Critics say the term distracts from the real risk factors.
What's in a name? A great deal, according to some diabetes organizations.
The American Diabetes Association (ADA) and the European Association for the Study of Diabetes say the term 'metabolic syndrome' creates confusion. In a joint paper published in September, they question whether the term, which describes a cluster of certain risk factors for heart disease, counts as a syndrome at all (Diabetes Care 28, 2289–2304; 2005, Diabetologia 10.1007/s00125-005-1876-2).
There is no evidence as yet to attribute the symptoms of metabolic syndrome to a common cause, says Richard Kahn, the ADA's chief scientific and medical officer. Diagnosing individuals with this term misleads them to believe they have a unique disease, he says.
We have an obligation to clarify the confusion. Jeffrey Mechanick,, American Association of Clinical Endocrinologists
Kahn's co-author on the paper, John Buse of the University of North Carolina in Chapel Hill, says the term distracts some people from the threat of individual risk factors. “Patients would come up to me and say 'Oh well, I have diabetes, but I don't have metabolic syndrome,'” he notes. Buse says treating risk factors—such as high blood pressure and obesity—separately is a better approach.
Definitions of metabolic syndrome vary widely. One group describes a person with the syndrome as having a large waist circumference combined with hypertension, low levels of 'good' cholesterol and high levels of glucose and triglycerides. Another common definition relies on the body mass index instead of waist size.
To resolve the differences, the International Diabetes Federation in April gathered a task force of 21 experts who arrived at a consensus. Their new description evaluates the waist size component of the equation according to ethnicity. For example, a man of European descent would have to have a waist circumference greater than 93 centimeters, whereas a Japanese male would meet the criterion with a waist circumference larger than 84 centimeters. This takes into account differences in body build among ethnic groups, says Sir George Alberti, past president of the organization and co-chair of the task force.
Using the term 'metabolic syndrome' can help gently remind overweight individuals of the importance of a healthier lifestyle, he says. “It is less confrontational than saying to a patient 'You are grossly overweight, and you have high blood pressure, and your blood lipids are too high.'”
But some researchers dismiss the skepticism about metabolic syndrome as the result of diabetes organizations wanting to protect their professional turf.
The debate over metabolic syndrome looks set to continue for some time. In response to the recent objections to the term, organizations such as the American Association of Clinical Endocrinologists have begun reassessing its use. “We have an obligation to clarify the confusion as to whether metabolic syndrome exists,” says Jeffrey Mechanick, chairman of the association's nutrition committee.
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Khamsi, R. Diabetes groups question whether 'metabolic syndrome' exists. Nat Med 11, 1017 (2005). https://doi.org/10.1038/nm1005-1017b