Eight Primary Metabolic Diseases

Metabolic Disease (Phenomenological List):
  1. Insulin Resistance
  2. Dyslipidemia
  3. Fatty Liver Disease
  4. Hypertension
  5. Cardiovascular Disease
  6. Polycystic Ovarian Syndrome (PCOS)
  7. Cancer
  8. Dementia

Central obesity, endothelial dysfunction, and pro-inflammatory/thrombotic events are all part of the syndrome as well — but they are processes, not diseases. 

Dr. Robert Lustig states that mitochondrial dysfunction is at the base of all of the diseases on the list.

Attached are two tables (adults, children) of all the organizations who defined it, and how they defined it. 

Table 1. Comparison of definitions of metabolic syndrome in adults.

 

WHO

AHA/NHLBI Grundy, 2005, 2006. 

NCEP/ATP III 2001

IDF

Alberti, 2005

EGIR

Balkau, 1999

Diagnostic criteria

Glucose intolerance, impaired glucose tolerance, or diabetes mellitus and/or insulin resistance plus at least 2 of 6 criteria listed below

Any 3 of the 5 criteria listed below

At least 3 of the criteria listed below

Elevated waist circumference + any 2 of the other 4 criteria

Hyperinsulinemia and 2 or more of the 4 additional criteria

BMI

> 30 kg/m2

 

 

 

 

Elevated BP

≥ 140/90 mmHg

SBP ≥ 130 mmHg or DBP ≥ 85 mmHg or drug treatment for hypertension

≥ 130/85 mmHg

SBP ≥ 130 mmHg or DBP ≥ 85 mmHg or treatment of previously diagnosed hypertension

SBB ≥ 140 mmHg and/or DBP ≥ 90 mmHg and/or treatment for hypertension

Elevated fasting glucose

 

≥ 100 mg/dL or drug treatment for elevated glucose

≥ 110 mg/dl

≥ 100 mg/dL or previously diagnosed type 2 diabetes

≥ 110 mg/dL

Hyperinsulinemia

 

 

 

 

Fasting insulin concentration above the upper quartile for the non-diabetic subjects (ages and sexes combined)

 

Elevated TG

≥ 150 mg/dL (1.7 mmol/L)

≥ 150 mg/dL (1.7 mmol/L) or drug treatment for elevated TG

≥ 150 mg/dL

≥ 150 mg/dL (1.7 mmol/L) or specific treatment for this lipid abnormality

≥ 180 mg/dL and/or HDL < 50 mg/dL and/or treatment for dyslipidemia

Elevated waist circumference

Males: waist to hip ratio > 0.90 or females: waist to hip ratio > 0.85

Men ≥ 102 cm or women ≥ 88 cm

Men >102 cm (>40 in) or women >88 cm (>35 in)

Men ≥ 94 cm or women ≥ 80 cm

≥94 cm for men, ≥80 cm for women

Microalbuminuria

urinary albumin excretion rate ≥ 20 µg/min or albumin: creatinine ratio ≥ 30 mg/g

 

 

 

 

 

Reduced HDL-C

Men <35 mg/dL (0.9 mm/dL) or women < 39 mg/dl (1.0 mmol/L)

Men < 40 mg/dL (1.03 mmol/L), women < 50 mg/dL (1.3 mmol/L), or drug treatment for reduced HDL-C

Men < 40 mg/dL or women < 50 mg/dL

Males < 40 mg/dL (1.03 mmol/L), females < 50 mg/dL (1.29 mmol/L), or specific treatment for this lipid abnormality

 

 

Abbreviations: WHO, World Health Organization; AHA, American Heart Association; NHLBI, National Heart, Lung, and Blood Institute; NCEP, National Cholesterol Education Program; ATP, Adult Treatment Panel; EGIR, European Group for the Study of Insulin Resistance.

Table 2. Comparison of definitions of metabolic syndrome in youth.

Components

Torok 2001

Cook 2003

Andersen 2003

Cruz 2004

Weiss 2004

Lambert 2004

Duncan 2004

De Ferranti 2006

Waist circumference

 

≥90th% (age, sex)

 

≥90th% (age, sex, ethnicity)

 

 

≥90th%

≥75th%

BMI

 

 

 

 

>97th% (age, sex)

≥85th% (age, sex)

 

 

Skin folds

 

 

sum of 4: highest quartile (age, sex)

 

 

 

 

 

Weight for height

>20%

 

 

 

 

 

 

 

Body fat

>25% (males), >30% (females)

 

 

 

 

 

 

 

Triglycerides

>1.5 mmol/L

≥110 mg/dL

Highest quartile (age, sex)

≥90th% (age, sex)

≥95th% (age, sex)

≥75th% (age, sex)

≥110 mg/dL

≥100 mg/dL

HDL

<0.9 mmol/L

 ≤40 mg/dL

 

 ≤10th% (age, sex)

<5th% (age, sex)

 ≤25th% (age, sex)

≤40 mg/dL

≤50  mg/dL; ≤45 mg/dL 15-19 years old

HDL/Total cholesterol

 

 

Lowest quartile (age, sex)

 

 

 

 

 

Total cholesterol

>5.2 mmol/L

 

 

 

 

 

 

 

SBP

SBP/DBP: 2nd Task Force 1981: >95th% (age, sex); ABPM >95th% (sex, height)

 

SBP: highest quartile (age, sex)

SBP/DBP: NHBPEP 1996: >90th% (age, sex, height)

SBP/DBP: NHBPEP 1996: >95th%

SBP ≥75th%

SBP or DBP ≥90th%

SBP ≥90th%

Glucose

WHO 1985 definition of IGT

≥110 mg/dL

 

ADA 2002

FG > 200 mg/dL or OOGT 140-200 mg/dL

≥6.1 mmol/L

FG≥110 mg/dL

FG≥110 mg/dL

Insulin

>18.7 μU/ml

 

Highest quartile (age, sex)

 

 

≥75th% (age, sex)

 

 

Definition

Obesity + hyperinsulinemia + hypertension + IGT or dyslipidemia

3 or more

4 or more

3 or more

3 or more

Hyperinsulinemia + 2 or more

3 or more

3 or more

 

Abbreviations: BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; ABPM, ambulatory blood pressure monitoring; WHO, World Health Organization; IGT, impaired glucose tolerance; ADA, American Diabetes Association; FG, fasting glucose; NHBPEP, National Blood Pressure Education Program; OOGT, 2 hour oral glucose tolerance test.

 

 

 

 


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