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In contrast to the previous definitions, IDF made abdominal obesity a mandatory criterion using waist circumference (WC) cut-points based on gender and ethnicity [9].

In the same year, the NCEP-ATP III was modified to incorporate a lower fasting glucose threshold of ≥5.6 mmol/L and the same WC criteria as proposed by the IDF for Asians living in the United States [10].

JIS definition gave the highest overall prevalence (43.4%) compared to NCEP-ATP III (26.5%) and IDF (37.4%), .

Indians had significantly higher age-adjusted prevalence compared to other ethnic groups across all Met S definitions (30.1% by NCEP-ATP III, 50.8% by IDF, and 56.5% by JIS).

The JIS committee agreed that the presence of any 3 out of 5 risk factors constitutes a diagnosis of Met S.The first definition was introduced by the World Health Organization (WHO) in 1998 [7] followed by the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP-ATP III) in 2001 [8].Subsequently, the International Diabetes Federation (IDF) established a new worldwide definition for Met S in 2005 [9].However, the modified NCEP-ATP III maintained that the diagnosis of Met S should be made based on the presence of any 3 out of 5 risk factors.After several years of continuing debate and discussion, the various stakeholders finally agreed to harmonize the definition.

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