METABOLIC SYNDROME

What is the metabolic syndrome?

The metabolic syndrome is characterized by a group of metabolic risk factors in one person. They include:

• Obesitas sentral
• Atherogenic dyslipidemia (blood fat disorders — mainly high triglycerides and low HDL cholesterol — that foster plaque buildups in artery walls)
• Insulin resistance or glucose intolerance (the body can’t properly use insulin or blood sugar)
• Prothrombotic state (e.g., high fibrinogen or plasminogen activator inhibitor [–1] in the blood)
• Raised blood pressure (130/85 mmHg or higher)
• Proinflammatory state (e.g., elevated high-sensitivity C-reactive protein in the blood)

The underlying causes of this syndrome are overweight/obesity, physical inactivity and genetic factors. People with the metabolic syndrome are at increased risk of coronary heart disease, other diseases related to plaque buildups in artery walls (e.g., stroke and peripheral vascular disease) and type 2 diabetes.

How common is metabolic syndrome?

Metabolic syndrome is quite common. Approximately 20-30% of the population in industrialized countries have metabolic syndrome. By the year 2010, the metabolic syndrome is expected to affect 50-75 million people in the US alone.

Who has the metabolic syndrome?

The metabolic syndrome has become increasingly common in the United States. It’s estimated that about 47 million U.S. adults have it.

The syndrome is closely associated with a generalized metabolic disorder called insulin resistance, in which the body can’t use insulin efficiently. This is why the metabolic syndrome is also called the insulin resistance syndrome.

Some people are genetically predisposed to insulin resistance. Acquired factors, such as excess body fat and physical inactivity, can elicit insulin resistance and the metabolic syndrome in these people. Most people with insulin resistance have central obesity. The biologic mechanisms at the molecular level between insulin resistance and metabolic risk factors aren’t fully understood and appear to be complex.

When to seek medical advice

If you know you have at least one aspect of metabolic syndrome — such as high blood pressure, high cholesterol or an apple-shaped body — you may have the others and not know it. It's worth checking with your doctor. Ask whether you need testing for other components of the syndrome and what you can do to avoid serious diseases.

How is the metabolic syndrome diagnosed?

There are no well-accepted criteria for diagnosing the metabolic syndrome. The criteria proposed by the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) are the most current and widely used.

According to the ATP III criteria, the metabolic syndrome is identified by the presence of three or more of these components:

• Central obesity as measured by waist circumference:
  Men — Greater than or equal to 40 inches Women — Greater than or equal to 35 inches
• Fasting blood triglycerides greater than or equal to 150 mg/dL
• Blood HDL cholesterol:
  Men — Less than 40 mg/dL
  Women — Less than 50 mg/dL
• Blood pressure greater than or equal to 130/85 mmHg
• Fasting glucose greater than or equal to 100 mg/dL

The ATP III panel did not find evidence to recommend routine measurement of insulin resistance (e.g., increased fasting blood insulin), prothrombotic state or proinflammatory state.

What causes metabolic syndrome?

As is true with many medical conditions, genetics and the environment both play important roles in the development of the metabolic syndrome.

Genetic factors influence each individual component of the syndrome, and the syndrome itself. A family history that includes type 2 diabetes, hypertension, and early heart disease greatly increases the chance that an individual will develop the metabolic syndrome.

Environmental issues such as low activity level, sedentary lifestyle, and progressive weight gain also contribute significantly to the risk of developing the metabolic syndrome.

Metabolic syndrome is present in about 5% of people with normal body weight, 22% of those who are overweight and 60% of those considered obese. Adults who continue to gain 5 or more pounds per year raise their risk of developing metabolic syndrome by up to 45%.

While obesity itself is likely the greatest risk factor, others factors of concern include:

women who are post-menopausal,

smoking,

eating an excessively high carbohydrate diet,

lack of activity (even without weight change), and

consuming an alcohol-free diet.

Why should you know about metabolic syndrome?

Metabolic syndrome is worth caring about because it is a condition that can pave the way to both diabetes and heart disease, two of the most common and important chronic diseases today.

Metabolic syndrome increases the risk of type 2 diabetes (the common type of diabetes) anywhere from 9-30 times over the normal population. That's a huge increase. As to the risk of heart disease, studies vary, but the metabolic syndrome appears to increase the risk 2-4 times that of the normal population.

