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Review |
1 Division of Cardiovascular Medicine, Falk CVRC, Stanford Medical Center, 300 Pasteur Dr., Stanford, CA 94305. Fax 650-725-1599;
ae-mail greaven{at}cvmed.stanford.edu.
Values for insulin-mediated glucose disposal vary continuously throughout a population of apparently healthy individuals, with at least a sixfold variation between the most insulin sensitive and most insulin resistant of these individuals. The more insulin resistant a person, the more insulin must be secreted to prevent decompensation of glucose tolerance. Insulin resistance is not a disease, but a description of a physiologic state, and approximately one third of an apparently healthy population is sufficiently insulin resistant to be at increased risk to develop a cluster of abnormalities and related clinical syndromes. The primary value of the concept of insulin resistance is that it provides a conceptual framework with which to place a substantial number of apparently unrelated biological events into a pathophysiological construct. In contrast, the metabolic syndrome was introduced as a diagnostic category to identify individuals that satisfy three of five relatively arbitrarily chosen criteria to initiate lifestyle changes with the goal of decreasing risk of cardiovascular disease. Consequently, the value of the notion of the metabolic syndrome must be considered not in pathophysiologic terms, but as a pragmatic approach to obtain a better clinical outcome. In this review, an effort is made to critically evaluate the concept of the metabolic syndrome, the criteria chosen to identify individuals with the syndrome, and the clinical utility of making, or not making, a diagnosis of the metabolic syndrome.
The following articles in journals at HighWire Press have cited this article:
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  E. A M Gale Should we dump the metabolic syndrome?: Yes BMJ, March 22, 2008; 336(7645): 640 - 640. [Full Text] [PDF]
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 E. Ritz Metabolic Syndrome: An Emerging Threat to Renal Function Clin. J. Am. Soc. Nephrol., September 1, 2007; 2(5): 869 - 871. [Full Text] [PDF]
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 S. A Lear, K. H Humphries, S. Kohli, A. Chockalingam, J. J Frohlich, and C L. Birmingham Visceral adipose tissue accumulation differs according to ethnic background: results of the Multicultural Community Health Assessment Trial (M-CHAT) Am. J. Clinical Nutrition, August 1, 2007; 86(2): 353 - 359. [Abstract] [Full Text] [PDF]
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 H. Bergman, L. Ferrucci, J. Guralnik, D. B. Hogan, S. Hummel, S. Karunananthan, and C. Wolfson Frailty: An Emerging Research and Clinical Paradigm Issues and Controversies J. Gerontol. A Biol. Sci. Med. Sci., July 1, 2007; 62(7): 731 - 737. [Abstract] [Full Text] [PDF]
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 Ar. Mani, J. Radhakrishnan, H. Wang, Al. Mani, M.A. Mani, C. Nelson-Williams, K.S. Carew, S. Mane, H. Najmabadi, D. Wu, et al. Metabolic Syndrome--What We Know and What We Don't Know: LPR6 Mutation in a Family with Early Coronary Disease and Metabolic Risk Factors. Science 315: 1278-1282, 2007 J. Am. Soc. Nephrol., June 1, 2007; 18(6): 1619 - 1623. [Full Text] [PDF]
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 E. Goodman, S. R. Daniels, J. B. Meigs, and L. M. Dolan Instability in the Diagnosis of Metabolic Syndrome in Adolescents Circulation, May 1, 2007; 115(17): 2316 - 2322. [Abstract] [Full Text] [PDF]
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R. Kahn Metabolic Syndrome: Is It a Syndrome? Does It Matter? Circulation, April 3, 2007; 115(13): 1806 - 1811. [Full Text] [PDF]
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 C. J. Jolliffe and I. Janssen Development of Age-Specific Adolescent Metabolic Syndrome Criteria That Are Linked to the Adult Treatment Panel III and International Diabetes Federation Criteria J. Am. Coll. Cardiol., February 27, 2007; 49(8): 891 - 898. [Abstract] [Full Text] [PDF]
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 A. Roos, S. J. L. Bakker, T. P. Links, R. O. B. Gans, and B. H. R. Wolffenbuttel Thyroid Function Is Associated with Components of the Metabolic Syndrome in Euthyroid Subjects J. Clin. Endocrinol. Metab., February 1, 2007; 92(2): 491 - 496. [Abstract] [Full Text] [PDF]
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 S. J. L. Bakker, R. T. Gansevoort, and D. de Zeeuw Metabolic syndrome: a fata morgana? Nephrol. Dial. Transplant., January 1, 2007; 22(1): 15 - 20. [Full Text] [PDF]
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C. Iribarren, A. S. Go, G. Husson, S. Sidney, J. M. Fair, T. Quertermous, M. A. Hlatky, and S. P. Fortmann Metabolic Syndrome and Early-Onset Coronary Artery Disease: Is the Whole Greater Than Its Parts? J. Am. Coll. Cardiol., November 7, 2006; 48(9): 1800 - 1807. [Abstract] [Full Text] [PDF]
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 I. KYROU, G. P CHROUSOS, and C. TSIGOS Stress, Visceral Obesity, and Metabolic Complications Ann. N.Y. Acad. Sci., November 1, 2006; 1083(1): 77 - 110. [Abstract] [Full Text] [PDF]
