Metabolic syndrome: the dysmetabolic state of dysfunctional adipose tissue and insulin resistance
Bibliographic record
Abstract
The current world epidemic of obesity represents a tremendous medical and public health challenge. A major consequence of obesity has been a rapid acceleration in the prevalence of type 2 diabetes;1 however, it is now recognized that even before the development of diabetes, many individuals have the constellation of athero-thrombotic inflammatory abnormalities characteristic of type 2 diabetes.2 Thus, the cluster of metabolic abnormalities is not the consequence of the hyperglycaemic state of type 2 diabetes but is rather pathophysiologically related to insulin resistance, the most prevalent form of insulin resistance being present in individuals with excess visceral as well as ectopic fat.3 Thus, even in the absence of hyperglycaemia, abdominally obese patients with an excess of visceral and ectopic fat deposition are likely to have the clustering of risk factors associated with insulin resistance. In this regard, the pivotal role of insulin resistance in the pathophysiology of the cluster of risk factors was first reported by Reaven4 and designated syndrome X. Since his seminal paper, numerous groups have utilized the term insulin resistance syndrome in the description of this cluster of athero-thrombotic inflammatory abnormalities.5,6 In 2001, the guidelines developed by the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) committee considered abdominal obesity as central in the pathophysiological development of the insulin resistance syndrome.7 Since the measurement of insulin resistance was not practical in the context of primary care clinical practice, the guidelines provided clinicians with simple diagnostic criteria, including waist circumference, triglycerides, high-density lipoprotein (HDL) cholesterol, blood glucose, and blood pressure to identify patients with the cluster of risk factors, resulting in an increased risk of diabetes and cardiovascular disease (CVD). The cluster of athero-thrombotic inflammatory risk factors was designated as the metabolic syndrome. Many groups have confused the NCEP-ATP III five criteria to diagnose the metabolic syndrome in the context of clinical practice with the conceptual definition of the syndrome. The definition of the metabolic syndrome has a pathophysiological basis3,8 and places insulin resistance and abdominal obesity at the core of the cluster of abnormalities. The NCEP-ATP III five criteria should not be considered as the definition of the metabolic syndrome but rather as simple screening tools. Refining the discriminating capabilities of these tools is work in progress. For instance, the International Diabetes Federation (IDF)9 has placed more emphasis than NCEP-ATP III on the importance of abdominal obesity and recognized the important ethnic differences in susceptibility to visceral adiposity and related metabolic abnormalities.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".