Meeting Themes Metabolic Syndrome
3rd Asia-Pacific Diabetes Epidemiology Course Knut Borch-Johnsen, Denmark
Syndrome X
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Reaven 1988 • Insulin resistance • Glucose intolerance • Raised triglycerides • Low HDL cholesterol • Hypertension
ECE 2003
The Metabolic Syndrome Proposed definitions ________________________________________________
WHO
Diagnostic criteria Insulin resistance OR DM / IGT / IFG
Other components 1)Blood pressure ≥140/90 2)Dyslipidemia 3)Central obesity 4)Microalbuminura (two or more)
ECE 2003
The Metabolic Syndrome Proposed definitions ________________________________________________
WHO
Main criteria Insulin resistance OR DM / IGT / IFG
Other components 1)Blood pressure ≥140/90 2)Dyslipidemia 3)Central obesity 4)Microalbuminura (two or more)
EGIR
Main criteria Hyperinsulinemia
Other components 1)Hyperglycemia 2) Blood pressure ≥140/90 3)Dyslipidemia 4)Abd. obesity (two or more)
ECE 2003
The Metabolic Syndrome Proposed definitions ________________________________________________
WHO
Main criteria Insulin resistance OR DM / IGT / IFG
Other components 1)Blood pressure ≥140/90 2)Dyslipidemia 3)Central obesity 4)Microalbuminura (two or more)
EGIR
Main criteria Insulin resistance
ATPIII
1)Abdominal obesity 2)High triglycerides 3)Low HDL cholesterol 4)Blood pressure ≥130/85 5)High fasting glucose (three or more)
Other components 1)Hyperglycemia 2) Blood pressure ≥140/90 3)Dyslipidemia 4)Central obesity (two or more)
Prevalence of the Metabolic Syndrome in selected countries (EGIR) ________________________________________________
MEN age > 55 years
Barilla D.E.S.I.R Ely Glostrup Morgen Viva Malmö 0 10 20 30 40 50 EGIR WHO
Percent %
Definition of the Metabolic Syndrome –
have we reached the end of the road?
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√ Defining insulin resistance Defining obesity Defining glucose intolerance
ECE 2003
defining insulin resistance
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• hyperinsulinemic euglucemic clamp • hyperinsulinemia • HOMA IR (upper quartile in a normoglycemic background population)
ECE 2003
Insulin levels in the EGIR study*
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*FI concentaions above the upper quartile ofr the non-diabetic subjets
Country
Denmark England France Italy Netherlands Spain
Study
Glostup Eli Study D.E.S.I.R. Barilla Morgen VIVA
FI pmol/l Age
51 55 56 129 84 107 60 40-65 30-65 22-73 20-60 35-68
Balkau. Diabetes Metab. 2002
Definition of the Metabolic Syndrome –
have we reached the end of the road?
________________________________________________
Defining insulin resistance √ Defining obesity Defining glucose intolerance
ECE 2003
Defining obesity in the Metabolic Syndrome ________________________________________________
• WHO WHR > 0.9 for men WHR > 0.85 for women or BMI > 30 kg/m2 Waist circumference ≥ 94cm for men ≥ 80 for women Waist circumference ≥ 102 cm for men ≥ 88 for women
ECE 2003
• EGIR • ATPIII
Obesity and HDL cholesterol Inuit and Europeans ________________________________________________
HDL cholesterol ● Denmark(6,784) □ Greenland(1,108)
2
MALES
1,8
FEMALES
1,6
mmol/l
1,4 1,2 1 <80 80-84 85-89 90-94 95-99 100-4 105+ <70 70-74 76-79 80-84 85-89 90-94 95+
Waist circumference (cm)
Jorgensen ME. Diabetologia 2002
Obesity and blood pressure Inuit and Europeans ________________________________________________
Blood ● Denmark(6,784) pressure □ Greenland(1,108)
160
MALES
140
FEMALES
120
mmHg
100 80 60 <80 80-84 85-89 90-94 95-99 100-4 105+ <70 70-74 76-79 80-84 85-89 90-94 95+
waist circumference (cm)
ECE 2003
Jorgensen ME. Diabetologia 2002
Definition of the Metabolic Syndrome –
________________________________________________
have we reached the end of the road?
Defining insulin resistance Defining obesity √ Defining glucose intolerance
ECE 2003
Defining glucose intolerance
________________________________________________
• WHO
fasting p-glucose ≥ 6.1 mmol/l (IFG+DM) 2-h p-glucose ≥ 7.8 (IGT + DM) Known diabetes fasting p-glucose ≥ 6.1 mmol/l (IFG) fasting p-glucose ≥ 6.1 mmol/l (IFG)
• EGIR • ATPIII
ECE 2003
Epidemiology of the Metabolic Syndrome
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• Definition of the Metabolic Syndrome
have we reached the end of the road? No!
• Is the Metabolic Syndrome a predictor of incident diabetes and/or cardiovascular disease? • Is it appropriate to dichotomise CVD risk? • Is a global definition relevant?
ECE 2003