The metabolic syndrome: overeating, inactivity, poor compliance or 'dud' advice?

Death from myocardial infarction was a rare clinical entity at the beginning of this century, but with an ageing population it is poised to become the most common cause of death worldwide. Ample epidemiological evidence confirms the clinical impression that cardiovascular risk factors--hypertension, glucose intolerance, dyslipidaemia, obesity--tend to 'cluster' in individual patients. This metabolic syndrome, or 'Syndrome X', which is thought to be underpinned by decreased insulin sensitivity, was first described in 1966 by Camus and popularized by Reaven in 1988. The enthusiasm and interest generated have led to the elucidation of some details concerning the pathogenesis of insulin resistance and coronary artery disease but have done little to change treatments or outcomes. Meanwhile, a global epidemic of Type 2 diabetes mellitus is said to be on the horizon- and it has been calculated that by the year 2230, 100% of the adult United States population will be obese.