T he criteria for metabolic syndrome as identified by the modified National Cholesterol Education PanelAdult Treatment Panel (NCEP-ATP III) include abdominal obesity, an atherogenic dyslipidemia manifest as elevated levels of triglycerides (TGs) and low levels of high density lipoprotein-cholesterol (HDL-C), raised blood pressure, and impaired fasting glucose. 1 The importance of metabolic syndrome is that it confers at least a two-fold increased risk of cardiovascular disease and at least five-fold increased risk for subsequent diabetes. [2][3][4][5] In their report in Metabolic Syndrome and Related Disorders, Bartoli et al. 6 study the association of posttraumatic stress disorder (PTSD) and metabolic syndrome. The authors found six studies that met their criteria for inclusion in their meta-analysis involving 528 subjects with PTSD and 846 comparison patients; 5 of these had at least a trend toward a positive association. The studies included both men and women (although two of the studies were exclusively and one 92% men) with mean ages of 43.7-61 years of age (one study reported age as < 40 or ‡ 40 years of age). Four studies were of war veterans, one was of police officers, and one was of subjects recruited from the waiting rooms of primary care clinics at a busy inner city hospital. Four papers were from the United States and two were from Europe (Bosnia and Herzegovina). Individuals suffering from PTSD were more likely (36%) than the general population (28%) to have dyslipidemia, hypertension, diabetes, and obesity. The pooled odds ratio [95% confidence intervals (CI)] for metabolic syndrome in people suffering from PTSD was 1.37 (1.03-1.82) compared with those without PTSD.The findings in this meta-analysis are of interest, but several questions remain. Much remains to be learned concerning whether the relationship between PTSD and metabolic syndrome is independent of other factors that have been associated with metabolic syndrome or metabolic syndrome components. For example, lower socioeconomic class, 7 poor dietary quality, 8 physical inactivity/increased sedentary behavior, 9 active smoking, 10 increased alcohol consumption, 11 and specific symptoms of insomnia, including difficulty falling asleep and unrefreshing sleep, 12 have been associated with metabolic syndrome or metabolic syndrome components in individuals without psychiatric disorders. One of the most commonly reported symptoms of PTSD is insomnia. 13 PTSD is also associated with poor dietary quality, physical inactivity, higher rates of smoking, and increased alcohol consumption. 14 Importantly, several behavioral factors that are more prevalent in individuals with PTSD, including poor dietary quality, 15 active smoking, 10 and higher alcohol consumption 11 are prospectively associated with metabolic syndrome/metabolic syndrome components incidence. Among Iraq combat veterans, worsening insomnia during deployment predicted worsening PTSD symptoms, whereas worsening PTSD did not predict worsening insomnia, 16 suggesting that insomnia may pla...