ABSTRACT

The physiological construct that is most widely known today as metabolic syndrome (MetS) was born in clinical practice almost a century ago when a Swedish physician recognized that hypertension, hyperglycemia, and gout commonly occurred together.1 Several years later, a French physician named Jean Vague recorded the keen observation that cardiovascular and metabolic dysfunctions were associated with an accumulation of upper body fat.2,3 Dr. Vague is credited with introducing the terms android and gynoid phenotypes to describe upper and lower body fat distribution and to document the greater health risk that appeared with the android pattern. The relationships between obesity, android adiposity, and the presence of hyperinsulinemia, hypertension, and elevated triglycerides gained greater recognition with the modernization of assays to reliably measure insulin, lipids, and other blood constituents.4-7 Prospective clinical studies, conducted just as obesity rates began to climb in the 1980s, con­rmed the greater health risks of abdominal fat that were ­rst observed by Vague. The waist circumference measurement was recognized to be a strong correlate of abdominal fat, and the waist-to-hip ratio was introduced as

Origins of the Metabolic Syndrome ....................................................................... 311 Elusive De­nition of Metabolic Syndrome ........................................................... 313 Describing the Metabolic Syndrome in the United States of America .................. 318 Controversies of MetS in Science and Medicine ................................................... 319 Predicting Cardiometabolic Risk from MetS ......................................................... 321 Obesity and the Etiology of Insulin Resistance and MetS ..................................... 322 Screening and Evaluation for MetS ....................................................................... 325 Treatment and Management of MetS ..................................................................... 326

Lifestyle Behaviors: Healthy Diet, Physical Activity, and Weight Loss ........... 326 Dyslipidemia ..................................................................................................... 328 Blood Pressure .................................................................................................. 329 Blood Glucose Management ............................................................................. 330 Atherothrombosis and In°ammation ................................................................. 330

Summary ................................................................................................................ 331 References .............................................................................................................. 332

a surrogate marker of body fat phenotypes.8-14 Evidence to support the theory that insulin resistance15,16 and hyperinsulinemia17,18 were metabolic conditions linking obesity, hypertension, and type 2 diabetes was accumulating.