This is in response to Dr. Arthur Friedlander and colleagues’ February JADA article, "Metabolic Syndrome: Pathogenesis, Medical Care, and Dental Implications" (
JADA 2007;138[2]:179–87
). I must disagree with the categorization of metabolic syndrome as a disease. Recently, after much international debate, research and discussion on this topic, the American Diabetes Association and the European Association for the Study of Diabetes issued a joint position statement in 2005 with regard to the metabolic syndrome. This was published in Diabetes Care. The article abstract with regard to metabolic syndrome read as follows:
The term "metabolic syndrome" refers to a clustering of specific cardiovascular disease (CVD) risk factors whose underlying pathophysiology is thought to be related to insulin resistance. Since the term is widely used in research and clinical practice, we undertook an extensive review of the literature in relation to the syndrome’s definition, underlying pathogenesis, and association with CVD and to the goals and impact of treatment. While there is no question that certain CVD risk factors are prone to cluster, we found that the metabolic syndrome has been imprecisely defined, there is a lack of certainty regarding its pathogenesis, and there is considerable doubt regarding its value as a CVD risk marker. Our analysis indicates that too much critically important information is missing to warrant its designation as a "syndrome." Until much needed research is completed, clinicians should evaluate and treat all CVD risk factors without regard to whether a patient meets the criteria for diagnosis of the "metabolic syndrome."1
The authors’ review of the literature for the period cited should have revealed that
- – there was considerable controversy on classifying the metabolic syndrome as a disease category with five different definitions;
- – its value as a CVD risk marker is in doubt;
- – on the basis of this report, it would be nearly impossible to implicate specific dental problems in a medical condition when there is no formal agreement on its pathogenesis and designation.
With the advent of multiple medical intervention trials dealing with this collection of risk factors, it appears that the issue of defining metabolic syndrome is in a state of flux. The medical focus has shifted to issues of insulin resistance and insulin sensitivity and their effects on the cardiometabolic risk profile of the patient.
If the sole basis for this research article was to document dental implications of metabolic syndrome, I must question the scientific basis and rationale for this article, since the parts do not equal the whole. And past dental articles have dealt with the components of metabolic syndrome. In other words, collectively, the components of metabolic syndrome do not convey any added risk over each component, given the current medical research.
Dental research also should focus on identifying those at risk and the problems managing insulin resistance syndromes, diabetes and the increased cardiometabolic risks that affect the outcomes of dental care and treatment. Improving our knowledge of this group of metabolic disorders places a greater value on the role of the dental professional in the care of these patients and this worldwide epidemic of obesity, metabolic syndrome, prediabetes and diabetes.
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