Endocrine Abstracts

Bjorntorp first coined the term ‘metabolic syndrome’ (MS) in the 1980’s to describe the association between obesity, regional fat distribution, disease endpoints and their risk factors (cardiovascular disease, premature death, stroke, non-insulin-dependent diabetes mellitus and female carcinomas). This description also recognised the potential contribution from adreno-cortical activity and stress. Since that time a plethora of research has highlighted the causative links between visceral fat and insulin resistance in the syndrome. Two differing, but overlapping, definitions developed during the 1990’s reflecting the clinical background from which they were developed. The WHO definition (1998) required the presence of insulin resistance, while the National Cholesterol Education Program Expert Panel on the Treatment of High Blood Cholesterol in Adults, Adult Treatment Panel III (2001) focussed on the importance of lipid abnormalities. In 2005 the International Diabetes Federation proposed that central obesity (defined by ethic –specific waist measurements) was required + two of raised TG level, reduced HDL cholesterol, raised blood pressure, raised fasting plasma were necessary to define presence of the syndrome. They recommended that ‘…Once a diagnosis of MS is made, management of the condition should be aggressive and uncompromising in its aim to reduce the risk of CVD and type 2 diabetes’ and that primary intervention ‘…for MS is healthy lifestyle promotion (to) include moderate calorie restriction (to achieve a 5–10 per cent loss of bodyweight in the first year), moderate increase in physical activity, change in dietary composition’. It was recognised currently to be necessary to treat the individual components of the syndrome.

The value of ‘diagnosing’ the syndrome is under debate and the ADA and EASD have suggested (2005) that ‘… too much critically important information is missing to warrant its designation as a ‘syndrome.’ Until much needed research is completed, clinicians should evaluate and treat all CVD risk factors without regard to whether a patient meets the criteria for diagnosis of the ‘metabolic syndrome.’

Conclusion: Improved screening for obesity is a priority for referral into weight management services. This study has shown that clinically effective weight reduction can be achieved in the Primary Care setting.