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 M. Monami, L. Lambertucci, A. Ungar, M. Pieri, G. Masotti, N. Marchionni, and E. Mannucci Is the third component of metabolic syndrome really predictive of outcomes in type 2 diabetic patients? Diabetes Care, November 1, 2006; 29(11): 2515 - 2517. [Full Text] [PDF]
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 E. Bertrand, C. Fritsch, S. Diether, G. Lambrou, D. Muller, F. Schaeffel, P. Schindler, K. L. Schmid, J. van Oostrum, and H. Voshol Identification of Apolipoprotein A-I as a "STOP" Signal for Myopia Mol. Cell. Proteomics, November 1, 2006; 5(11): 2158 - 2166. [Abstract] [Full Text] [PDF]
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 A. R. Sinaiko, J. Steinberger, A. Moran, C.-P. Hong, R. J. Prineas, and D. R. Jacobs Jr Influence of Insulin Resistance and Body Mass Index at Age 13 on Systolic Blood Pressure, Triglycerides, and High-Density Lipoprotein Cholesterol at Age 19 Hypertension, October 1, 2006; 48(4): 730 - 736. [Abstract] [Full Text] [PDF]
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B. L. Rodriguez, W. Y. Fujimoto, E. J. Mayer-Davis, G. Imperatore, D. E. Williams, R. A. Bell, R. P. Wadwa, S. L. Palla, L. L. Liu, A. Kershnar, et al. Prevalence of Cardiovascular Disease Risk Factors in U.S. Children and Adolescents With Diabetes: The SEARCH for Diabetes in Youth Study Diabetes Care, August 1, 2006; 29(8): 1891 - 1896. [Abstract] [Full Text] [PDF]
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 M. Blaha and T. A. Elasy Clinical Use of the Metabolic Syndrome: Why the Confusion? Clin. Diabetes, July 1, 2006; 24(3): 125 - 131. [Abstract] [Full Text] [PDF]
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R. Kahn The Metabolic Syndrome (Emperor) Wears No Clothes Diabetes Care, July 1, 2006; 29(7): 1693 - 1696. [Full Text] [PDF]
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R. H. Eckel, R. Kahn, R. M. Robertson, and R. A. Rizza Preventing Cardiovascular Disease and Diabetes: A call to action from the American Diabetes Association and the American Heart Association Diabetes Care, July 1, 2006; 29(7): 1697 - 1699. [Full Text] [PDF]
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R. H. Eckel, R. Kahn, R. M. Robertson, and R. A. Rizza Preventing Cardiovascular Disease and Diabetes: A Call to Action From the American Diabetes Association and the American Heart Association Circulation, June 27, 2006; 113(25): 2943 - 2946. [Full Text] [PDF]
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G. M Reaven The metabolic syndrome: is this diagnosis necessary? Am. J. Clinical Nutrition, June 1, 2006; 83(6): 1237 - 1247. [Abstract] [Full Text] [PDF]
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C. Meisinger, B. Koletzko, and J. Heinrich Metabolic syndrome: older than usually assumed, but still too young to die. Clin. Chem., May 1, 2006; 52(5): 897 - 898. [Full Text] [PDF]
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G. M. Reaven The Metabolic Syndrome: What's in a Name? Reply to: Meisinger et al. Metabolic Syndrome: Older than Usually Assumed, But Still Too Young to Die. Clin. Chem., May 1, 2006; 52(5): 898 - 899. [Full Text] [PDF]
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C. H. Saely, L. Koch, F. Schmid, T. Marte, S. Aczel, P. Langer, G. Hoefle, and H. Drexel Adult Treatment Panel III 2001 but Not International Diabetes Federation 2005 Criteria of the Metabolic Syndrome Predict Clinical Cardiovascular Events in Subjects Who Underwent Coronary Angiography Diabetes Care, April 1, 2006; 29(4): 901 - 907. [Abstract] [Full Text] [PDF]
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P. T. Katzmarzyk, I. Janssen, R. Ross, T. S. Church, and S. N. Blair The Importance of Waist Circumference in the Definition of Metabolic Syndrome: Prospective analyses of mortality in men Diabetes Care, February 1, 2006; 29(2): 404 - 409. [Abstract] [Full Text] [PDF]
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K.M. V. Narayan The Metabolic Syndrome: Some Second Thoughts? Clin. Diabetes, January 1, 2006; 24(1): 38 - 39. [Full Text] [PDF]
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 B. Goldfarb ADA/EASD Statement Casts Critical Eye on Metabolic Syndrome DOC News, October 1, 2005; 2(10): 1 - 5. [Full Text]
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S. M. Grundy Point: The Metabolic Syndrome Still Lives Clin. Chem., August 1, 2005; 51(8): 1352 - 1354. [Full Text] [PDF]
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G. Reaven Counterpoint: Just Being Alive Is Not Good Enough Clin. Chem., August 1, 2005; 51(8): 1354 - 1357. [Full Text] [PDF]
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 S. Craft Insulin Resistance and Cognitive Impairment: A View Through the Prism of Epidemiology Arch Neurol, July 1, 2005; 62(7): 1043 - 1044. [Full Text] [PDF]
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S. A. Lear Waist Circumference Is Simpler than Body Mass Index Clin. Chem., June 1, 2005; 51(6): 1082 - 1084. [Full Text] [PDF]
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G. M. Reaven Dr. Reaven responds: Clin. Chem., June 1, 2005; 51(6): 1083 - 1084. [Full Text] [PDF]
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