• Metabolic Syndrome

    (Syndrome X; Insulin Resistance Syndrome; Dysmetabolic Syndrome)

    Definition

    Metabolic syndrome is a group of risk factors for cardiovascular disease. The factors are related to the breakdown and use of food and the action of the hormone insulin. These conditions are risk factors for health issues, such as:
    In general, metabolic syndrome is characterized by:
    • Abdominal obesity—high amount of fat around the waist
    • Low levels of "good cholesterol", also called high density lipoprotein (HDL) cholesterol
    • High triglyceride level—type of fat measured in the blood
    • High blood pressure
    • Insulin resistance (glucose intolerance or prediabetes )—insulin helps move glucose out of the blood into cells, resistance increases blood glucose levels
    Coronary Heart Disease
    Stereostatic Biopsy
    Copyright © Nucleus Medical Media, Inc.

    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)
    • 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 may include the following:
    • Overweight (especially excessive fat in the abdominal region)
    • Poor diet leading to weight gain
      • 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, including diet soda
    • 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 factors: low income
    • 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. The following symptoms are associated with obesity:
    • 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:
      • Glucose levels
      • Hemoglobin A1c
      • Insulin levels
      • Triglyceride level
      • Cholesterol levels
      • C reactive protein
    • Blood pressure
    • Urine test for protein
    • Calculation of body mass index (BMI)
    • Measurement of waist circumference
    • Calculation of 10-year risk of cardiovascular disease
    According to the National Heart Lung and Blood Institute, you may be diagnosed with metabolic syndrome if you have at least three of the following:
    • 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 glucose level—greater than or equal to 100 mg/dL* (5.55 mmol/L)
    • Triglyceride level—greater than or equal to 150 mg/dL (1.7 mmol/L)
    • HDL 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:
    • Treatment of underlying causes
    • Treatment of specific metabolic abnormality
    Gastric bypass or other weight loss surgery may be helpful to treat metabolic syndrome. Talk to your doctor to learn if this is an option for you.

    Treatment of Underlying Causes

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

    Treatment of Specific Metabolic Abnormality

    • High blood pressure—treated with anti-hypertensive medicines
    • Insulin resistance—treated with diabetes medicines (eg, metformin ) and lifestyle changes (eg, exercise)
    • High cholesterol—treated with cholesterol-lowering medicines called statins
    • 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 healthy 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 healthy 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 . Smoking greatly increases cardiovascular risk
    • Drink alcohol in moderation. This means no more than two drinks daily for men, one drink daily for women.

    RESOURCES

    American Heart Association http://www.americanheart.org/

    National Institute of Diabetes & Digestive & Kidney Diseases http://www.niddk.nih.gov/

    CANADIAN RESOURCES

    Canadian Cardiovascular Society http://www.ccs.ca/home/index%5Fe.aspx/

    Canadian Diabetes Association http://www.diabetes.ca/

    References

    Batsis JA, Romero-Corral A, Collazo-Clavell ML, et al. Effect of bariatric surgery on the metabolic syndrome: a population-based, long-term controlled study. Mayo Clin Proc . 2008 Aug;83(8):897-907.

    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 31, 2010.

    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. 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 November 2010. Accessed January 19, 2011.

    National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov .

    National Institute of Diabetes & Digestive & Kidney Diseases website. 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 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.

    1/13/2009 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.

    2/17/2009 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.

    5/11/2009 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.

    Revision Information

  • Join WellZones today.

    Make a Change For LifeLearn more

    Wellmont LiveWell is creating a new tradition of wellness in the mountains by providing individuals with tools and encouragement to live healthier lifestyles.

  • HeartSHAPE Spotlight

    At risk for a heart attack? Learn more

    Fight heart disease early and prevent heart attacks with HeartSHAPE® - a painless, non-invasive test that takes pictures of your heart to scan for early-stage coronary disease.

  • Calories and Energy Needs

    Calorie NeedsLearn more

    How many calories do you need to eat each day to maintain your weight and fuel your physical activity? Enter a few of your stats into this calculator to find out.

  • Ideal Body Weight

    Ideal Body WeightLearn more

    Using body mass index as a reference, this calculator determines your ideal body weight range. All you need to do is enter your height.

  • Body Mass Index

    Body Mass IndexLearn more

    This tool considers your height and weight to assess your weight status.


  • Can we help answer your questions?

    Wellmont Nurse Connection is your resource for valuable health information any time, 24 hours a day, seven days a week. Speak to a Nurse any time, day or night, at (423) 723-6877 or toll-free at 1-877-230-NURSE.