1. Paul Zimmet & George Alberti
The Metabolic Syndrome: International Diabetes Federation (IDF) consensus definition
Paul Zimmet & George Alberti
Co-Chairmen

2. A cluster of risk factors for diabetes and cardiovascular disease
METABOLIC SYNDROME
A cluster of risk factors for diabetes and cardiovascular disease

3. The Metabolic Syndrome
(“Deadly Quartet”)
A cluster of risk factors for diabetes and cardiovascular disease consisting of:
Central (abdominal) obesity
Diabetes, IFG and IGT
Hypertension
Dyslipidaemia

4. International Diabetes Federation (IDF) consensus definition
In 2004, the IDF held an expert workshop to examine how the currently available definitions for the Metabolic Syndrome could be improved and developed with the aim of reaching a consensus for the introduction of a new and unifying definition.

5. THE ORIGINS 1920s 1940s/50s – Vague 1967 – Avogaro & Crepaldi
Reaven

6. Kylin 1923 Description Kylin E:
Studien ϋber das Hypertonie-Hyperglykämie – Hyperurika miesyndrome
1923

7. Crepaldi 1965 Description
“seems to suggest a peculiar syndrome including hyperlipemia, obesity and diabetes. The development of ischaemic heart disease … and hypertension is often found in these patients.”
Avogaro & Crepaldi, 1965

8. The 2000 WHO Working Group attempt to describe & define the Metabolic Syndrome was an initiative to create interest and debate – it was never meant to be the final answer.

9. Metabolic Syndrome – WHO 1999+
At least 1 of
at least 2 of
Metabolic syndrome
Type 2 diabetes
IGT
Insulin resistance
Hypertension
Obesity
Raised TG or low HDL
Microalbuminuria
Hyperuricemia
Hypercoagulability
Hyperleptinemia
Not required for definition,
but may be part of the syndrome

10. The Metabolic Syndrome (ATP III) & Criteria
Risk Factor
Criterion
Abdominal Obesity
Men
Women
Waist Circumference
>102 cm (>40 in)
>88 cm (>35 in)
Triglycerides
150 mg/dL
HDL-Cholesterol Men Women
<40 mg/dL <50 mg/dL
Blood Pressure
130/85 mm Hg
Fasting Glucose
110 mg/dL
NCEP ATP III. JAMA. 2001;285:

11. EGIR Definition of Metabolic Syndrome: 1999
Insulin resistance + 2 or more of:
Central obesity (94 cm -M; 80 cm - F)
TG >2.9 mM OR HDL <1.0
Hypertension (> 140/90)
FPG > 6.1 mM

12. The Metabolic Syndrome in Australia; Different Prevalences for Different Criteria

13. Prevalence of the Metabolic Syndrome in Australian Adults (>25 years): AusDiab

14. Metabolic Syndrome prevalence: 3 definitions in Australians - AusDiab
WHO (25.3%)
ATP III (22.4%)
4.8
4.3
12.0
4.8
4.2
0.8
EGIR (19.0%)
2.0

15. RESULT
Confusion!!!

16. “Consensus Means That A Lot Of People Say Collectively What No One Believes Individually”.
Abba Eban

17. Central obesity: a driving force for cardiovascular disease & diabetes
“Balzac” by Rodin
Front
Back

18. Developing A New Definition of the Metabolic Syndrome: IDF Objectives
Needs:
To identify individuals at high risk of developing cardiovascular disease (and diabetes)
To be useful for clinicians
To be useful for international comparisons

19. International Diabetes Federation (IDF) Consensus Definition 2005
The new IDF definition focusses on abdominal obesity rather than insulin resistance

20. International Diabetes Federation (IDF) Consensus Definition 2005
Central Obesity
Waist circumference – ethnicity specific*
– for Europids: Male > 94 cm
Female > 80 cm
plus any two of the following:
Raised triglycerides
> 150 mg/dL (1.7 mmol/L)
or specific treatment for this lipid abnormality
Reduced HDL cholesterol
< 40 mg/dL (1.03 mmol/L) in males
< 50 mg/dL (1.29 mmol/L) in females
Raised blood pressure
Systolic : > 130 mmHg or
Diastolic: > 85 mmHg or
Treatment of previously diagnosed hypertension
Raised fasting plasma glucose
Fasting plasma glucose > 100 mg/dL (5.6 mmol/L) or
Previously diagnosed type 2 diabetes
If above 5.6 mmol/L or 100 mg/dL, OGTT is strongly recommended but is not necessary to define presence of the syndrome.

21. Tests Recommended for Research: May Be Added To Definition Later
CRP
Insulin
Resistance*
Adipo-
nectin
TG
IFG &
Diabetes
 BP
OGTT
Abdominal
Obesity
Microalb
HDL
PAI-1
Apo B
Little LDL
* HOMA, euglycemic clamp, fasting insulin etc

22. Treatment of Metabolic Syndrome: 2005
Stop smoking
Oral hypoglycaemics
ACEI &/or A2 receptor blockers
Diet, Exercise, Lifestyle change
Insulin
Aspirin
CB1 Receptor Blocker
Antihypertensives
Statins & Fibrates

23. Recommendations for treatment
Primary management for the Metabolic Syndrome is healthy lifestyle promotion. This includes:
moderate calorie restriction (to achieve a 5-10% loss of body weight in the first year)
moderate increases in physical activity
change dietary composition to reduce saturated fat and total intake, increase fibre and, if appropriate, reduce salt intake.

24. Management of the Metabolic Syndrome
Appropriate & aggressive therapy is essential for reducing patient risk of cardiovascular disease
Lifestyle measures should be the first action
Pharmacotherapy should have beneficial effects on
Glucose intolerance/diabetes
Obesity
Hypertension
Dyslipidaemia
Ideally, treatment should address all of the components of the syndrome and not the individual components

25. Summary: new IDF definition for the Metabolic Syndrome
The new IDF definition addresses both clinical and research needs:
provides a simple entry point for primary care physicians to diagnose the Metabolic Syndrome
providing an accessible, diagnostic tool suitable for worldwide use, taking into account ethnic differences
establishing a comprehensive ‘platinum standard’ list of additional criteria that should be included in epidemiological studies and other research into the Metabolic Syndrome