(Syndrome X; Insulin Resistance Syndrome; Deadly Quartet)
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:
- 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
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
Risk factors for metabolic syndrome include the following:
- Overweight (especially excessive fat in the abdominal region)
- Poor diet
- Sedentary lifestyle
- 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:
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
- Central obesity
- Elevated blood pressure
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)
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,
- Exercise may also help to reduce insulin resistance. ]]>*²]]>
- 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
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. ]]>*¹]]>
- If you smoke, ]]>quit]]> .
- Drink alcohol in moderation only.
American Heart Association
National Institute of Diabetes & Digestive & Kidney Diseases
Canadian Cardiovascular Society
Canadian Diabetes Association
Cornier MA, Dabelea D, Hernandez TL et al: the metabolic syndrome. Endocr Rev. 2008;29:777-822.
Deen D. Metabolic syndrome: time for action. Am Fam Physician . 2004;69:2875-2882.
Eckel RH, Grundy SM, Zimmet PA. The metabolic syndrome. Lancet . 2005;365:1415-1428.
Findings and recommendations from the American College of Endocrinology on the insulin resistance syndrome. American Association of Clinical Endocrinologists website. Available at: http://www.aace.com . Accessed January 17, 2003.
Gami AS, Witt BJ, Howard DE, et al. Metabolic syndrome and risk of incident cardiovascular events and death. J Am Coll Cardiol . 2007;49:403-414.
Grundy SM, Brewer HB, Cleeman JI, et al. American Heart Association, NHLBI. Definition of metabolic syndrome: report of the NHLBI/AHA conference on scientific issues related to definition. Circulation . 2004;109:433-438.
Grundy SM, Cleeman JI, Diniels SR, et al. AHA/NHLBI Diagnosis and management of the metabolic syndrome: an AHA/NHLBI Scientific Statement. Circulation . 2005;112:2735-2752.
Metabolic syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated May 2009. Accessed May 18, 2009.
National Heart, Lung, and Blood Institute. Available at: http://www.nhlbi.nih.gov .
National Institute of Diabetes & Digestive & Kidney Diseases. Available at: http://www.niddk.nih.gov .
Reaven GM. The metabolic syndrome or the insulin resistance syndrome? Different names, different concepts, and different goals. Endocrinol Metab Clin North Am . 2004; 33: 283-304.
Steinberger J, Daniels SR, Eckel RH et al: AHA scientifc statement: progress and challenges in metabolic syndrome in children and adolescents. Circulation. 2009;119:628-647.
Syndrome x or metabolic syndrome. American Heart Association website. Available at: http://www.americanheart.org . Accessed January 17, 2003.
Wright Jr JT, Harris-Haywood S, Pressel S, et al. Clinical outcomes by race in hypertensive patients with and without the metabolic syndrome (ALLHAT). Arch Int Med. 2008;168:207-217.
*¹1/13/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Salas-Salvadó J, Fernández-Ballart J, Ros E, et al. Effect of a Mediterranean diet supplemented with nuts on metabolic syndrome status: one-year results of the PREDIMED randomized trial. Arch Intern Med. 2008;168:2449-2458.
*²2/17/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Davidson LE, Hudson R, Kilpatrick K, et al. Effects of exercise modality on insulin resistance and functional limitation in older adults: a randomized controlled trial. Arch Intern Med. 2009;169:122-131.
*³5/11/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Nettleton JA, Lutsey PL, Wang Y, Lima JA, Michos ED, Jacobs DR. Diet soda intake and risk of incident metabolic syndrome and type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care. 2009;32:688-694.
Last reviewed February 2009 by ]]>David Juan, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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