Evaluating CMR

Etiology and treatment of the metabolic syndrome and its components according to the IDF

Page: 3 of 9

IDF clinical criteria for the metabolic syndrome acknowledge that abdominal obesity and insulin resistance are pivotal causal factors. To assess abdominal obesity, the IDF suggests measuring waist circumference because it is independently associated with every single marker of the metabolic syndrome and because intra-abdominally obese individuals are at much greater risk of cardiovascular disease (CVD) and type 2 diabetes at any body mass index (BMI) level (4-6). Compared to NCEP-ATP III clinical criteria, IDF criteria set out lower cut-offs in men and women of any ethnicity. However, NCEP-ATP III has also suggested that individuals with a waist circumference slightly below the proposed cut-offs could still be at increased risk of developing or having the metabolic syndrome if they have at least two other clinical criteria. This suggests that IDF and NCEP-ATP III waist circumference criteria do not differ substantially. For individuals with a BMI above 30 kg/m², the IDF states that there is no need to measure waist circumference since 95% of obese individuals are likely to have a waist circumference above proposed cut-off values (7). Further research is clearly required in this area, especially in regions were few population studies are available to study the relationship between waist circumference, metabolic syndrome, and CVD and type 2 diabetes risk. For treatment of obesity, the IDF suggests adopting healthy lifestyle habits that include regular physical activity or exercise. The key goal for individuals with the metabolic syndrome should be moderate weight loss (5 to 10% of initial body weight). Moderate caloric restriction combined with increased physical activity yields optimal results. According to the IDF, patients should strive to perform at least 180 minutes of moderate physical activity and at least 60 minutes of vigorous physical activity per week. In terms of nutrition, the IDF recommends decreasing total fat intake, modifying diet composition to increase fibre intake, and reducing intake of saturated fats and sodium.

Reference

close

4. Carr DB, Utzschneider KM, Hull RL, et al. Intra-abdominal fat is a major determinant of the National Cholesterol Education Program Adult Treatment Panel III criteria for the metabolic syndrome. Diabetes 2004; 53: 2087-94.

5. Ohlson LO, Larsson B, Svardsudd K, et al. The influence of body fat distribution on the incidence of diabetes mellitus. 13.5 years of follow-up of the participants in the study of men born in 1913. Diabetes 1985; 34: 1055-8.

6. Pouliot M-C, Després JP, Lemieux S, et al. Waist circumference and abdominal sagitttal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol 1994; 73: 460-8.

7. Alberti KG, Zimmet P and Shaw J. Metabolic syndrome--a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med 2006; 23: 469-80.

Page: 3 of 9