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* Overweight and obesity are associated with insulin resistance and the metabolic syndrome. However, the
presence of abdominal obesity is more highly correlated with the metabolic risk factors than is an elevated
body mass index (BMI). Therefore, the simple measure of waist circumference is recommended to identify the
body weight component of the metabolic syndrome.
† Some male patients can develop multiple metabolic risk factors when the waist circumference is only
marginally increased, e.g., 94-102 cm (37-39 in). Such patients may have a strong genetic contribution to
insulin resistance. They should benefit from changes in life habits, similarly to men with categorical
increases in waist circumference.
The risk factors of the metabolic syndrome are highly concordant; in
aggregate they enhance risk for CHD at any given LDL cholesterol level.
For purposes of ATP III, the diagnosis of the metabolic syndrome is made
when three or more of the risk determinants shown in Table 8 are present.
These determinants include a combination of categorical and borderline risk
factors that can be readily measured in clinical practice.
Management of the metabolic syndrome has a two-fold objective: (1) to
reduce underlying causes (i.e., obesity and physical inactivity), and (2) to
treat associated nonlipid and lipid risk factors.
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