Metabolic Syndrome in Older Adults: When Function Trumps Numbers

This editorial critiques the limitations of traditional metabolic syndrome criteria in older adults, arguing that age-related changes in body composition, vascular stiffness and frailty render standard thresholds inadequate. Highlighting the 'obesity paradox' and risks of intensive blood pressure/lipid control, the article advocates for a frailty-centred approach integrating functional status, body composition (e.g. dual-energy X-ray absorptiometry) and inflammation markers over rigid numerical targets. Practical strategies include sarcopenia screening (SARC-F), resistance training and individualized glycaemic/blood pressure goals to avoid overtreatment in frail patients. The paradigm shift aims to improve risk stratification and align care with geriatric priorities.