The Metabolic Syndrome: Time for a Critical Appraisal

Joint statement from the American Diabetes Association and the European Association for the Study of Diabetes

  1. Richard Kahn, PHD1,
  2. John Buse, MD, PHD2,
  3. Ele Ferrannini, MD3 and
  4. Michael Stern, MD4
  1. 1American Diabetes Association, Alexandria, Virginia
  2. 2Division of Endocrinology and of General Medicine & Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
  3. 3Department of Internal Medicine, University of Pisa School of Medicine, Pisa, Italy
  4. 4Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
  1. Address correspondence and reprint requests to Richard Kahn, PhD, American Diabetes Association, 1701 N. Beauregard St., Alexandria, VA 22311. E-mail: rkahn{at}


The term “metabolic syndrome” refers to a clustering of specific cardiovascular disease (CVD) risk factors whose underlying pathophysiology is thought to be related to insulin resistance. Since the term is widely used in research and clinical practice, we undertook an extensive review of the literature in relation to the syndrome’s definition, underlying pathogenesis, and association with CVD and to the goals and impact of treatment. While there is no question that certain CVD risk factors are prone to cluster, we found that the metabolic syndrome has been imprecisely defined, there is a lack of certainty regarding its pathogenesis, and there is considerable doubt regarding its value as a CVD risk marker. Our analysis indicates that too much critically important information is missing to warrant its designation as a “syndrome.” Until much needed research is completed, clinicians should evaluate and treat all CVD risk factors without regard to whether a patient meets the criteria for diagnosis of the “metabolic syndrome.”


  • This statement was reviewed and approved by the Professional Practice Committee of the American Diabetes Association and by an ad hoc committee of the European Association for the Study of Diabetes (members: H. Beck-Nielsen [Odense, Denmark], K. Borch-Johnsen [Gentofte, Denmark], E.A.M. Gale [Bristol, U.K.], L. Groop [Malmö, Sweden], H.-U. Häring [Tübingen, Germany], R.J. Heine [Amsterdam, the Netherlands], and D.R. Matthews [Oxford, U.K.]).

    Simultaneous publication: This article is being simultaneously published in 2005 in Diabetes Care and Diabetologia by the American Diabetes Association and the European Association for the Study of Diabetes.

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