Harmonizing the Metabolic Syndrome: A Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity
Open accessAbstract
A cluster of risk factors for cardiovascular disease and type 2 diabetes mellitus, which occur together more often than by chance alone, have become known as the metabolic syndrome. The risk factors include raised blood pressure, dyslipidemia (raised triglycerides and lowered high-density lipoprotein cholesterol), raised fasting glucose, and central obesity. Various diagnostic criteria have been proposed by different organizations over the past decade. Most recently, these have come from the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute. The main difference concerns the measure for central obesity, with this being an obligatory component in the International Diabetes Federation definition, lower than in the American Heart Association/National Heart, Lung, and Blood Institute criteria, and ethnic specific. The present article represents the outcome of a meeting between several major organizations in an attempt to unify criteria. It was agreed that there should not be an obligatory component, but that waist measurement would continue to be a useful preliminary screening tool. Three abnormal findings out of 5 would qualify a person for the metabolic syndrome. A single set of cut points would be used for all components except waist circumference, for which further work is required. In the interim, national or regional cut points for waist circumference can be used.
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Weight gain together with cardiometabolic disease exacerbates insulin resistance and leads to greater storage of fat in the intra-abdominal depot, ectopic accumulation of fat in liver and muscle cells, and heightened dysregulation of adipocytokines and systemic inflammation.
“Although lean individuals can have insulin resistance and CMD, weight gain together with CMD exacerbates insulin resistance and leads to greater storage of fat in the intra-abdominal depot, ectopic accumulation of fat in liver and muscle cells, and heightened dysregulation of adipocytokines and systemic inflammation.670–673”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [672]
The paper’s discussion of metabolic risk factors (indexed under Abstract; page unavailable) says abdominal obesity and insulin resistance commonly coexist in metabolic syndrome, which is also associated with a proinflammatory state. It does not say that weight gain together with cardiometabolic disease causes the proposed progression to intra-abdominal and ectopic fat storage or adipocytokine dysregulation; it says the underlying mechanisms are not fully understood. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe health effects of excess adiposity are manifest by the development of adverse weight-related complications that are the cause of morbidity and mortality.
“The health effects of excess adiposity are manifest by the development of adverse weight-related complications that are the cause of morbidity and mortality.672,673”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [672]
The Abstract (page not provided) describes metabolic syndrome as a medical complication of obesity and reports increased risks of cardiovascular disease and type 2 diabetes. It supports the claim that obesity-related complications contribute to morbidity, but does not address mortality or establish that weight-related complications generally cause it. (LLM, conf=0.83)
Experimental — accuracy not yet measuredBMI is currently used as a general screening tool to diagnose overweight (BMI 25-29.9 kg/m2) and obesity (BMI ≥30 kg/m2), but these cutoffs do not capture risk of adiposity among varied ethnic groups and do not identify individual cardiometabolic disease risk.
“BMI is currently used as a general screening tool to diagnose overweight (BMI 25 to 29.9 kg/m2) and obesity (BMI ≥30 kg/m2), but these BMI cutoffs do not capture risk of adiposity among varied ethnic groups, nor do they identify individual CMD risk.”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [672]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredVisceral fat distribution, i.e. abdominal obesity, mediates the majority of the cardiometabolic risk.
“Visceral fat distribution, i.e. abdominal obesity, mediates the majority of the cardiometabolic risk. 42”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [42]
The passage labeled Abstract says abdominal obesity appears to contribute to metabolic risk factors, but it also names insulin resistance as a contributor and says the mechanisms are not fully understood. It does not establish that visceral fat distribution mediates the majority of cardiometabolic risk. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe current cut-offs of >94 cm in men and >80 cm in women for Caucasians (and adjusted for other ethnicities) are associated with an increased cardiometabolic risk and increased risk for MASLD.
“The current cut-offs of > -94 cm in men and > -80 cm in women for Caucasians (and adjusted for other ethnicities) are associated with an increased cardiometabolic risk 40,42 and increased risk for MASLD.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [42]
ABCD is a medical diagnostic term that recognizes that excessive weight gain engenders abnormalities in the mass, distribution, and function of adipose tissue and leads to chronic complications that confer morbidity and mortality.
“ABCD is a medical diagnostic term that recognizes that excessive weight gain engenders abnormalities in the mass, distribution, and function of adipose tissue and leads to chronic complications that confer morbidity and mortality.672,673”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [672]
The Abstract defines metabolic syndrome and discusses abdominal obesity as one of its risk factors, but it does not define ABCD. Searches for ABCD, adipose-tissue mass, distribution and function, and the claimed sequence of chronic complications found no passage addressing that diagnostic term. (LLM, conf=0.74)
Experimental — accuracy not yet measuredABCD is clinically meaningful in contradistinction to BMI-based diagnosis, which provides no indication of the impact on health, and avoids multiple meanings and stigmatization associated with the term obesity.
“Thus, ABCD is clinically meaningful in contradistinction to the BMI-based diagnosis that provides no indication of the impact on health675 and avoids multiple meanings and stigmatization associated with the term obesity.672”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [672]
The cited paper discusses waist circumference, metabolic risk, and BMI-equivalent cut points (Abstract; page unavailable). It does not address the claim attached to this citation: that a BMI-based diagnosis provides no indication of its impact on health. Searches for that assertion and close paraphrases found no supporting passage. (LLM, conf=0.76)
Experimental — accuracy not yet measuredAACE and the European Association for the Study of Obesity have advocated for the use of ABCD as a medical diagnostic term for obesity.
