Here are various official criteria for the diagnosis of metabolic syndrome/insulin resistance from around the globe:

WHO criteria (1988)

Metabolic syndrome is defined as:

• Type 2 DM (i.e., fasting plasma glucose greater than or equal to 126 mg/dL [greater than or equal to 7 mmol/L], or 2-hour postglucose load [oral glucose tolerance test] greater than or equal to 200 mg/dL [greater than or equal to 11.1 mmol/L]), or
• Impaired fasting glucose (i.e., >100 mg/dL [greater than or equal to 5.6 mmol/L]) or
• Impaired glucose tolerance (i.e., glucose <200 mg/dL [<11.1 mmol/L] and >140 mg/dL [greater than or equal to 7.7 mmol/L] after oral glucose tolerance test) or
• For those with normal fasting glucose levels, glucose uptake below the lowest quartile for the background population under hyperinsulinaemic and euglycaemic conditions is used.

Plus 2 of the following:

• Abdominal obesity (waist-to-hip ratio >0.9 in men or >0.85 in women, or BMI >30 kg/m^2)
• Triglycerides 150 mg/dL (1.7 mmol/L) or greater, and/or HDL-cholesterol <40 mg/dL (<1.04 mmol/L) in men and <50 mg/dL (<1.29 mmol/L) in women
• BP 140/90 mmHg or greater
• Microalbuminuria (urinary albumin secretion rate 20 micrograms/minute or greater, or albumin-to-creatinine ratio 30 mg/g or greater).

European Group for the Study of Insulin Resistance criteria (1999)

Plasma insulin above the 75th percentile of non-diabetic patients plus 2 of the following lead to a diagnosis of metabolic syndrome:

• Waist circumference 94 cm (37 inches) or greater in men, 80 cm (31 inches) or greater in women
• Triglycerides 150 mg/dL (1.7 mmol/L) or greater and/or HDL-cholesterol <39 mg/dL (<1.01 mmol/L) in men or women
• BP 140/90 mmHg or greater or taking antihypertensive drugs
• Fasting glucose 110 mg/dL (6.1 mmol/L) or greater.

National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATPIII) criteria (2001)

Any 3 of the following lead to a diagnosis of metabolic syndrome:

• Waist circumference >102 cm (40 inches) in men, >88 cm (35 inches) in women
• Triglycerides 150 mg/dL (1.7 mmol/L) or greater
• HDL-cholesterol <40 mg/dL (<1.04 mmol/L) in men and <50 mg/dL (<1.29 mmol/L) in women
• BP 130/85 mmHg or greater
• Fasting glucose 110 mg/dL (6.1 mmol/L) or greater.

American Association of Clinical Endocrinology criteria (2003)

Impaired glucose tolerance or impaired fasting glucose plus any of the following based on clinical judgement lead to a diagnosis of metabolic syndrome:

• BMI 25 kg/m^2 or greater
• Triglycerides 150 mg/dL (1.7 mmol/L) or greater and/or HDL-cholesterol <40 mg/dL (<1.04 mmol/L) in men and <50 mg/dL (<1.29 mmol/L) in women
• BP 130/85 mmHg or greater.

International Diabetes Federation (IDF) criteria (2005)

Central obesity (defined as waist circumference but can be assumed if BMI >30 kg/m^2) with ethnicity-specific values* plus 2 of the following lead to a diagnosis of metabolic syndrome:

• Triglycerides 150 mg/dL (1.7 mmol/L) or greater
• HDL-cholesterol <40 mg/dL (<1.04 mmol/L) in men and <50 mg/dL (<1.29 mmol/L) in women
• BP 130/85 mmHg or greater
• Fasting glucose 100 mg/dL (5.6 mmol/L) or greater.

*To meet the criteria, waist circumference must be: for Europeans, >94 cm (>37 inches) in men and >80 cm (>31 inches) in women; and for South Asians, Chinese, and Japanese, >90 cm (>35 inches) in men and >80 cm (>31 inches) in women. For ethnic South and Central Americans, South Asian data are used, and for sub-Saharan Africans and Eastern Mediterranean and Middle East (Arab) populations, European data are used. [60]

American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) criteria (2005)

Any 3 of the following lead to a diagnosis of metabolic syndrome:

• Waist circumference 102 cm (40 inches) or greater in men, 88 cm (35 inches) or greater in women
• Triglycerides 150 mg/dL (1.7 mmol/L) or greater
• HDL-cholesterol <40 mg/dL (<1.04 mmol/L) in men and <50 mg/dL (<1.29 mmol/L) in women
• BP 130/85 mmHg or greater
• Fasting glucose 100 mg/dL (5.6 mmol/L) or greater.

Consensus definition (incorporating IDF and AHA/NHLBI definitions) [61]

Any 3 of the following lead to a diagnosis of metabolic syndrome:

• Elevated waist circumference (population- and country-specific definitions)
• Triglycerides 1.7 mmol/L (150 mg/dL) or greater
• HDL-cholesterol <1.04 mmol/L (<40 mg/dL) in men and <1.29 mmol/L (<50 mg/dL) in women
• BP 130/85 mmHg or greater
• Fasting glucose 5.6 mmol/L (100 mg/dL) or greater.

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