The size of the waistline is the key
to selecting patients to investigate.
People who are genetically predisposed
and who take in an excessive
amount of calories are most
likely to develop this condition.
The lean man with a pot belly, a
shape seen commonly in general
practice, could be considered the
most toxic shape of all.
Objective assessment of known
risk factors (cholesterol, fasting
lipids, blood glucose level, blood
pressure, smoking, obesity and
sedentariness) is also necessary.
Risk factors for metabolic syndrome
often cluster together and have
a multiplicative rather than an additive
effect. In women, it is the level
of fasting triglycerides, rather than
cholesterol, that predicts subsequent
cardiovascular disease and death.
Waist target parameters have
tightened over time and vary according
to genetic polymorphism (see
table below).
If BMI is >30kg/m2, central
obesity can be assumed and waist
circumference does not need to be
measured. Abnormal blood glucose
should be investigated with a
glucose tolerance test.
About a third of patients with diabetes
will be picked up by the
glucose tolerance test compared with
just focusing on the fasting glucose.
Obesity and central adiposity
seem to co-segregate, not only with
cardiovascular and diabetes risk, but
also with an increased risk of certain
types of malignancy, such as breast
and endometrial cancer.