“AACE672 and the European Association for the Study of Obesity673 have advocated for the use of ABCD as a medical diagnostic term for obesity.”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [672]
The paper’s Abstract discusses diagnostic criteria for metabolic syndrome, including abdominal obesity, but does not address using ABCD as a diagnostic term for obesity. Searches for ABCD, AACE, and the European Association for the Study of Obesity found no passage supporting the attributed advocacy. (LLM, conf=0.78)
Experimental — accuracy not yet measuredWomen with PCOS have an increased prevalence of the metabolic syndrome.
“Women with PCOS have an increased prevalence of the metabolic syndrome (74, 75).”
From Metformin and Combined Oral Contraceptive Pills in the Management of Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis (2024) · cites this paper as [74]
The available passages from “Harmonizing the Metabolic Syndrome” (section labeled Abstract; no page number supplied) discuss the syndrome’s diagnostic criteria, prevalence in the general population, and association with insulin resistance. Searches for “PCOS” and “polycystic ovary syndrome” found no passage addressing whether women with PCOS have an increased prevalence of the metabolic syndrome. (LLM, conf=0.72)
Experimental — accuracy not yet measuredA combination of high waist circumference and elevated TG is a simple and inexpensive screening tool to identify people with MetS at high CVD risk for global risk evaluation.
“A combination of high waist circumference and elevation of TG is a simple and inexpensive screening tool to discriminate people with MetS at high CVD risk for global risk evaluation.95”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [95]
Waist circumference thresholds of more than 80 cm for women of any ethnicity, more than 94 cm for men of European ancestry, and more than 90 cm for men of Asian origin indicate abdominal adiposity even in people of normal weight.
“Measurements of waist circumference . 80 cm for women of any ethnicity and . 94 cm for men of European ancestry or . 90 cm for men of Asian origin indicate the presence of abdominal adiposity, even in people of normal weight ( Table 14 ). 180”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [180]
A combination of large waist circumference and elevated triglycerides is a simple and inexpensive screening tool to identify people with MetS at high CVD risk for global risk evaluation.
“A combination of large waist circumference and elevation of TGs is a simple and inexpensive screening tool to discriminate people with MetS at high CVD risk for global risk evaluation. 180”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [180]
Waist circumference above 80 cm for women and above 94 cm for men of European ancestry or above 90 cm for men of Asian origin indicate abdominal adiposity, even in normal weight people.
“Measurements of waist circumference >80 cm for women of any ethnicity and >94 cm for men of European ancestry or >90 cm for men of Asian origin indicate the presence of abdominal adiposity, even in people of normal weight (Table 14).180”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [180]
In 2009, several major organizations released a statement harmonizing the criteria for MetS, which is in use today.
“In 2009, several major organizations released a statement harmonizing the criteria for MetS, which is in use today (38).”
From The CardioMetabolic Health Alliance (2015) · cites this paper as [38]
Clinical outcome studies have failed to demonstrate the prognostic significance of triglyceride levels in MetS.
“Nonetheless, clinical outcome studies have failed to demonstrate the prognostic significance of triglyceride levels in MetS.”
From Triglycerides and Cardiovascular Disease: A Scientific Statement From the American Heart Association (2011) · cites this paper as [184]
Other factors (low HDL-C, elevated glucose, or elevated blood pressure) independently predicted CVD and all-cause mortality in RCTs.
“Rather, other factors (eg, low HDL-C, elevated glucose, or elevated blood pressure) independently predicted CVD and all-cause mortality in RCTs.184 -187”
From Triglycerides and Cardiovascular Disease: A Scientific Statement From the American Heart Association (2011) · cites this paper as [184]
The prevalence of triglyceride levels >=150 mg/dL is nearly twice as high in subjects with MetS as in those without MetS.
“The prevalence of triglyceride levels Ն150 mg/dL is nearly twice as high in subjects with MetS as in those without MetS.184,185”
From Triglycerides and Cardiovascular Disease: A Scientific Statement From the American Heart Association (2011) · cites this paper as [184]
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- Authors
- Alberti, K. G. M. M., Eckel, R. H., Grundy, S. M., Zimmet, P. Z., Cleeman, J. I., Donato, K. A., Fruchart, J.-C., James, W. P. T., Loria, C. M., & Smith, S. C.
- Affiliations
- American Heart Association (US)
- Baker Heart and Diabetes Institute (AU)
- Wolters Kluwer Health (US)
- Venue
- Circulation
- Published
- 2009-10-20
- Volume
- 120
- Issue
- 16
- Pages
- 1640-1645
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2143104968
- Cited by
- 14,860
- References
- 19
- Citations by year
- 2026: 815 · 2025: 908 · 2024: 1080 · 2023: 1002 · 2022: 1120 · 2021: 1238 · 2020: 1080 · 2019: 969 · 2018: 950 · 2017: 901 · 2016: 875 · 2015: 857 · 2014: 836 · 2013: 775 · 2012: 658
- FWCI
- 346.23
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Heart Association
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- metabolic syndrome, diagnostic criteria, cardiovascular risk factors, type 2 diabetes, abdominal obesity, waist circumference, dyslipidemia, hypertriglyceridemia, low HDL cholesterol, hyperglycemia, hypertension, IDF criteria, AHA/NHLBI criteria, cut points, screening
- MeSH terms
- Blood Glucose, Cardiovascular Diseases, Diabetes Mellitus, Humans, Hypertension, Insulin Resistance, Cholesterol, HDL, Terminology as Topic, Obesity, Risk Factors, Triglycerides, Metabolic Syndrome, Abdominal Fat, Waist Circumference
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