There are other concerns as well that should be mentioned. Metabolic syndrome is associated with fat accumulation in the liver (fatty liver), resulting in inflammation and the potential for cirrhosis. The kidneys can also be affected, as there is an association with microalbuminuria -- the leaking of protein into the urine, a subtle but clear indication of kidney damage.

Other problems associated with metabolic syndrome include obstructive sleep apnea, polycystic ovary syndrome , increased risk of dementia with aging, and cognitive decline in the elderly.

What is the treatment?

Tackling one of the risk factors of metabolic syndrome is tough — taking on all of them might seem overwhelming. But aggressive lifestyle changes and, in some cases, medication can improve all of the metabolic syndrome components. Getting more physical activity, losing weight and quitting smoking help reduce blood pressure and improve cholesterol and blood sugar levels. These changes are key to reducing your risk.

• Exercise. Doctors recommend getting 30 to 60 minutes of moderate intensity exercise, such as brisk walking, every day.
• Lose weight. Losing as little as 5 percent to 10 percent of your body weight can reduce insulin levels and blood pressure and decrease your risk of diabetes.
• Eat healthy. The Dietary Approaches to Stop Hypertension (DASH) diet and the Mediterranean Diet, like many healthy-eating plans, limit unhealthy fats and emphasize fruits, vegetables, fish and whole grains. Both of these dietary approaches have been found to offer important health benefits - in addition to weight loss - for people who have components of metabolic syndrome. Ask your doctor for guidance before starting a new eating plan.
• Stop smoking. Smoking cigarettes increases insulin resistance and worsens the health consequences of metabolic syndrome. Talk to your doctor if you need help kicking the cigarette habit.

Work with your doctor to monitor your weight and your blood glucose, cholesterol and blood pressure levels to ensure that lifestyle modifications are working. If you're not able to achieve your goals with lifestyle changes, your doctor may also prescribe medications to lower blood pressure, control cholesterol or help you lose weight. Insulin sensitizers may be prescribed to help your body use insulin more effectively. Aspirin therapy may help reduce your risk of heart attack and stroke.

How to Prevention?

Whether you have one, two or none of the components of metabolic syndrome, the following lifestyle changes will reduce your risk of heart disease, diabetes and stroke:

• Commit to a healthy diet. Eat plenty of fruits and vegetables. Choose lean cuts of white meat or fish over red meat. Avoid processed or deep-fried foods. Eliminate table salt and experiment with other herbs and spices.
• Get moving. Get plenty of regular, moderately strenuous physical activity.
• Schedule regular checkups. Check your blood pressure, cholesterol and blood sugar levels on a regular basis. Make additional lifestyle modifications if the numbers are going the wrong way.

important for patients and their doctors:

• Routinely monitor body weight (especially the index for central obesity), blood glucose, lipoproteins and blood pressure.
• Treat individual risk factors (hyperlipidemia, hypertension and high blood glucose) according to established guidelines.
• Carefully choose anti-hypertensive drugs because different agents have different effects on insulin sensitivity.

Summary

The term “metabolic syndrome” is a way of identifying individuals at high risk for the development of heart disease and diabetes. Intuitively we all know that obesity, high cholesterol, and hypertension are bad omens. We also know that insulin resistance precedes type 2 diabetes, and can itself be an important condition meriting treatment. Everyone reading this article knows someone who is overweight, hypertensive, or has cholesterol levels that are “a little high.” It may be a brother, sister, parent, neighbor, or even yourself.

For the physician, while the actual definition of "metabolic syndrome" may vary, the known clustering that occurs means that adults with any major cardiovascular risk should be evaluated for the presence of other risk factors. Patients at risk should receive education and counseling on lifestyle modification, and all risk factors for heart disease should be treated aggressively.

For the patient, the main point to understand is that it is important to treat the risk factors as bad things, before worse things happen. And while these changes can be addressed at a doctor's office, the other 99.999% of the time, they need to be addressed in the real world. We need to start having healthier food options readily available. We need to have time during the day to take a walk.

We basically need to restructure some fundamentals in our society. This author believes this has to happen, but it will take time. Until then, we each need to surround ourselves with people who support our goals and needs. We need to be aware of our own heath, and to make whatever changes we can to improve it.

The final take home message is:

Find a walk buddy.

Take a walk during your work break, even if it is just around the building.

Go to a health food store.

Look at what you feed your kids.

Urge them to get outside and play.

It all adds up. Preventing metabolic syndrome really means having a healthy lifestyle.