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ObesityandMetabolicSyndromeObesityandMetabolicSyndromeStevenM.Haffner,MDConceptualFrameworkfortheMetabolicConceptualFrameworkfortheMetabolicSyndromeSyndromeEnvironmentalcausesareresponsiblefortheepidemicofthemetabolicsyndrome(NCEP)–Treatment:reduceobesityandincreaseactivityInsulinresistanceistheunderlyingcauseofthemetabolicsyndrome(WHO)–Treatment:a)reduceobesityandincreaseactivityb)insulinsensitizersInflammationistheunderlyingcauseofthemetabolicsyndrome–Treatment:a)reduceobesityandincreaseactivityb)insulinsensitizersc)statins,ACEInhibitors,ARBsMetabolicSyndromeIncreasesRiskforMetabolicSyndromeIncreasesRiskforCHDandType2DiabetesCHDandType2DiabetesExpertPanelonDetection,Evaluation,andTreatmentofHighBloodCholesterolinAdults.JAMA2001;285:2486-2497.CoronaryHeartDiseaseCoronaryHeartDiseaseType2Type2DiabetesDiabetesHighHighLDL-CLDL-CMetabolicMetabolicSyndromeSyndromeTheMetabolicSyndrome:TheMetabolicSyndrome:HistoricalPerspectiveHistoricalPerspectiveReavenG.Diabetes.1988;37:1565-1607.InsulinInsulinResistanceResistanceInsulinInsulinResistanceResistanceGlucoseGlucoseIntoleranceIntoleranceGlucoseGlucoseIntoleranceIntoleranceHyperinsulinemiaHyperinsulinemiaHyperinsulinemiaHyperinsulinemiaTGTGTGTGHDL-CHDL-CHypertensionHypertension1988:SyndromeX1988:SyndromeXCORONARYHEARTDISEASECORONARYHEARTDISEASECORONARYHEARTDISEASECORONARYHEARTDISEASETheMetabolicSyndrome:TheMetabolicSyndrome:CurrentPerspectiveCurrentPerspectiveAdaptedfromReavenG.Drugs.1999;58(suppl):19-20BodySizeBodySizeBMIBMICentralAdiposityCentralAdiposityBodySizeBodySizeBMIBMICentralAdiposityCentralAdiposityGlucoseGlucoseMetabolismMetabolismGlucoseGlucoseMetabolismMetabolismUricAcidUricAcidMetabolismMetabolismUricAcidUricAcidMetabolismMetabolismDyslipidemiaDyslipidemiaDyslipidemiaDyslipidemiaHemodynamicHemodynamicNovelRiskFactorsNovelRiskFactorsCORONARYHEARTDISEASECORONARYHEARTDISEASECORONARYHEARTDISEASECORONARYHEARTDISEASEInsulinResistanceInsulinResistanceInsulinResistanceInsulinResistanceHyperinsulinemiaHyperinsulinemiaHyperinsulinemiaHyperinsulinemia++TGTGPPlipemiaPPlipemiaHDL-CHDL-CPHLAPHLASmall,denseLDLSmall,denseLDL±±GlucoseGlucoseintoleranceintoleranceUricacidUricacidUrinaryUrinaryuricuricacidclearanceacidclearanceSNSactivitySNSactivityNaretentionNaretentionHypertensionHypertensionCRPCRPPAI-1PAI-1FibrinogenFibrinogenATPIII:TheMetabolicSyndrome*ATPIII:TheMetabolicSyndrome**Diagnosisisestablishedwhen*Diagnosisisestablishedwhen>>3oftheseriskfactorsarepresent3oftheseriskfactorsarepresent*TheExpertPanelonDetection,Evaluation,andTreatmentofHighBloodCholesterolinAdults.JAMA.2001;285:2486-2497.**TheExpertCommitteeontheDiagnosisandClassificationofDiabetesMellitus:Follow-upreportonthediagnosisofdiabetesmellitus.DiabetesCare26:3160-3167,2003RiskFactorDefiningLevelAbdominalobesity†(Waistcircumference‡)Men>102cm(>40in)Women>88cm(>35in)TG>150mg/dLHDL-CMen<40mg/dLWomen<50mg/dLBloodPressure>130/>85mmHgFastingglucose>110(>100)**mg/dL**2003NewADAIFGcriteria(ExpertPanel…,DiabetesCare26:3160-3167,2003)WHOMetabolicSyndromeDefinition1999:WHOMetabolicSyndromeDefinition1999:BasedonClinicalCriteriaBasedonClinicalCriteriaInsulinresistance(type2diabetes,IFG,IGT)*Plusany2ofthefollowing:–ElevatedBP(>140/90ordrugRx)–PlasmaTG>150mg/d...