الفهرس 
INTRODUCTION
The Metabolic syndromeOnly 14 pages are availabe for public view
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Abstract
The metabolic syndrome is a complex of interrelated risk factors for atherosclerotic cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). These factors include dysglycemia, raised blood pressure, elevated triglyceride levels, low high-density lipoprotein cholesterol levels, and obesity (particularly central adiposity). Over the last two decades, there has been a continuous dispute over which measure of overweight or obesity is best able to identify individuals being at increased cardiovascular risk. Although body mass index (BMI) is the gold standard method used by the WHO to define severity of overweight and obesity, it has been increasingly replaced by the measures of central adiposity; waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) as more accurate predictors of obesity-related cardiovascular risk and as a diagnostic criterion of metabolic syndrome.
Compared with BMI, anthropometric measures of abdominal obesity e.g. WC, WHR, and WHtR appear to be more strongly associated with metabolic risk factors, incident CVD events, and death. The cardio-metabolic risk associ¬ated with abdominal obesity is mainly due to the presence of visceral adipose tissue, which promotes insulin resist¬ance, hypertension, dyslipidemia, prothrombotic state, dysregulated adipokine secretion or function, and a proinflammatory state. WC, WHR, and WHtR correlate with visceral adipose tissue; however, WC is more strongly associated.
Many large epidemiologic studies revealed the outstanding importance of WC in predicting cardiometabolic risk fac¬tors such as elevated blood pressure, dyslipidemia, and hyperglycemia; in addition to prediction of the adverse outcomes themselves e.g. DM, CVD, and mortality. The relative risk of developing DM between subjects in the highest and lowest categories of reported WC often exceeds 10 and that of developing coronary heart disease (CHD) ranges from 1.5- 2.5.
One of the most important practical tools to heighten awareness about obesity related adverse outcomes and to help setup preventive strategies, is the determination of WC cutoff point to distinguish individuals at increased risk for developing cardiovascular disease or diabetes. However, the relations between WC and metabolic risk factors or health outcomes are affected by demographic variables, most importantly race-ethnicity, sex, and age.
The International Diabetes Federation (IDF), in 2005, highlighted that the cutoff level used for WC to define central obesity and metabolic syndrome should be different among different ethnic groups and suggested also that European cut-off points would be used for Middle East countries until more specific data are available from this region. However, these cutoffs may not fit well for our Egyptian or Arab populations. There is few data available about the optimal cut-off values in the Middle East and Eastern Mediterranean Region.