The metabolic syndrome in Japan

Abstract

Since its conception, the metabolic syndrome has received worldwide recognition as a useful clinical aid for predicting cardiovascular risk. The earliest definition, which included risk factors such as insulin resistance, hyperglycemia, hypertension, and cholesterol, has undergone many transformations. Two revisions have focused on visceral adiposity as an essential component of the syndrome, particularly in Asian populations. The Japanese national guidelines have also suggested that abnormalities in adipose tissue metabolism are an underlying molecular cause of the syndrome. In addition, emerging evidence suggests that lowering the threshold of waist circumference in Asian populations increases the prevalence of the metabolic syndrome. Inevitably, this widening of the threshold will capture more patients at risk of cardiovascular events. The aim of this Article is to consider the country-specific impact of the metabolic syndrome, using the evolution of the definition in Japan as a model.

Key Points

• The metabolic syndrome has been acknowledged in Japan as a major public-health concern and is being addressed at a national level by the development of country-specific guidelines

• As well as the traditional risk factors of dyslipidemia, raised blood pressure, and raised fasting plasma glucose, the Japanese guidelines also include waist circumference

• Although adiposity was included in early definitions of the metabolic syndrome, the syndrome's prevalence remained low in Asian populations until obesity cut-off values were altered according to ethnicity

• The inclusion of visceral adiposity suggests that abnormalities in adipose tissue present a potential molecular basis for the metabolic syndrome