What is Metabolic Syndrome?
The Metabolic Syndrome is a cluster of the most dangerous heart attack risk factors: diabetes and raised fasting plasma glucose, abdominal obesity, high cholesterol and high blood pressure. It is estimated that around 20-25 percent of the world’s adult population have the Metabolic Syndrome and they are twice as likely to die from and three times as likely to have a heart attack or stroke compared with people without the syndrome.
In addition, people with Metabolic Syndrome have a fivefold greater risk of developing type 2 diabetes. They would add to the 230 million people worldwide who already have diabetes, one of the most common chronic diseases worldwide and the fourth or fifth leading cause of death in the developed world. The clustering of cardiovascular disease (CVD) risk factors that typifies the metabolic syndrome is now considered to be the driving force for a new CVD epidemic.
In most people with glucose intolerance or type 2 diabetes, there is a multiple set of risk factors that commonly appear together, forming what is now known as the ‘Metabolic Syndrome’. This ‘clustering’ of metabolic abnormalities that occur in the same individual appears to confer a substantial additional cardiovascular risk over and above the sum of the risk associated with each abnormality.
However, even before levels of blood glucose are high enough for a person to be diagnosed with diabetes, hyperglycaemia and related changes in blood lipids (increase in triglycerides and decrease in the ‘good’ cholesterol HDL-c) increase a person’s risk of CVD. The more components of the metabolic syndrome that are evident, the higher is the cardiovascular mortality rate.
What causes the Metabolic Syndrome?
The underlying cause of the Metabolic Syndrome continues to challenge the experts but both insulin resistance and central obesity are considered significant factors. Genetics, physical inactivity, aging, a proinflammatory state, and hormonal changes may also have a causal effect, but the role of these may vary depending on ethnic group.
Insulin resistanceInsulin resistance occurs when cells in the body (liver, skeletal muscle, and adipose/fat tissue) become less sensitive and eventually resistant to insulin, the hormone which is produced by the beta cells in the pancreas to facilitate glucose absorption. Glucose can no longer be absorbed by the cells but remains in the blood, triggering the need for more and more insulin (hyperinsulinaemia) to be produced in an attempt to process the glucose. The production of ever-increasing amounts of insulin weakens and may eventually wear out the beta cells. Once the pancreas is no longer able to produce enough insulin then a person becomes hyperglycaemic (too much glucose in the blood) and will be diagnosed with type 2 diabetes. Even before this happens, the damage is occurring to the body, including a build-up of triglycerides which further impairs insulin sensitivity.
Central obesityObesity is associated with insulin resistance and the Metabolic Syndrome. Obesity contributes to hypertension, high serum cholesterol, low HDL-c and hyperglycaemia, and is independently associated with higher CVD risk. The risk of serious health consequences in the form of type 2 diabetes, coronary heart disease (CHD) and a range of other conditions, including some forms of cancer, has been shown to rise with an increase in body mass index (BMI) but it is an excess of body fat in the abdomen, measured simply by waist circumference, that is more indicative of the Metabolic Syndrome profile than BMI. The International Obesity Task Force (IOTF) reports that 1.7 billion of the world’s population is already at a heightened risk of weight-related, non-communicable diseases such as type 2 diabetes.
How to diagnose Metabolic Syndrome?According to the new (International Diabetes Federation (IDF) definition, for a person to be defined as having the Metabolic Syndrome they must have Metabolic Syndrome labs done to determine the following:
1. Central obesity (defined as waist circumference with ethnicity-specific values): Men 37″ and Women 31.5″ plus any two of the following four factors:
2. Raised triglycerides: 150 mg/dL (1.7 mmol/L)
3. Reduced HDL cholesterol: < 40 mg/dL (1.03 mmol/L) in males and < 50 mg/dL (1.29 mmol/L) in females
4. Raised blood pressure: systolic BP 130 or diastolic BP 85 mm Hg
5. Raised fasting glucose: >100 mg/dL (5.6 mmol/L) At least three criteria must be fulfilled with one of the three central obesity. This results in a diagnosis of Metabolic Syndrome.There comes a point when the body has had enough. Metabolic Syndrome is caused by long-term improper nutrition. We begin to have an awareness that something doesn’t feel right. The consequences of Metabolic Syndrome show up in any number of ways including the following:
What are the recommendations for treatment?Once a diagnosis of the Metabolic Syndrome is made, the future management of the condition should be aggressive and uncompromising in its aim to reduce the risk of CVD and type 2 diabetes. Patients should undergo a full cardiovascular risk assessment (including smoking status) in conjunction with the following:
Primary intervention:IDF recommends that primary management for Metabolic Syndrome is a healthy lifestyle. This includes: 1. Moderate calorie restriction (to achieve a 5–10 percent loss of body weight in the first year) 2. Moderate increase in physical activity 3. Change in dietary composition. The results of Finnish and American prevention of diabetes studies have shown the marked clinical benefits associated with a small weight loss (as well as increased physical activity) in terms of preventing (or at least delaying by several years) the conversion to type 2 diabetes among high-risk individuals with glucose intolerance who were, generally, obese.
Secondary interventionIn people for whom lifestyle change is not enough and who are considered to be at high risk for CVD, drug therapy may be required to treat the Metabolic Syndrome. There is a definite need for a treatment that could modulate the underlying mechanisms of the Metabolic Syndrome as a whole and thereby reduce the impact of all the risk factors and the long term metabolic and cardiovascular consequences. However, these mechanisms are currently unknown and specific pharmacological agents are therefore not yet available. It is currently necessary instead to treat the individual components of the syndrome in order that a lower individual risk associated with each component will reduce the overall impact on CVD and diabetes risk.
Can Metabolic Syndrome be reversed?
- type 2 diabetes
- abnormal lipids (HDL, Triglycerides, sugar levels)
- high blood pressure
- liver and gall bladder disorders
- cardiovascular diseases
- cancerous tumors
- ovarian cysts