International Diabetes Federation (IDF) Consensus Definition 2005

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The Metabolic Syndrome International Diabetes
Federation (IDF) consensus definition
Paul Zimmet George Alberti Co-Chairmen
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METABOLIC SYNDROME

• A cluster of risk factors for diabetes and
  cardiovascular disease

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The Metabolic Syndrome
(Deadly Quartet)

• A cluster of risk factors for diabetes and
  cardiovascular disease consisting of
• Central (abdominal) obesity
• Diabetes, IFG and IGT
• Hypertension
• Dyslipidaemia

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International Diabetes Federation (IDF) consensus
definition

• In 2004, the IDF held an expert workshop to
  examine how the currently available definitions
  for the Metabolic Syndrome could be improved and
  developed with the aim of reaching a consensus
  for the introduction of a new and unifying
  definition.

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THE ORIGINS

• 1920s
• 1940s/50s Vague
• 1967 Avogaro Crepaldi
• 1988 - Reaven

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Kylin 1923 Description

• Kylin E
• Studien ?ber das Hypertonie-Hyperglykämie
  Hyperurika miesyndrome
• 
  1923

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Crepaldi 1965 Description

• seems to suggest a peculiar syndrome including
  hyperlipemia, obesity and diabetes. The
  development of ischaemic heart disease and
  hypertension is often found in these patients.
• Avogaro Crepaldi, 1965

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The 2000 WHO Working Group attempt to describe
define the Metabolic Syndrome was an initiative
to create interest and debate it was never
meant to be the final answer.
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Metabolic Syndrome WHO 1999

At least 1 of
at least 2 of

• Type 2 diabetes
• IGT
• Insulin resistance

• Hypertension
• Obesity
• Raised TG or low HDL
• Microalbuminuria

• Hyperuricemia
• Hypercoagulability
• Hyperleptinemia

Not required for definition,
but may be part of the syndrome
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The Metabolic Syndrome (ATP III)
Criteria
Risk Factor Criterion
Abdominal Obesity Men Women Waist Circumference gt102 cm (gt40 in) gt88 cm (gt35 in)
Triglycerides ?150 mg/dL
HDL-CholesterolMenWomen lt40 mg/dLlt50 mg/dL
Blood Pressure ?130/?85 mm Hg
Fasting Glucose ?110 mg/dL
NCEP ATP III. JAMA. 20012852486-2497.
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EGIR Definition of Metabolic Syndrome 1999

• Insulin resistance 2 or more of
• Central obesity (94 cm -M 80 cm - F)
• TG gt2.9 mM OR HDL lt1.0
• Hypertension (gt 140/90)
• FPG gt 6.1 mM

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The Metabolic Syndromein Australia Different
Prevalences for Different Criteria
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Prevalence of the Metabolic Syndromein
Australian Adults (gt25 years) AusDiab
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Metabolic Syndrome prevalence3 definitions in
Australians - AusDiab
WHO (25.3)
ATP III (22.4)
4.8
4.3
12.0
4.8
4.2
0.8
EGIR (19.0)
2.0
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RESULT

• Confusion!!!

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(No Transcript)
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Central obesity a driving force for
cardiovascular disease diabetes
Balzac by Rodin
Front
Back
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Developing A New Definition of the Metabolic
Syndrome IDF Objectives

• Needs
• To identify individuals at high risk of
  developing cardiovascular disease (and diabetes)
• To be useful for clinicians
• To be useful for international comparisons

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International Diabetes Federation (IDF) Consensus
Definition 2005

• The new IDF definition focusses on abdominal
  obesity rather than insulin resistance

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International Diabetes Federation (IDF) Consensus
Definition 2005
Central Obesity Central Obesity
Waist circumference ethnicity specific for Europids Male gt 94 cm Female gt 80 cm Waist circumference ethnicity specific for Europids Male gt 94 cm Female gt 80 cm
plus any two of the following plus any two of the following
Raised triglycerides gt 150 mg/dL (1.7 mmol/L) or specific treatment for this lipid abnormality
Reduced HDL cholesterol lt 40 mg/dL (1.03 mmol/L) in males lt 50 mg/dL (1.29 mmol/L) in females or specific treatment for this lipid abnormality
Raised blood pressure Systolic gt 130 mmHg or Diastolic gt 85 mmHg or Treatment of previously diagnosed hypertension
Raised fasting plasma glucose Fasting plasma glucose gt 100 mg/dL (5.6 mmol/L) or Previously diagnosed type 2 diabetes If above 5.6 mmol/L or 100 mg/dL, OGTT is strongly recommended but is not necessary to define presence of the syndrome.
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Tests Recommended for Research May Be Added To
Definition Later
CRP
Insulin Resistance
Adipo- nectin
?TG IFG Diabetes
? BP
Abdominal Obesity
Microalb
?HDL
PAI-1
Apo B Little LDL
HOMA, euglycemic clamp, fasting insulin etc
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Treatment of Metabolic Syndrome 2005
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Recommendations for treatment

• Primary management for the Metabolic Syndrome
  is healthy lifestyle promotion. This includes
• moderate calorie restriction (to achieve a 5-10
  loss of body weight in the first year)
• moderate increases in physical activity
• change dietary composition to reduce saturated
  fat and total intake, increase fibre and, if
  appropriate, reduce salt intake.

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Management of the Metabolic Syndrome

• Appropriate aggressive therapy is essentialfor
  reducing patient risk of cardiovascular disease
• Lifestyle measures should be the first action
• Pharmacotherapy should have beneficial effects on
• Glucose intolerance/diabetes
• Obesity
• Hypertension
• Dyslipidaemia
• Ideally, treatment should address all of the
  components of the syndrome and not the individual
  components

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Summary new IDF definition for the Metabolic
Syndrome

• The new IDF definition addresses both
  clinical and research needs
• provides a simple entry point for primary care
  physicians to diagnose the Metabolic Syndrome
• providing an accessible, diagnostic tool suitable
  for worldwide use, taking into account ethnic
  differences
• establishing a comprehensive platinum standard
  list of additional criteria that should be
  included in epidemiological studies and other
  research into the Metabolic Syndrome