Metabolic syndrome is a combination of medical disorders that increase the risk of developing cardiovascular disease and diabetes. It affects one in five people, and prevalence increases with age. Some studies estimate the prevalence in the USA to be up to 25% of the population. Metabolic syndrome is also known as metabolic syndrome X, syndrome X, insulin resistance syndrome, Reaven's syndrome, and CHAOS (Australia).
The exact mechanisms of the complex pathways of metabolic syndrome are not yet completely known. The pathophysiology is extremely complex and has been only partially elucidated. Most patients are older, obese, sedentary, and have a degree of insulin resistance. The most important factors in order are:
4. Sedentary lifestyle
There is debate regarding whether obesity or insulin resistance is the cause of the metabolic syndrome or if they are consequences of a more far-reaching metabolic derangement. A number of markers of systemic inflammation, including C-reactive protein, are often increased, as are fibrinogen, interleukin 6 (IL-6), Tumour necrosis factor-alpha (TNFα) and others. Interestingly all these inflammatory markers are associated with the pathogenesis of cancer. Some have pointed to oxidative stress due to a variety of causes including increased uric acid levels caused by dietary fructose.
Commonly there is development of visceral fat after which the adipocytes (fat cells) of the visceral fat increase plasma levels of TNFα and alter levels of a number of other substances (e.g., adiponectin, resistin, PAI-1). TNFα has been shown not only to cause the production of inflammatory cytokines, but possibly to trigger cell signalling by interaction with a TNFα receptor that may lead to insulin resistance. An experiment with rats that were fed a diet one-third of which was sucrose has been proposed as a model for the development of the metabolic syndrome. The sucrose first elevated blood levels of triglycerides, which induced visceral fat and ultimately resulted in insulin resistance . The progression from visceral fat to increased TNFα to insulin resistance has some parallels to human development of metabolic syndrome.
Overweight and Obesity
Central obesity is a key feature of the syndrome, reflecting the fact that the syndrome's prevalence is driven by the strong relationship between waist circumference and increasing adiposity. However, despite the importance of obesity, patients who are normal weight may also be insulin-resistant and have the syndrome.
Physical inactivity is a predictor of CVD events and related mortality. Many components of the metabolic syndrome are associated with a sedentary lifestyle, including increased adipose tissue (predominantly central); reduced HDL cholesterol; and a trend toward increased triglycerides, blood pressure and glucose in the genetically susceptible. Compared with individuals who watched television or videos or used their computer <1 h daily, those who carried out these behaviors for >4 h daily have a twofold increased risk of the metabolic syndrome.
The metabolic syndrome affects 44% of the U.S. population older than age 50. A greater percentage of women older than age 50 have the syndrome than men. The age dependency of the syndrome's prevalence is seen in most populations around the world.
It is estimated that the large majority (~75%) of patients with type 2 diabetes or impaired glucose tolerance (IGT) have metabolic syndrome. The presence of the metabolic syndrome in these populations is associated with a higher prevalence of CVD than found in patients with type 2 diabetes or IGT without the syndrome. Hypoadiponectinemia (adiponectin is an adipose-specific protein with is putatively antiatherogenic and antiinflammatory effects), has been shown to increase insulin resistance and is considered to be a risk factor for developing metabolic syndrome.
Coronary Heart Disease
The approximate prevalence of the metabolic syndrome in patients with coronary heart disease (CHD) is 50%, with a prevalence of 37% in patients with premature coronary artery disease (age 45), particularly in women. With appropriate cardiac rehabilitation and changes in lifestyle (e.g., nutrition, physical activity, weight reduction, and, in some cases, Drugs), the prevalence of the syndrome can be reduced.
Signs and symptoms
Symptoms and features are:
- Fasting hyperglycemia - diabetes mellitus type 2 or impaired fasting glucose, impaired glucose tolerance, or insulin resistance;
- High blood pressure;
- Central obesity (also known as visceral, male-pattern or apple-shaped adiposity), overweight with fat deposits mainly around the waist;
- Decreased HDL cholesterol (the good cholesterol);
- Elevated triglycerides;
Associated diseases and signs are:
- hyperuricemia, fatty liver (especially in concurrent obesity) progressing to non-alcoholic fatty liver disease
- polycystic ovarian syndrome (in women)
- acanthosis nigricans( hyperpignentation of the skin due to insulin spill over)
The World Health Organization criteria (1999) require
- presence of diabetes mellitus,
- impaired glucose tolerance,
- impaired fasting glucose or insulin resistance,
AND two of the following:
* blood pressure: ≥ 140/90 mmHg
* dyslipidaemia: triglycerides (TG): ≥ 1.695 mmol/L and high-density lipoprotein cholesterol (HDL-C) ≤ 0.9 mmol/L (male), ≤ 1.0 mmol/L (female)
* central obesity: waist:hip ratio > 0.90 (male); > 0.85 (female), and/or body mass index > 30 kg/m2
* microalbuminuria: urinary albumin excretion ratio ≥ 20 mg/min or albumin:creatinine ratio ≥ 30 mg/g
The European Group for the Study of Insulin Resistance (1999) requires;
- insulin resistance defined as the top 25% of the fasting insulin values among non-diabetic individuals
AND two or more of the following:
* central obesity: waist circumference ≥ 94 cm (male), ≥ 80 cm (female)
* dyslipidaemia: TG ≥ 2.0 mmol/L and/or HDL-C < 1.0 mmol/L or treated for dyslipidaemia
* hypertension: blood pressure ≥ 140/90 mmHg or antihypertensive medication
* fasting plasma glucose ≥ 6.1 mmol/L
Various strategies have been proposed to prevent the development of metabolic syndrome. These include increased physical activity (such as walking 30 minutes every day), and a healthy, reduced calorie diet.
There are many studies that support the value of a healthy lifestyle as above. However, one study stated that these measures are effective in only a minority of people, primarily due to a lack of compliance with lifestyle and diet changes. The International Obesity Taskforce states that interventions on a sociopolitical level are required to reduce development of the metabolic syndrome in populations.
A 2007 study of 2,375 male subjects over 20 years suggested that daily intake of a pint of milk or equivalent dairy products more than halved the risk of metabolic syndrome.
The first line treatment is change of lifestyle (i.e., caloric restriction and physical activity). However, drug treatment is frequently required. Generally, the individual disorders that comprise the metabolic syndrome are treated separately.
Diuretics and ACE inhibitors may be used to treat hypertension.
Cholesterol drugs may be used to lower LDL cholesterol and triglyceride levels, if they are elevated, and to raise HDL levels if they are low.
Use of drugs that decrease insulin resistance, e.g., metformin and thiazolidinediones, is controversial; this treatment is not approved by the U.S. Food and Drug Administration.
A 2003 study indicated that cardiovascular exercise was therapeutic in approximately 31% of cases. The most probable benefit was to triglyceride levels, with 43% showing improvement; but fasting plasma glucose and insulin resistance of 91% of test subjects did not improve.
Many other studies have supported the value of increased physical activity and restricted caloric intake (exercise and diet) to treat metabolic syndrome.
For a full explanation of herbal medicines to treat blood sugar imbalace please see Carahealth Blood Sugar.
For a full naturopathic approach to treat metabolic syndrome please see also Natural Alternatives to the Antidiabetic Drug Avandia
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