Metabolic syndrome: why the controversy?

As originally conceived, the metabolic syndrome defined a clustering of cardiovascular disease risk factors with insulin resistance as the common, underlying pathophysiologic determinant. The definition of the syndrome has evolved since then, with several groups proposing somewhat differing definitions. Partly, this has been motivated by efforts to make the syndrome a clinically useful entity. However, recent articles have called the clinical use of the metabolic syndrome into question. In this review, some of these concerns and counterarguments for the continued use of the metabolic syndrome are reviewed.