The metabolic syndrome – utility of the concept

1. The metabolic syndrome – utility of the concept

2. Frequent questions on the metabolic syndrome…. • Which definition is the most appropriate for our population? • Is it a diagnosis? • Should the population be screened for it, and how? • Is it appropriate for raising awareness of risk factor clustering in the general population?

4. Main objective: To put the metabolic syndrome concept into perspective

5. What is the utility of the metabolic syndrome concept? • In pathophysiology research……. elucidating disease pathways? • In epidemiology……. searching for a unitary definition?

6. What is the utility of the metabolic syndrome concept? • In clinical work……………. increasing awareness of risk factor clustering? • In public health …………. as a health promotion tool?

7. What research questions need to be answered to further evolve the metabolic syndrome concept? What research to encourage and support?

8. Report to be published in Diabetologia WHO Expert Consultation, Geneva 21-22 November, 2008

9. Utility of the metabolic syndrome concept - Pathophysiology • No accepted underlying mechanism (insulin resistance, central obesity, disorder of hypothalamu-pituitary-adrenal axis, inflammation, molecules produced by cytokines) • Definitions are only provisional

10. Utility of the metabolic syndrome concept - Epidemiology • Existence of different definitions has led to confusion in comparisons of prevalence and impact • Currently there is little firm basis for a global definition

11. Utility of the metabolic syndrome concept - Clinical work • Met sy criteria are outperformed by traditional CVD risk algorithms and do not enhance risk prediction • Dichotomization discards crucial information • Omission of important risk factors (age, sex, smoking, ethnicity………..)

12. Utility of the metabolic syndrome concept - Clinical work • Describes relative risk, not absolute risk • CVD & DM risk varies according to risk factor combination in an individual

13. Utility of the metabolic syndrome concept – Public health • Provides an easily comprehensible public health message • Educational value for health professionals: look for clusters of risk factors!

14. Utility of the metabolic syndrome concept – Public health • Provides an easily comprehensible public health message - anecdotal evidence • Educational value for health professionals: look for clusters of risk factors! – anecdotal evidence

15. WHO Consultation on the metabolic syndrome concept - conclusions • Focus for future research: • Elucidation of common metabolic pathways underlying DM and CVD • Early life determinants of metabolic risk • Context-specific DM /CVD risk identification and prevention

16. WHO Consultation on the metabolic syndrome concept - conclusions • Should be considered as a pre-morbid condition • Should not be a clinical diagnosis

17. WHO Consultation on the metabolic syndrome concept - conclusions • An evolving concept • Potentially useful as an educational concept • Limited utility as diagnostic and management tool • Limited utility in doing further studies that compare different definitions