Changing diagnostic criteria and their impact on metabolic syndrome: a systematic review
5 affiliations
- 1Human Nutrition and Dietetics, Department of Nutrition and Food Technology, The University of Jordan
- 2Department of Therapeutic Nutrition and Dietetics, College of Applied Medical Sciences, Amman Arab University
- 3Department of Diet Therapy Technology and Dietetics, Faculty of Allied Medical Sciences, Zarqa University
- 4Human Nutrition and Dietetics, College of Health Sciences, Abu-Dhabi Universityi
- 5Head of Preparatory Year Program, Batterjee Medical College
Abstract
Introduction: The prevalence of metabolic syndrome (MetS) is difficult to define because there is no universal consensus on the definition of MetS and similarities and differences in definitions of the components and the architecture of the definitions can significantly affect the prevalence and individual classification. The aim of this systematic review was to assess the impact of alternative definitions of MetS on prevalence, diagnostic agreement, reclassification, metabolic components and ethnicity-specific classification.
Methods: A systematic review was carried out following the PRISMA 2020 guidelines. Studies met inclusion criteria if they included a comparison of 2 or more MetS diagnostic definitions in the same adult population. Information was gathered about study characteristics, diagnostic frameworks, thresholds for the components of MetS, prevalence of MetS, agreement between the two diagnostic methods, reclassification, and regional or ethnic specific criteria. A descriptive synthesis of finding was completed because of the significant degree of population and diagnostic heterogeneity.
Results: Nine studies were included in the evidence synthesis. The prevalence of MetS was highly heterogeneous when the same population was assessed using different diagnostic criteria. The prevalence rates in Finnish adults ranged from 17.7% (WHO criteria) to 43.0% (JIS criteria), and the prevalence rates in the nationwide Iranian study ranged from 32.0% (IDF criteria) to 47.6% (JIS criteria). There was high diagnostic concordance between structurally similar definitions such as between IDF versus JIS in Finland (κ = 0.97) while lower levels of concordance were found between comparisons using WHO criteria. The most frequently reported factors associated with diagnostic discordance were central obesity and waist circumference. In addition, there were significant variations in prevalence of MetS depending on the region-specific adjustment of waist-circumference thresholds. Furthermore, the prevalence of MetS varied significantly by region-specific adjustment of waist circumference thresholds.
Discussion: The prevalence of MetS from one diagnostic framework to another may not be directly comparable since it is highly definition-dependent. Waist thresholds may vary by ethnicity and this can be a significant factor in classification. Further research should include precise diagnostic criteria and thresholds, cross-classification data and validation of alternative definitions with clinically relevant outcomes.
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BibTeX
@article{obeidat2026changing,
title = {{Changing diagnostic criteria and their impact on metabolic syndrome: a systematic review}},
author = {Ahmad A. Obeidat and Dalia M. Abu Al-Haijaa and Razan J. Rahahleh and Mousa N. Ahmad and Sarah Jaradat and Najla Al Nassar and Nermin A. Khamis and Firas S. Azzeh},
journal = {Frontiers in Endocrinology},
year = {2026},
month = oct,
doi = {10.3389/fendo.2026.1976380},
url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1976380/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Changing diagnostic criteria and their impact on metabolic syndrome: a systematic review
AU - Ahmad A. Obeidat
AU - Dalia M. Abu Al-Haijaa
AU - Razan J. Rahahleh
AU - Mousa N. Ahmad
AU - Sarah Jaradat
AU - Najla Al Nassar
AU - Nermin A. Khamis
AU - Firas S. Azzeh
PY - 2026
DA - 2026/10/20
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.1976380
UR - https://www.frontiersin.org/articles/10.3389/fendo.2026.1976380/full
AB - Introduction: The prevalence of metabolic syndrome (MetS) is difficult to define because there is no universal consensus on the definition of MetS and similarities and differences in definitions of the components and the architecture of the definitions can significantly affect the prevalence and individual classification. The aim of this systematic review was to assess the impact of alternative definitions of MetS on prevalence, diagnostic agreement, reclassification, metabolic components and ethnicity-specific classification. Methods: A systematic review was carried out following the PRISMA 2020 guidelines. Studies met inclusion criteria if they included a comparison of 2 or more MetS diagnostic definitions in the same adult population. Information was gathered about study characteristics, diagnostic frameworks, thresholds for the components of MetS, prevalence of MetS, agreement between the two diagnostic methods, reclassification, and regional or ethnic specific criteria. A descriptive synthesis of finding was completed because of the significant degree of population and diagnostic heterogeneity. Results: Nine studies were included in the evidence synthesis. The prevalence of MetS was highly heterogeneous when the same population was assessed using different diagnostic criteria. The prevalence rates in Finnish adults ranged from 17.7% (WHO criteria) to 43.0% (JIS criteria), and the prevalence rates in the nationwide Iranian study ranged from 32.0% (IDF criteria) to 47.6% (JIS criteria). There was high diagnostic concordance between structurally similar definitions such as between IDF versus JIS in Finland (κ = 0.97) while lower levels of concordance were found between comparisons using WHO criteria. The most frequently reported factors associated with diagnostic discordance were central obesity and waist circumference. In addition, there were significant variations in prevalence of MetS depending on the region-specific adjustment of waist-circumference thresholds. Furthermore, the prevalence of MetS varied significantly by region-specific adjustment of waist circumference thresholds. Discussion: The prevalence of MetS from one diagnostic framework to another may not be directly comparable since it is highly definition-dependent. Waist thresholds may vary by ethnicity and this can be a significant factor in classification. Further research should include precise diagnostic criteria and thresholds, cross-classification data and validation of alternative definitions with clinically relevant outcomes.
SN - 1664-2392
ER -