The metabolic syndrome as a clinical problem.

Insulin resistance is a common metabolic problem characterized by an impaired physiological response to insulin. It is a key factor in the pathogenesis of type-2 diabetes and is present in more than 50% of patients with the condition [1]. Importantly, it may predate the development of hyperglycemia by several years. The clustering of insulin resistance and several other metabolic and vascular disorders is known as the metabolic syndrome or insulin resistance syndrome. Both insulin resistance and the metabolic syndrome are associated with an increased risk of cardiovascular disease. The characteristic features of the metabolic syndrome include upper body (central) obesity, hypertension, dyslipidemia, glucose intolerance and specific abnormalities of coagulation and endothelial function. In addition, it is frequently associated with fatty infiltration of the liver and the development of non-alcoholic steatohepatitis (NASH). The precise origins of the metabolic syndrome remain poorly understood. However, they are unquestionably related to increasing body fatness. Clinicians should be made familiar with the risks associated with insulin resistance and the metabolic syndrome just as they are aware of the established interventions that reduce the risk of heart disease. Early intervention that targets the metabolic syndrome will, if successful, prevent the progression to type-2 diabetes, diminish the risk of coronary heart disease and reduce the future burden to health care. Despite this, many clinicians continue to consider obesity to be self-inflicted and fail to recognize the metabolic syndrome and its medical significance and, as a consequence, do not seize the early opportunity to intervene. Allison SP, Go VLW (eds): Metabolic Issues of Clinical Nutrition. Nestlé Nutrition Workshop Series Clinical & Performance Program, vol 9, pp 77–92, Nestec Ltd., Vevey/S. Karger AG, Basel, © 2004.