An official and comprehensive analysis on the metabolic syndrome was recently published by Kahn et al. (1). Taking into consideration not only their own experience but also an impressive list of references, they express some critical ideas regarding the definition, the underlying pathophysiology, and the treatment of this condition. Although the demonstration of Kahn et al. seems very solid, we believe that their conclusions will produce many controversial reactions.
In our opinion, the problem of the metabolic syndrome will be significantly simplified if we renounce to consider it first as a cluster of specific cardiovascular risk factors. Otherwise, the debate becomes endless: why include only some cardiovascular risk factors and not include others?
The International Diabetes Federation marked an important progress in the pathophysiology and diagnosis of the metabolic syndrome, suggesting that the key element is central obesity (2). Unfortunately, in the report of Kahn et al., this very useful observation was minimized.
Generally speaking, all the components of the metabolic syndrome, from all the existing definitions, can be discovered in the picture of obesity. In particular, their concentration is higher in that special form of disease, named central or visceral obesity (3, 4). Therefore, we can postulate that obesity represents the background of the problem or “the roots of evil”; central obesity is a complex and aggressive form of disease with a huge potential for cardiovascular and metabolic disorders. The metabolic syndrome is, in fact, a complication of this type of obesity. Eventually, we can consider it as a central obesity syndrome. Such a term seems more adequate, both from medical and semantic points of view (5).
