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Introduction<br />The metabolic syndrome - the clustering of<br />abdominal obesity, dyslipidemia, hyperglycemia and<br />hypertension - is a major public health challenge<br />worldwide.1,2 The metabolic syndrome is not benign;<br />it is associated with a substantially elevated risk of<br />type 2 diabetes (5-fold) and of cardiovascular disease<br />(CVD) (2-3-fold),1 and its increasing prevalence could<br />possibly reverse the gains made through recent<br />declining CVD mortality.<br />The metabolic syndrome is not a new condition. It<br />was first described in the 1920s by Kylin, a Swedish<br />physician, as the association of hypertension,<br />hyperglycemia and gout.3 In the 1940s, attention was<br />drawn to upper body adiposity (android or male-type<br />obesity) as the obesity phenotype commonly<br />associated with type 2 diabetes and CVD.4<br />This constellation of CVD risk factors has been given<br />a number of names, including "deadly quartet",<br />"syndrome X", and "insulin resistance syndrome",1<br />but "metabolic syndrome" is likely to hold sway for<br />the foreseeable future.<br />Just as the metabolic syndrome has borne a variety of<br />different names, numerous definitions have also<br />surfaced. The World Health Organization definition,5<br />and two others, developed by the European Group<br />for the Study of Insulin Resistance6 and the National<br />Cholesterol Education Program - Third Adult<br />Treatment Panel (ATP III),7 have been the main ones<br />in use. Each of these agreed on the core components<br />of obesity, hyperglycemia, dyslipidemia and<br />hypertension. However, the definitions differ in the<br />cut-points used for each component, and the way in<br />which the components are combined, leading to<br />considerable confusion.1 The confusion has been<br />particularly apparent in attempts to compare the<br />burden in different populations, where the use of<br />different definitions has seriously hampered the<br />ability to make comparisons between and within<br />communities.1,2