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Paul Zimmet & George Alberti Co-Chairmen

The Metabolic Syndrome: International Diabetes Federation (IDF) consensus definition. Paul Zimmet & George Alberti Co-Chairmen. METABOLIC SYNDROME. A cluster of risk factors for diabetes and cardiovascular disease. The Metabolic Syndrome. (“Deadly Quartet”).

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Paul Zimmet & George Alberti Co-Chairmen

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  1. The Metabolic Syndrome:International Diabetes Federation (IDF) consensus definition Paul Zimmet & George Alberti Co-Chairmen

  2. METABOLIC SYNDROME A cluster of risk factors for diabetes and cardiovascular disease

  3. 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

  4. 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.

  5. THE ORIGINS • 1920s • 1940s/50s – Vague • 1967 – Avogaro & Crepaldi • 1988 - Reaven

  6. Kylin 1923 Description Kylin E: Studien ϋber das Hypertonie-Hyperglykämie – Hyperurika miesyndrome 1923

  7. 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

  8. 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.

  9. Metabolicsyndrome 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

  10. The Metabolic Syndrome (ATP III) & Criteria NCEP ATP III. JAMA. 2001;285:2486-2497.

  11. EGIR Definition of Metabolic Syndrome: 1999 • Insulin resistance + 2 or more of: • Central obesity (94 cm -M; 80 cm - F) • TG >2.9 mM OR HDL <1.0 • Hypertension (> 140/90) • FPG >6.1 mM

  12. The Metabolic Syndromein Australia; Different Prevalences for Different Criteria

  13. Prevalence of the Metabolic Syndromein Australian Adults (>25 years): AusDiab

  14. Metabolic Syndrome prevalence:3 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

  15. RESULT Confusion!!!

  16. “Consensus Means That A Lot Of People Say Collectively What No One Believes Individually”. Abba Eban

  17. Central obesity: a driving force for cardiovascular disease & diabetes “Balzac” by Rodin Front Back

  18. 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

  19. International Diabetes Federation (IDF) Consensus Definition 2005 The new IDF definition focusses on abdominal obesity rather than insulin resistance

  20. International Diabetes Federation (IDF) Consensus Definition 2005

  21. OGTT 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

  22. Stop smoking Oral hypoglycaemics ACEI &/or A2 receptor blockers Diet, Exercise, Lifestyle change Aspirin Insulin CB1 Receptor Blocker Statins & Fibrates Antihypertensives Treatment of Metabolic Syndrome: 2005

  23. 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.

  24. 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

  25. 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

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