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 (24), 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.

1
Oda E: The metabolic syndrome (emperor) wears no clothes (Letter).
Diabetes Care
29
:
2566
,
2006
2
Alberti KG, Zimmet P, Shaw J: The metabolic syndrome: a new worldwide definition.
Lancet
366
:
1059
–1062,
2005
3
Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C: Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition.
Circulation
109
:
433
–438,
2004
4
Grundy SM: Does the metabolic syndrome exist? (Commentary).
Diabetes Care
29
:
1689
–1692,
2006