Metabolic Syndrome

Metabolic syndrome is a cluster of metabolic abnormalities that occur together and increase the risk of cardiovascular disease, type 2 diabetes, and stroke. It’s a significant public health concern due to its association with a range of serious chronic diseases.

Criteria for Diagnosis:

While definitions might vary slightly depending on the organization, the National Cholesterol Education Program (NCEP) Adult Treatment Panel III defines metabolic syndrome as the presence of three or more of the following five criteria:

  1. Waist Circumference:
    • Men: ≥102 cm (40 inches)
    • Women: ≥88 cm (35 inches)
  2. Hypertriglyceridemia:
    • Triglyceride level of ≥150 mg/dL (1.7 mmol/L) or on treatment for elevated triglycerides.
  3. Reduced HDL (“good”) Cholesterol:
    • Men: <40 mg/dL (1.0 mmol/L)
    • Women: <50 mg/dL (1.3 mmol/L) or on treatment for reduced HDL cholesterol.
  4. Elevated Blood Pressure:
    • Systolic ≥130 mmHg and/or diastolic ≥85 mmHg or on antihypertensive drug treatment.
  5. Elevated Fasting Glucose:
    • ≥100 mg/dL (5.6 mmol/L) or on treatment for elevated glucose.

Pathophysiology:

The exact mechanism leading to metabolic syndrome is not entirely understood, but it’s believed to involve a combination of genetic, metabolic, and environmental factors. Insulin resistance, where cells do not respond to insulin efficiently, plays a central role. This results in elevated blood glucose levels, prompting the pancreas to produce more insulin. Over time, this hyperinsulinemia can contribute to further metabolic dysregulation.

Risk Factors:

  1. Obesity, particularly central or abdominal obesity.
  2. Age, as the risk increases with getting older.
  3. Sedentary lifestyle.
  4. A family history of type 2 diabetes, hypertension, or early heart disease.
  5. Certain ethnic groups, such as Asian Indians, Hispanics, and African-Americans, seem to be at a higher risk.
  6. Other conditions like polycystic ovary syndrome (PCOS), fatty liver, and certain rare genetic conditions.

Complications:

Individuals with metabolic syndrome are at a higher risk of:

  1. Cardiovascular disease.
  2. Type 2 diabetes.
  3. Non-alcoholic fatty liver disease (NAFLD) and its more severe form, non-alcoholic steatohepatitis (NASH).
  4. Polycystic ovary syndrome (PCOS) in women.
  5. Sleep apnea.
  6. Certain forms of cancer.

Management:

Management primarily involves lifestyle modifications:

  1. Regular physical activity.
  2. A heart-healthy diet that is low in saturated fats, trans fats, cholesterol, and salt.
  3. Weight loss for those who are overweight or obese.
  4. Managing individual risk factors, like hypertension, high triglycerides, or high blood glucose, with medications as necessary.

Early detection and intervention can help reduce the risk of developing associated complications, especially cardiovascular disease and type 2 diabetes.