Definition of the metabolic syndrome

Criteria used for defining MetS and cutoff points for their components, including the WHO [29], IDF (International Diabetes Federation) [30], ATP III (Adult Treatment Panel III) [31], and JIS (Joint Interim Statement) [32], are summarized in Table ​Table1.1. The report of the Iranian National Committee of Obesity recommended that WC criteria follow the appropriate country- and population-specific cutoff points; thus, abdominal obesity for the IDF and JIS definitions was defined as having a WC of ≥ 95 cm for both men and women [33, 34]. However, in the present analysis, we used ATP III criteria with the original WC cutoffs (> 102 cm for men and > 88 cm for women) [31]. As recommended by the European Group for the Study of Insulin Resistance (EGIR) [35], microalbuminuria from the WHO definition was excluded for the usage in the epidemiological studies [36]. Therefore, a modified version of the WHO criteria was used in the present study than the proposed version [29]; accordingly, measuring urine albumin excretion and serum insulin was disregarded.

Metabolic syndrome defined by the modified WHO, IDF, ATP III, and JIS diagnostic criteria

FPG ≥ 100 mg/dl

(5.6 mmol/l) or drug treatment

FPG ≥ 110 mg/dl (6.1

mmol/l)

FPG ≥ 100 mg/dl

(5.6 mmol/l) or drug treatment

TG ≥ 150 mg/dl (1.7 mmol/l)

or

M: HDL-C < 35 mg/dl

(0.9 mmol/l)

F: HDL-C < 39 mg/dl

(1.0 mmol/l)

TG ≥ 150 mg/dl (1.7 mmol/l)

or drug treatment

TG ≥ 150 mg/dl

(1.7 mmol/l)

M: HDL-C < 40 mg/dl

(1.03 mmol/l)

F: HDL-C < 50 mg/dl

(1.29 mmol/l)

or drug treatment

M: HDL-C < 40 mg/dl

(1.03 mmol/l)

F: HDL-C < 50 mg/dl

(1.29 mmol/l)

M: HDL-C < 40 mg/dl

(1.03 mmol/l)

F: HDL-C < 50 mg/dl

(1.29 mmol/l)

or drug treatment

BMI > 30 kg/m²

or

M: WHR > 0.90

F: WHR > 0.85

M: WC > 102 cm

F: WC > 88 cm

JIS Joint Interim Statement, IDF International Diabetes Federation, ATP III Adult Treatment Panel III, WHO World Health Organization, FPG fasting plasma glucose, DM diabetes mellitus, IGT impaired glucose tolerance, 2 h-PG 2-h post-challenge glucose, WHR waist to hip ratio, WC waist circumference, BMI body mass index, TG triglycerides, HDL-C high-density lipoprotein cholesterol, BP blood pressure, M male, F female