HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kahn, R. Search for Related Content PubMed Articles by Kahn, R. Social Bookmarking                What's this?

The Metabolic Syndrome (Emperor) Wears No Clothes

American Diabetes Association, Alexandria, Virginia

Address correspondence and reprint requests to Richard Kahn, PhD, American Diabetes Association, 1701 N. Beauregard St., Alexandria, VA 22311. E-mail: rkahn@diabetes.org

Abbreviations: ATP, Adult Treatment Panel • CHD, coronary heart disease • CVD, cardiovascular disease • FPG, fasting plasma glucose

The first 300 words of the full text of this article appear below.

There are several key features of the metabolic syndrome that virtually all interested individuals and organizations agree upon. First, that certain "metabolic" factors tend to associate with each other more often than chance would dictate. Second, these risk factors taken alone or in any possible combination are associated with an elevated risk for cardiovascular disease (CVD) and diabetes. Third, there is no definitive treatment for the "syndrome" per se. Rather, therapy is individualized according to the degree to which any specific risk factor(s) is present in a patient, and everyone with any risk factor(s) should be given lifestyle modification counseling. Finally, despite over 10,000 articles on the subject, there is much missing information.

It is this last fact that has lead to the concern and consternation voiced by some organizations (1) and individuals (2–6). That is, the basic question is whether we know enough about this constellation of risk factors to warrant adopting a unique clinical construct that has value to either physicians or patients. After all, the fundamental purpose of a medical label (diagnosis) is to inform physicians and/or patients to take (or not take) action that would otherwise be different.

In this issue of Diabetes Care (7) and recently elsewhere (8), Scott Grundy, MD, PhD, perhaps the chief proponent of the syndrome as a clinical construct, defends its existence with a variety of arguments. Although he suggests the basic disagreement is one of "differences in perspectives and biases [between the] cardiovascular and diabetes communities" (7) and that it may boil down to "how to integrate the metabolic syndrome into concepts of insulin resistance, pre-diabetes, and type 2 diabetes" (8), in fact, the issues are much more fundamental, speak to the lack of a solid . . . [Full Text of this Article]

What are the problems?

There is no biological basis for the diagnostic algorithm.
The syndrome is a relatively poor predictor of future diabetes or CVD.
The whole is not greater than the sum of the parts.
There is no scientific evidence that the syndrome has clinical utility.
Labeling a person with the metabolic syndrome can be very misleading to the physician and the patient.
So what should we do?

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				C. L. Greenstone Clinician's Corner: The Metabolic Syndrome: A Lifestyle Medicine Foe Worthy of a Seek and Destroy Mission American Journal of Lifestyle Medicine, April 1, 2008; 2(2): 109 - 112. [Abstract] [PDF]

				J. A. Morrison, L. A. Friedman, and C. Gray-McGuire Metabolic Syndrome in Childhood Predicts Adult Cardiovascular Disease 25 Years Later: The Princeton Lipid Research Clinics Follow-up Study Pediatrics, August 1, 2007; 120(2): 340 - 345. [Abstract] [Full Text] [PDF]

				R. Kahn Metabolic Syndrome: Is It a Syndrome? Does It Matter? Circulation, April 3, 2007; 115(13): 1806 - 1811. [Full Text] [PDF]

				E. S. Kilpatrick, A. S. Rigby, and S. L. Atkin Insulin Resistance, the Metabolic Syndrome, and Complication Risk in Type 1 Diabetes: "Double diabetes" in the Diabetes Control and Complications Trial Diabetes Care, March 1, 2007; 30(3): 707 - 712. [Abstract] [Full Text] [PDF]

				M. B. Davidson Does the metabolic syndrome exist: response to grundy. Diabetes Care, November 1, 2006; 29(11): 2565 - 2565. [Full Text] [PDF]

				E. Oda The metabolic syndrome (emperor) wears no clothes: response to kahn. Diabetes Care, November 1, 2006; 29(11): 2566 - 2566. [Full Text] [PDF]