Metabolic Syndrome TheNationalCholesterolEducationProgram(AdultTreatment Panel III) originally defined metabolic syndrome as the pres- ence of 3 of the following: (1) abdominal obesity as deter- mined by waist circumference >102 cm (>40 in) for men and >88 cm (>35 in) for women; (2) triglycerides 150 mg/dL; (3) HDL cholesterol <40 mg/dL for men and <50 mg/dL for women; (4) BP 130/ 85 mmHg; and (5) fasting glucose A modified criterion for fasting glucose was published in 2004.617 The International Diabetes Foundation (IDF) then modified the definition by requiring inclusion of a waist circumference >88 cm for men and >80 cm in women plus 2 of the other National Cholesterol Education Program Adult Treatment Panel III criteria.618 In 2009, a harmonized definition was proposed wherein an identical set of thresholds was used for all components except waist circumference, an area in which further evidence for the relationship to CVD events was felt to be required.619 In the interim, the Harmonized Definition Work Group suggested that national or regional cut points for waist circumference should be used. 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. 