Definition

Metabolic syndrome is a group of risk factors. The factors are related to the breakdown and use of food. These conditions are risk factors for health issues such as:

In general, it is characterized by:
  • Abdominal obesity—high amount of fat in trunk area
  • Dyslipidemia —high triglycerides and low high-density lipoprotein (HDL, or “good”) cholesterol
  • High blood pressure
  • Insulin resistance (glucose intolerance or prediabetes)—insulin helps move glucose out of the blood into cells; if a resistance develops it will increase the amounts of blood glucose

Coronary Heart Disease

Stereostatic Biopsy
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Causes

The exact cause of metabolic syndrome is not known. It believed to be due to a combination of factors, such as:

  • Genetic factors
  • Insulin resistance
  • Obesity —especially central obesity, in core of body
  • Lack of physical activity
  • Poor diet
  • Fatty tissue abnormalities linked to insulin resistance and obesity
  • Psychological stress
  • Chronic low-grade inflammation
  • Aging

Risk Factors

Risk factors for metabolic syndrome include the following:

  • Overweight (especially excessive fat in the abdominal region)
  • Poor diet
    • Eating a diet high in calories, sugar, saturated fats, and starchy foods (eg, bread, cereal, rice, pasta, potatoes), and low in dietary fiber
    • Drinking a lot of soda, even diet soda, has been linked to metabolic syndrome
  • Sedentary lifestyle
  • Gender
    • No difference in Caucasians
    • African Americans: females more than males by 57%
    • Mexican Americans: females more than males by 26%
  • Genetics: family history of diabetes, lipid disorders, high blood pressure , or heart disease
  • Socioeconomic factor with high incidence in low household income families
  • Age: over 60 years old
  • Ethnicity: Latino/Hispanic American, African American, Native American, Asian American, Pacific Islander
  • History of glucose intolerance or gestational diabetes
  • A diagnosis of any of the following conditions:

Symptoms

Except for obesity, there are no obvious symptoms. Those who are obese may have the following symptoms and signs:

  • Sleep apnea
  • Back or knee pain
  • Shortness of breath
  • Reduced exercise tolerance
  • Fatigue
  • Central obesity
  • Elevated blood pressure

Diagnosis

The doctor will ask about your medical history. A physical exam will be done.

Your doctor may order lab tests such as:

  • Blood tests to measure:
    • Fasting blood sugar levels (glucose) or a two-hour post-glucose challenge blood sugar level
    • Fasting insulin
    • Triglyceride level
    • HDL cholesterol level
  • C Reactive Protein, especially highly sensitive CRP
  • Blood pressure
  • Calculation of body mass index (BMI) from weight and height
  • Calculation of the 10 year risk of cardiovascular disease

You may be diagnosed with metabolic syndrome if you have at least three of the following measures:

  • Waist measurement—greater than 40 inches in Caucasian men (35 inches in Asian men) or 35 inches in Caucasian women (30 inches in Asian women)
  • Fasting blood sugar (glucose)—greater than or equal to 100 mg/dL* (5.55 mmol/L)
  • Serum triglycerides—greater than or equal to 150 mg/dL (1.7 mmol/L)
  • Serum HDL (“good”) cholesterol—less than 40 mg/dL (1.0 mmol/L) in men and less than 50 mg/dL (1.3 mmol/L) in women
  • Blood pressure—greater than or equal to 130/85 millimeters of mercury (mm Hg)
*mg/dL = milligrams per deciliter blood, mmol/L = millimoles per liter blood

Treatment

The treatment of metabolic syndrome involves two parts:

  • Treatment of underlying causes
  • Treatment of specific metabolic abnormality

Treatment of Underlying Causes

  • Reducing excess weight by at least 10% in the next 6 to 12 months
  • Increasing physical activity to 30-60 minutes of moderate aerobic exercise four or more days per week
  • Lowering blood pressure to below 130/85 mmHg with diet, exercise, and possibly medication
  • Improving triglyceride and HDL cholesterol levels through diet, exercise, and possibly medication

Treatment of Specific Metabolic Abnormality

  • High blood pressure—treated with medications (eg, angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists)
  • Insulin resistance—treated with medications (eg, metformin , thiazolidinediones)
    • Exercise may also help to reduce insulin resistance.
  • High blood lipids—treated medications (eg, statins, ezetimibe , fibrates, nicotinic acid)
  • Clotting tendency—treated with low dose aspirin , especially in those with moderate to high cardiovascular risk

Prevention

To help prevent metabolic syndrome:

  • Achieve and maintain a healthful weight.
  • Do 30 minutes of moderate aerobic exercise at least four days per week.
  • See your doctor regularly.

In addition, other unhealthy lifestyle factors also contribute to heart disease, stroke, and peripheral vascular disease. To lower your risk of these diseases:

  • Eat a healthful diet . It should be low in saturated and trans fats. Also keep it low in cholesterol. Aim for a diet that is rich in whole grains, fruits, and vegetables. Avoid soda. Ask your doctor if the Mediterranean diet is right for you.
  • If you smoke, quit .
  • Drink alcohol in moderation only.