Metabolic Syndrome: Redefine and Expand Its Reach, Yet Preserve Its Clinical Value

To evaluate the rationale for preserving metabolic syndrome (MetS) amid proposals to subsume it within the cardiovascular-kidney-metabolic (CKM) framework, and to propose an updated definition reflecting its broader systemic relevance. Narrative review of published literature on MetS pathophysiology, epidemiology, diagnostic criteria, and multisystem complications. Key domains include gut microbiota-host interactions, tissue insulin resistance, adiposopathy, and organ-specific complications spanning neurological, hepatic, renal, pulmonary, reproductive, osteoarticular, cutaneous, and oncological systems. MetS affects 25% to 31% of the global adult population. Its pathophysiology initiates before clinically detectable visceral adiposity, driven by gut dysbiosis, metaflammation, and early multi-organ insulin resistance. The CKM framework, while valuable for cardiorenal specialist management, does not encompass this full spectrum. Subsuming MetS within CKM risks obscuring its preventive signal in primary care and under-recognising associations with neurodegeneration, cancer, and metabolic liver disease. Updated criteria, revised blood pressure thresholds, ethnicity-adjusted anthropometric indices, and emerging inflammatory biomarkers, are proposed. The pathophysiology of MetS starts before the increase in visceral adipose tissue, and the essence of the syndrome is not its name but its preventive power. Including MetS only as a core component of CKM could create confusion, hinder continuity with decades of research, and obscure the broader systemic relevance of metabolic dysfunction. Instead, the field should focus on updating the conceptual definition, emphasizing that MetS is not limited to predicting diabetes or cardiovascular disease, but rather represents a broad systemic risk framework that predisposes to nearly all chronic inflammatory and degenerative conditions of modern society.