This finding is supported by previous studies.21,29 It has shown that as the number of components of MetS increased, a progressive elevation in plasma acylated ghrelin and a decrease in plasma desacyl ghrelin were observed.30 Desacyl ghrelin is the major circulating form and acts as an antagonist of acylated ghrelin.31 Barazzoni et al finding suggested that the balance of the ratio of acylated to desacyl ghrelin affects insulin action in MetS.32 Here, INS is linked to metabolic syndrome.