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As central obesity is one of the factors included in the definition of the metabolic syndrome and, for a given BMI, central obesity is more common in men, it might be expected that prevalence of the metabolic syndrome would be higher in men than in women. Among non-diabetic European men and women from eight populations the prevalence of the metabolic syndrome (defined using modified WHO criteria) was generally higher in men than in women (Hu etal., 2004). The effect of generalized obesity is also extremely important (see below) such that, in populations in which obesity is more common in women than in men, the prevalence of the metabolic syndrome will be higher in women than in men. This pattern can be observed in Indian, Iranian and Turkish populations (Onat etal., 2002; Azizi etal., 2003; Gupta etal., 2003; Ramachandran etal., 2003; Ozsahin etal., 2004).

A cardiovascular risk factor survey in France identified that elevated body weight, waist girth and low HDL-cholesterol were significantly larger contributors to the metabolic syndrome in women than in men, whereas systolic and diastolic blood pressure contributed significantly less in women than in men and insulin, glucose and triglycerides made similar contributions in both sexes (Dallongeville etal., 2004). In contrast, in a Chinese population, hypertension was related to other features of the metabolic syndrome only in women (Chen etal., 2000). A study in Finland reported that the metabolic syndrome (defined using criteria similar to those of the WHO) was more common in men than in women among subjects with normal glucose tolerance (15 vs. 10 per cent) and impaired fasting glucose/glucose tolerance (64 vs. 42 per cent), but not in patients with type 2 diabetes (84 vs. 78 per cent) (Isomaa etal., 2001). In the Canary Islands hypertriglyceridaemia, hypertension and hyperglycaemia predominated in men, whereas in women abdominal obesity and low HDL-cholesterol were more common (Alvarez Leon, Ribas and Serra, 2003).

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