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diagnostic purposes, it is not clear that it has much predictive capacity, thus limiting its clinical utility. Most consider metabolic syndrome to be a prediabetic state, as the various components of the condition are invariably associated with some degree of insulin resistance. However, there are relatively little to no definitive data on the conversion rate of individuals with metabolic syndrome to frank diabetes. Also, although the ATP III guidelines provide a useful working definition, it is clear that the five diagnostic criteria are not independent. For example, low-serum HDL cholesterol and high-serum triglycerides tend to track together in individuals. This makes the current scoring mechanism (i.e., the need to have three of the five diagnostic criteria) seem somewhat artificial and negatively impacts its predictive utility.
Thus, there is room for further refining the clinical definition of metabolic syndrome. One potential improvement would be to provide differential weighting of the individual diagnostic conditions by providing a scoring system that incorporates the relative predictive capacity for future events or conversion to diabetes of the various components. Another would be to refine the predictive capacity through inclusion of additional diagnostic criteria, such as elevated high-sensitivity C-reac-tive protein (hsCRP), or, as we argue further on, through an assessment of cardiorespiratory fitness.
There are other, less obvious issues with the current definition. The ATP III and WHO (Tables 4.1 and 4.2) include elevated blood pressure as part of the diagnostic criteria. Although most would agree that elevated waist circumference, fasting serum glucose, low-serum HDL cholesterol, and high-serum triglycerides tend to all be a
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