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Should we dump the metabolic syndrome? No

BMJ 2008; 336 doi: (Published 20 March 2008) Cite this as: BMJ 2008;336:641

Rapid Response:

metabolic syndrome

Soon after the concept of the metabolic syndrome various groups of "experts" have attempted to place a diagnostic straitjacket on the mixture of discrete and continously variable factors which have been found to associate statistically. Originally the value of the syndrome was in the prediction of diabetes and cardiovascular disease, so I agree with Edwin Gale that it is surprising the the International Diabetes Federation should now include the presence of diabetes as one of the optional components. Incidentally, as increased waist circumference is the basic requirement, if one had diabetes and a waist circumference below the cut- off level, one would escape the syndrome!

The metabolic associations of the syndrome are undoubtably fascinating and deserve much more interdisciplinary research. But this will be hampered by arbitary - for that is what they are - definitions of the syndome based upon cut-off levels in continuous distributions in an attempt to provide clinical value, particularly as Alberti and Zimmet are only able to claim belief, ie no evidence, in favour. I would be happy to retain the term as a shorthand for the associations, but as a diagnostic label, then I am with Edwin Gale.

Competing interests: None declared

Competing interests: No competing interests

26 March 2008
Richard J Jarrett
emeritus professor
London SE26 4PA
45 Bishopsthorpe Road