What about non-alcoholic fatty liver disease as a new criterion to define metabolic syndrome?

Table 2 International Diabetes Federation: Definitions of metabolic syndrome

Central obesity plus any two of the following four factors
Raised triglyceride	150 mg/dL, or specific treatment for this lipid abnormality
Reduced HDL-C	< 40 mg/dL in men and < 50 mg/dL in women, or specific treatment for this lipid abnormality
Raised BP	Systolic BP 130 or diastolic BP 85 mmHg, or treatment of previously diagnosed hypertension
Raised FPG	100 mg/dL, or previously diagnosed type 2 diabetes. If above 100 mg/dL, OGTT is strongly recommended but is not necessary to define presence of the syndrome

OGTT: Oral glucose tolerance test; FPG: Fasting plasma glucose; HDL-C: High-density lipoprotein-cholesterol; BP: Blood pressure.