Metabolic syndrome in sub-Saharan Africa.

Metabolic syndrome is a cluster of metabolically related cardiovascular disease (CVD) risk factors that increases the risk of CVD by 2-fold and the risk of developing type 2 diabetes mellitus by 3-fold. The underlying pathophysiology is thought to be related to abdominal obesity and insulin resistance. Other associated pathophysiologic conditions are physical inactivity, aging, and polycystic ovarian syndrome. The cluster includes various combinations of obesity (total body obesity measured by body mass index, or central obesity measured by waist-tohip ratio or waist circumference), atherogenic dyslipidemia (increased triglycerides, decreased high-density lipoprotein cholesterol), elevated blood pressure (systolic and diastolic), abnormal glucose tolerance (fasting blood glucose, 2hour postprandial blood glucose), and insulin resistance measured by the homeostasis model assessment (HOMAIR) or fasting insulin. There have been several definitions using different criteria, including those of the World Health Organization (WHO) (1998, 1999), European Group for the Study of Insulin Resistance (1999), American Association of Clinical Endocrinology (2000), National Cholesterol Education Program Adult Treatment Panel III (ATP III) (2001, 2004). In 2005, the International Diabetes Federation (IDF) proposed a further definition for metabolic syndrome for use in epidemiology studies and clinical practice, which would allow for comparison between different population groups and the assessment of its relationship with various health outcomes. A prerequisite in the IDF definition of the metabolic syndrome is central obesity measured by ethnicity-specific waist circumference and it is recommended that European cutpoints be used for populations for which such data are not available, eg, in subSaharan Africans.