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The metabolic syndrome: ‘To be or not to be, that is the question

The existence and clinical relevance of the ‘metabolic syndrome’ has recently been challenged in a review article published on behalf of the current governing bodies of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) [1]. Among other points of contention, the authors argued that (i) the syndrome is poorly defined, with uncertainty regarding the optimum components to include and the thresholds to use; (ii) its underlying pathogenesis is poorly understood; and (iii) its value as a cardiovascular risk marker is uncertain. On these bases, they concluded that this condition should not be designated as a syndrome and implied that despite the existence of an ICD-9 classification (277.7; dysmetabolic syndrome X), the use of metabolic syndrome as a diagnosis should be avoided until further research into this topic has been carried out. Whilst some of the criticisms raised are clearly valid, it needs to be recognized that the concept of the metabolic syndrome has driven research, education and management of Type 2 diabetes over the last 10–15 years. At a time when a range of specialties, including diabetes, cardiology and hepatology, are embracing these concepts, it is perhaps precipitous to discard the metabolic syndrome in this way. Aware of the caveats raised by the ADA and EASD, we believe that the syndrome should be retained and used to drive further understanding of this condition.