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Consider visceral fat when addressing metabolic syndrome

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Endocrinology in the News Conference

PHILADELPHIA — A lack of phenotypic characteristics to define the metabolic syndrome has led to debate regarding treatment and the patients who are diagnosed, according to Osama Hamdy, MD, PhD, FACE, who presented information on the metabolic syndrome last weekend at the Endocrinology in the News Conference.

“The controversy about the metabolic syndrome definitely exists because we do not have any phenotypic characteristics for these people, but we are now starting to see common associations,” Hamdy said during his April 12 presentation.

Of those associations, Hamdy highlighted polycystic ovary syndrome, hemochromatosis, acanthosis nigricans, non-alcoholic steatohepatitis and skin tags. Multiple guidelines for defining the metabolic syndrome are also available from associations, such as the World Health Organization, the National Cholesterol Education Program with the Adult Treatment Panel III and the International Diabetes Federation. These definitions may assist in diagnosing patients, but they have also contributed to the controversy, Hamdy said.

Consider the criteria

“I believe the definition everyone accepts right now is the NCEP-ATP III criteria. However, if people are seen in clinical practice with those manifestations, we are not usually treating them because triglycerides, blood pressure or blood sugar at those ranges are not usually signaling for us to take action,” Hamdy said.

From those NCEP-ATP III criteria, waistline may be the most important. Compared with BMI, waistline measurements are most valuable in the diagnosis of the metabolic syndrome. Hamdy stressed the importance of visceral fat accumulation as a contributor to the metabolic syndrome.

“When measuring waistline and internal fat, waistline only correlates to diabetes, but internal (visceral) fat, the most dangerous type, correlates with every single risk factor for coronary heart disease,” Hamdy said. – by Stacey L. Adams

For more information:

• Hamdy O. Metabolic syndrome – Why the controversy? Presented at: Endocrinology in the News; April 12-13, 2008; Philadelphia.