Version July 2025
| Parameters | NCEP ATP III 2005* | IDF 2009 | EGIR 1999 | WHO 1999 | AACE 2003 |
| Required | Insulin resistance or fasting hyperinsulinemia (ie, in top 25% of the laboratory-specific reference range) | Insulin resistance in top 25%¶; fasting glucose ≥6.1 mmol/L (110 mg/dL); 2-hour glucose ≥7.8 mmol/L (140 mg/dL) | High risk of insulin resistanceΔ or BMI ≥25 kg/m2 or waist ≥102 cm (men) or ≥88 cm (women) | ||
| Number of abnormalities | ≥3 of: | ≥3 of: | And ≥2 of: | And ≥2 of: | And ≥2 of: |
| Glucose | Fasting glucose ≥5.6 mmol/L (100 mg/dL) or drug treatment for elevated blood glucose | Fasting glucose ≥5.6 mmol/L (100 mg/dL) or diagnosed diabetes | Fasting glucose 6.1 to 6.9 mmol/L (110 to 125 mg/dL) | Fasting glucose ≥6.1 mmol/L (110 mg/dL); ≥2-hour glucose 7.8 mmol/L (140 mg/dL) | |
| HDL cholesterol | <1.0 mmol/L (40 mg/dL; men); <1.3 mmol/L (50 mg/dL; women) or drug treatment for low HDL cholesterol◊ | <1.0 mmol/L (40 mg/dL; men); <1.3 mmol/L (50 mg/dL; women) or drug treatment for low HDL cholesterol | <1.0 mmol/L (40 mg/dL) | <0.9 mmol/L (35 mg/dL; men); <1.0 mmol/L (40 mg/dL; women) | <1.0 mmol/L (40 mg/dL; men); <1.3 mmol/L (50 mg/dL; women) |
| Triglycerides | ≥1.7 mmol/L (150 mg/dL) or drug treatment for elevated triglycerides◊ | ≥1.7 mmol/L (150 mg/dL) or drug treatment for high triglycerides | or ≥2.0 mmol/L (180 mg/dL) or drug treatment for dyslipidemia | or ≥1.7 mmol/L (150 mg/dL) | ≥1.7 mmol/L (150 mg/dL) |
| Obesity | Waist ≥102 cm (men) or ≥88 cm (women)§ | Waist ≥94 cm (men) or ≥80 cm (women)¥ | Waist ≥94 cm (men) or ≥80 cm (women) | Waist/hip ratio >0.9 (men) or >0.85 (women) or BMI ≥30 kg/m2 | |
| Hypertension | ≥130/85 mmHg or drug treatment for hypertension | ≥130/85 mmHg or drug treatment for hypertension | ≥140/90 mmHg or drug treatment for hypertension | ≥140/90 mmHg | ≥130/85 mmHg |
AACE: American Association of Clinical Endocrinology; BMI: body mass index; CVD: cardiovascular disease; EGIR: European Group for the Study of Insulin Resistance; HDL: high-density lipoprotein; IDF: International Diabetes Federation; NCEP ATP III: National Cholesterol Education Program Adult Treatment Panel III; WHO: World Health Organization.
* Most commonly agreed upon criteria for metabolic syndrome. Note that abdominal obesity is not a prerequisite for diagnosis; the presence of any 3 of the 5 risk criteria constitutes a diagnosis of metabolic syndrome.
¶ Insulin resistance measured using insulin clamp.
Δ High risk of being insulin resistant is indicated by the presence of at least 1 of the following: diagnosis of CVD, hypertension, polycystic ovary syndrome, metabolic dysfunction-associated steatotic liver disease, or acanthosis nigricans; family history of type 2 diabetes, hypertension, or CVD; history of gestational diabetes or glucose intolerance; non-White race; sedentary lifestyle; BMI 25 kg/m2 or waist circumference 94 cm (men) or 80 cm (women); and age 40 years.
◊ Treatment with 1 or more of fibrates or niacin.
§ In Asian patients, waist ≥90 cm (men) or ≥80 cm (women).
¥ For South Asian and Chinese patients, waist ≥90 cm (men) or ≥80 cm (women); for Japanese patients, waist ≥90 cm (men) or ≥80 cm (women).