Evaluating CMR

Metabolic Syndrome and Type 2 Diabetes/CVD Risk


WHO Definition and Criteria

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The original WHO recommendations were intended to serve as working guidelines for research purposes. They were not designed to provide an exact definition for clinical diagnosis. The initial recommendations have remained controversial for a number of reasons. First, debate continues as to whether microalbuminuria is a necessary component of the metabolic syndrome. Although microalbuminuria is a marker of endothelial dysfunction and a predictor of increased cardiovascular risk, its relationship with the other components of the metabolic syndrome and the need to include this criterion in the clinical diagnosis of the metabolic syndrome are not firmly established (3, 4). Controversy also surrounds the use of waist-to-hip ratio versus waist circumference alone. It has been shown that waist circumference better indicates absolute intra-abdominal (visceral) adipose tissue accumulation (as measured with computed tomography, the gold standard method) than waist-to-hip ratio which is an index of relative abdominal fat deposition (5). In addition, insulin resistance must be assessed for the metabolic syndrome to be properly diagnosed using WHO criteria. The preferred method is the clamp technique. Because this technique requires time and technical expertise, it was acknowledged that the euglycemic-hyperinsulinemic clamp would never be used by health professionals in clinical practice to screen for the presence of the metabolic syndrome in asymptomatic individuals. Moreover, apart from the European Group for the Study of Insulin Resistance (EGIR), very few epidemiological studies have measured subject insulin sensitivity with the clamp technique. It is therefore hard to develop large databases to generate population-based data on insulin resistance assessed with this technique (6). In its 1998 statement, WHO stressed that the metabolic syndrome could be present for up to 10 years before any measurable glycemic disorders were detected, underlining the fact that individuals with normal glycemic control could still be at increased cardiovascular disease (CVD) or type 2 diabetes risk if they show other features of the metabolic syndrome. WHO called for the early detection and aggressive management of the metabolic syndrome to prevent related chronic diseases. The WHO group also called for future research in this area in order to understand and integrate the relevance of each component of the metabolic syndrome.

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3. Chugh A and Bakris GL. Microalbuminuria: what is it? Why is it important? What should be done about it? An update. J Clin Hypertens (Greenwich) 2007; 9: 196-200.
4. Toft I, Bonaa KH, Eikrem J, et al. Microalbuminuria in hypertension is not a determinant of insulin resistance. Kidney Int 2002; 61: 1445-52.
5. Pouliot M-C, Després JP, Lemieux S, et al. Waist circumference and abdominal sagitttal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol 1994; 73: 460-8.
6. Hills SA, Balkau B, Coppack SW, et al. The EGIR-RISC STUDY (The European group for the study of insulin resistance: relationship between insulin sensitivity and cardiovascular disease risk): I. Methodology and objectives. Diabetologia 2004; 47: 566-70.