The possible inclusion of C-reactive protein (CRP) in the metabolic syndrome algorithm highlights the problems of the construct itself. If the syndrome is supposed to be a predictive tool for future cardiovascular events, then we should indeed test the benefit of adding CRP, along with age, sex, race, adiponectin, homocysteine, etc. If the utility of the syndrome is to call attention to obesity, then there is no need for expensive laboratory tests. If the virtue is to predict diabetes, then a measure of glucose intolerance alone is better. If the syndrome is supposed to identify those with insulin resistance, then there are simpler ways to do so; however, measuring CRP might be helpful.
Dr. Oda (1) seems to have one purpose for the construct; others have different perspectives. The problem is that no one, not even the proponents themselves (2–4), have conveyed the exact utility of the syndrome and shown that it is better than or even equal to other approaches, and the critical issue, therefore, is why clinicians should even bother diagnosing metabolic syndrome in the first place.