title: WHO and ATPIII proposals for the definition of the metabolic syndrome in patients with Type 2 diabetes.
abstract: OBJECTIVE
  Different criteria have been proposed by the World Health Organization (WHO) and by the Third Report of the National Cholesterol Education Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATPIII) for the diagnosis of the metabolic syndrome. Its identification is of particular importance for coronary risk assessment.
  
  
  METHODS
  The prevalence of the metabolic syndrome was determined according to the two different proposals in 1569 consecutive subjects with Type 2 diabetes.
  
  
  RESULTS
  By the WHO proposal, 81% of cases (95% confidence interval, 79-83) were labelled as metabolic syndrome. Microalbuminuria had the highest specificity (99%) and visceral obesity the highest sensitivity (93%). Seventy-eight per cent of patients (95% CI, 76-80) fulfilled the ATPIII criteria for metabolic syndrome, low HDL-cholesterol having the highest specificity (95%), elevated blood pressure having the highest sensitivity. According to both proposals, 1113 patients were positive; 183 were concordantly negative, indicative of a fairly good agreement (k statistics, 0.464). Subjects only positive for the WHO proposal were more frequently males, had a lower BMI and a higher arterial pressure. Only subjects identified by the ATPIII proposal had a significantly higher prevalence of previously detected coronary heart disease.
  
  
  CONCLUSIONS
  Minimum criteria for the metabolic syndrome are met in most patients with Type 2 diabetes. Correct identification of the syndrome is important for an integrated approach to reduce the high costs and the associated disabilities. The ATPIII proposal more clearly identifies the burden of coronary heart disease associated with the metabolic syndrome.
authors.affiliation: Unit of Metabolic Diseases, Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy. marchreg@med.unibo.it
authors.forename: G
authors.initials: G
authors.lastname: Marchesini
authors.forename: G
authors.initials: G
authors.lastname: Forlani
authors.forename: F
authors.initials: F
authors.lastname: Cerrelli
authors.forename: R
authors.initials: R
authors.lastname: Manini
authors.forename: S
authors.initials: S
authors.lastname: Natale
authors.forename: L
authors.initials: L
authors.lastname: Baraldi
authors.forename: G
authors.initials: G
authors.lastname: Ermini
authors.forename: G
authors.initials: G
authors.lastname: Savorani
authors.forename: D
authors.initials: D
authors.lastname: Zocchi
authors.forename: N
authors.initials: N
authors.lastname: Melchionda
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000150:complications / Q000453:epidemiology; D001824:Body Constitution; D008076:Cholesterol, HDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D015995:Prevalence; D012680:Sensitivity and Specificity; D017678:Sex Distribution
chemical_list: D008076:Cholesterol, HDL