference (94 cm for men and 80 cm for women) as the measure of centripetal adiposity and included modified cut points for other components.

++
Table Graphic Jump Location
Table 16–1. Current Definitions of the Metabolic Syndrome 

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.