Thus, because the waist circumference and risk for CVD and diabetes melli- tus vary around the world, the National Cholesterol Education Program Adult Treatment Panel III, IDF, and harmonized def- initions all make a provision for an ethnic/racial/geographic modification of waist circumference.620 Obesity and sedentary lifestyle, in addition to other genetic or acquired factors, seem to interact to produce the metabolic syndrome.621 Screening for the syndrome requires no more than a routine physical examination and routine blood tests.622 Obesity, discussed separately, is an important component of the metabolic syndrome and is associated with major health risk factors (such as diabetes mellitus, hypertension, and dys- lipidemia), poor health status, and, when extreme, lower life The visceral adiposity characteristic of the metabolic syndrome is associated with insulin resistance, inflammation, diabetes mellitus, and other metabolic and Visceral adipocytes provoke insulin resistance by promoting extensive lipolysis and release of fatty acids into the splanchnic circulation. Leptin, plasmin- ogen activator inhibitor-1, tumor necrosis factor- , and other proinflammatory cytokines, in addition to reduced production and release of adiponectin by adipocytes, have all been impli- cated in this pathophysiological process.626 The metabolic syndrome is highly prevalent in the United Applying the harmonized definition of the meta- bolic syndrome to data from the National Health and Nutrition Examination (2003 through 2006) in up to 3461 participants 20 years of age with a waist circumference threshold of 102 cm for men and 88 cm for women, the age-adjusted prevalence of metabolic syndrome was 34.3% among all adults, 36.1% among men, and 32.4% among women.627 With the use of race- or ethnicity-specific IDF criteria for waist circumference, the age-adjusted prevalence was 38.5% for all participants, 41.9% for men, and 35.0% for women. Prevalence increased with age, with the highest prevalence in subjects between 60 to 69 years of age. 