Definitions of the metabolic syndrome

Parameters	NCEP ATP3 2005*	IDF 2009	EGIR 1999	WHO 1999	AACE 2003
Required			Insulin resistance or fasting hyperinsulinemia (ie, in top 25% of the laboratory-specific reference range)	Insulin resistance in top 25%^Δ; fasting glucose ≥6.1 mmol/L (110 mg/dL); 2-hour glucose ≥7.8 mmol/L (140 mg/dL)	High risk of insulin resistance^◊ or BMI ≥25 kg/m² or waist ≥102 cm (men) or ≥88 cm (women)
Number of abnormalities	≥3 of:	≥3 of:	And ≥2 of:	And ≥2 of:	And ≥2 of:
Glucose	Fasting glucose ≥5.6 mmol/L (100 mg/dL) or drug treatment for elevated blood glucose	Fasting glucose ≥5.6 mmol/L (100 mg/dL) or diagnosed diabetes	Fasting glucose 6.1 to 6.9 mmol/L (110 to 125 mg/dL)		Fasting glucose ≥6.1 mmol/L (110 mg/dL); ≥2-hour glucose 7.8 mmol/L (140 mg/dL)
HDL cholesterol	<1.0 mmol/L (40 mg/dL) (men); <1.3 mmol/L (50 mg/dL) (women) or drug treatment for low HDL cholesterol^§	<1.0 mmol/L (40 mg/dL) (men); <1.3 mmol/L (50 mg/dL) (women) or drug treatment for low HDL cholesterol	<1.0 mmol/L (40 mg/dL)	<0.9 mmol/L (35 mg/dL) (men); <1.0 mmol/L (40 mg/dL) (women)	<1.0 mmol/L (40 mg/dL) (men); <1.3 mmol/L (50 mg/dL) (women)
Triglycerides	≥1.7 mmol/L (150 mg/dL) or drug treatment for elevated triglycerides^§	≥1.7 mmol/L (150 mg/dL) or drug treatment for high triglycerides	or ≥2.0 mmol/L (180 mg/dL) or drug treatment for dyslipidemia	or ≥1.7 mmol/L (150 mg/dL)	≥1.7 mmol/L (150 mg/dL)
Obesity	Waist ≥102 cm (men) or ≥88 cm (women)^¥	Waist ≥94 cm (men) or ≥80 cm (women)	Waist ≥94 cm (men) or ≥80 cm (women)	Waist/hip ratio >0.9 (men) or >0.85 (women) or BMI ≥30 kg/m²
Hypertension	≥130/85 mmHg or drug treatment for hypertension	≥130/85 mmHg or drug treatment for hypertension	≥140/90 mmHg or drug treatment for hypertension	≥140/90 mmHg	≥130/85 mmHg

NCEP: National Cholesterol Education Program; IDF: International Diabetes Federation; EGIR: Group for the Study of Insulin Resistance; WHO: World Health Organization; AACE: American Association of Clinical Endocrinologists; HDL: high-density lipoprotein; CVD: cardiovascular disease; BMI: body mass index.
* Most commonly agreed upon criteria for metabolic syndrome. Note that abdominal obesity is not a prerequisite for diagnosis; the presence of any 3 of the 5 risk criteria constitutes a diagnosis of metabolic syndrome.
¶ For South Asian and Chinese patients, waist ≥90 cm (men) or ≥80 cm (women); for Japanese patients, waist ≥90 cm (men) or ≥80 cm (women).
Δ Insulin resistance measured using insulin clamp.
◊ High risk of being insulin resistant is indicated by the presence of at least 1 of the following: diagnosis of CVD, hypertension, polycystic ovary syndrome, non-alcoholic fatty liver disease or acanthosis nigricans; family history of type 2 diabetes, hypertension or CVD; history of gestational diabetes or glucose intolerance; non-White race; sedentary lifestyle; BMI 25 kg/m² or waist circumference 94 cm (men) or 80 cm (women); and age 40 years.
§ Treatment with 1 or more of fibrates or niacin.
¥ In Asian patients, waist ≥90 cm (men) or ≥80 cm (women).

References:

Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120:1640.
Meigs J. Metabolic syndrome and risk for type 2 diabetes. Expert Rev Endocrin Metab 2006; 1:57. Table 1. Updated data from the International Diabetes Federation, 2006.
Bloomgarden ZT. American Association of Clinical Endocrinologists (AACE) consensus conference on the insulin resistance syndrome: 25-26 August 2002, Washington, DC. Diabetes Care 2003; 26:933.

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Definitions of the metabolic syndrome