EDITORIAL New Insights on Metabolic Syndrome: A “Silent ” But Visible Epidemic

As surgeons, we evaluate varied problems, depending on our background and experi-ence, but rarely make formal recommendations regarding the abnormalities observed in the metabolic syndrome (MS). The article by Ryan et al, from St. James Hospital/ Trinity College Dublin which appears in this issue of Annals of Surgery, linking proinflammatory changes with the extent of squamous intestinal metaplasia in a cohort of patients with Barrett epithelium focuses attention on a common problem that should be more widely addressed by the medical community.1 As a surgeon, I readily admit a focus on the “presenting problem ” and not on broader questions of health maintenance; this article forced me to recognize that I should be more involved in finding ways to deal with MS, which affects 25 % to 45 % of the population, depending on ethnicity and sex, and has such a variety of consequences, associated risks, including cardiovascular disease, and an ever widening list of cancers. Metabolic syndrome qualifies as a public health epidemic, but its cluster of abnormal-ities does not command the kind of attention directed towards more visible problems such as the preventable diseases of childhood or chronic lead poisoning, with more easily defined and recognizable consequences; this is probably not the correct approach.2–4 Because many of th