Metabolic Syndrome

Metabolic syndrome is a blanket term for a group of disorders that can increase your risk of heart disease, type 2 diabetes, fatty liver, and stroke. It is also known as Syndrome X or insulin resistance syndrome and includes any three of the following conditions; abdominal obesity, increased levels of blood sugar, high blood pressure, increased levels of cholesterol and triglycerides in your blood.

It is not necessary to have all of these conditions simultaneously, nor having any one of them is metabolic syndrome. However, having three or more of the conditions labels you as having a metabolic syndrome and makes you eligible for proper care related to it to be safe from a more serious illness like a heart attack or a stroke.

Metabolic syndrome is quite common and affects around 34% of people in the USA. You can manage the syndrome and prevent yourself from the grave sequela with proper care and treatment.

The causative factors and the pathways involved in developing metabolic syndrome are highly complex and still under research. The diet we eat that includes carbohydrates, fats, and proteins is metabolized and broken down in our bodies to provide energy. The imbalance between food provision and energy expenditure leads to metabolic derangement that can result in the generation of substances leading to inflammation and dysfunction of the body's metabolic factory, proceeding to the development of insulin resistance, chronic inflammation, hypertension, and atherosclerosis. Some of the factors considered responsible for causing metabolic syndrome are;

1.       Obesity and Sedentary lifestyle: Lack of physical activity in the setting of overeating can lead to the excess accumulation of fats around the waist resulting in insulin resistance, increased triglycerides, and other effects of metabolic syndrome.

2.       Stress: Physical and mental stress can disrupt the hormonal balance of the hypothalamic-pituitary-adrenal axis and result in the production of increased levels of the stress hormone called cortisol. Cortisol causes more insulin release and glucose production culminating in the accumulation of adipose tissue that results in obesity, insulin resistance, dyslipidemia, and hypertension.

3.       Disrupted sleep: Lack of sleep or interrupted sleep on the background of other risk factors can also cause disruptions of hormonal balance of the hypothalamic-pituitary-adrenal axis and result in the production of increased levels of cortisol, causing similar effects to that of stress.

4.       Obstructive sleep apnea: New studies have shown the association of this disorder with metabolic syndrome. Obstructive sleep apnea is a condition caused by improper muscle toning of the throat, causing blockage of airway and cessation of breathing resulting in disrupted sleep. The disorder itself causes hypertension, mood disorders, headaches, difficulty concentration, and other problems.  

The prevalence of Metabolic syndrome is increasing day by day owing to the surge in the frequency of obesity, sedentary lifestyle, stress, etc. Almost two-thirds of the US population was obese or overweight in 2008, and more than one-fourth met the diagnostic criteria of metabolic syndrome. The prevalence has increased from 25.3% in 1994 to 34.2% in 2007. In the US, it is more prevalent in African Americans and minorities. The risk increases with increasing age, affecting almost 40% of people older than 60 years. 

Having the following risk factors can put you at higher risk of developing metabolic syndrome;

• Rising Age
• Genetic susceptibility and family history
• Excessive consumption of sugary food items
• Westernized diet
• Less amount of physical activity and exercise
• Disrupted sleep
• Increased physical and mental stress
• Excessive consumption of alcohol
• Having mood disorders and using psychotropic medicines

If you have metabolic syndrome, you may show the following signs and symptoms;

• Excess fat around the waist: The cardinal sign of metabolic syndrome is central obesity, also known as the male-pattern, visceral, or apple-shaped adiposity, and is due to the accumulation of adipose tissue/fat tissue around the waist and the trunk.
• Hypertension: High blood pressure is one of the most important signs that can lead to stroke.
• High blood sugar levels: You may have impaired sugar levels in your blood that are either in the range of diabetes or at the pre-diabetic stage. Due to these, you can have an increased urine frequency or feel hungry or tired most of the time.
• Deranged blood cholesterol and triglycerides levels: You may have increased levels of triglycerides and LDL-cholesterol (bad cholesterol) and low levels of HDL- cholesterol (good cholesterol).
• Xanthomas or xanthelasmas: These are lipid accumulation around the eyes or skin if you have high levels of lipids in blood for a long duration.
• Acanthosis nigricans and hirsutism: If you are having insulin resistance with high blood sugar levels or diabetes, you may show these signs. Acanthosis nigricans is the presence of darker and thicker patches on skin folds like the back of the neck or armpit. Hirsutism is abnormal hair growth or pattern.

Metabolic syndrome is a multifactorial disease. To make the diagnosis, your health practitioner will ask you questions regarding the symptoms of all the components of metabolic syndrome. They will examine you for the signs discussed above, such as measuring your waist circumference, blood pressure, hirsutism, xanthelasma, acanthosis nigricans, etc.  They may also advise you to undergo some blood tests to check the levels of triglycerides, LDL, and HDL- cholesterol, sugar levels. Your doctor will decide whether or not you meet the diagnostic criteria for metabolic syndrome, based on your lab results. According to the guidelines of the National Heart, Lung, and Blood Institute (NHLBI) and the American Heart Association (AHA), having any three of the following five disorders makes the diagnosis of metabolic syndrome.

• Blood glucose (Fasting):  Greater than or equal to 100 mg/dL (or receiving treatment for hyperglycemia)
• Blood pressure measurement (Systolic/Diastolic): Greater than or equal to 130/85 mm Hg (or receiving treatment for hypertension).
• Blood Triglycerides: Greater than or equal to 150 mg/dL (or receiving treatment for hypertriglyceridemia).
• Blood HDL-Cholesterol: Less than 40 mg/dL in men or less than 50 mg/dL in women (or receiving treatment for reduced HDL-C).
• Waist circumference greater than or equal to 102 cm (40 inches) in men or greater than or equal to 88 cm (35 inches) in women; if Asian American, greater than or equal to 90 cm (35 in) in men or greater than or equal to 80 cm (32 inches) in women

Following disorders can be related to or present like metabolic syndrome and must be looked deeper into to make an efficient diagnosis and proper management.

• Polycystic ovarian syndrome
• Obstructive sleep apnea
• Renin and aldosterone hormone system disorders
• Familial hypercholesterolemia
• Thyroid dysfunction
• Pheochromocytomas

Despite the complex nature of the disorder, the management is somewhat simple and doable.

• Weight loss and lifestyle changes: making efforts to lose weight and adopting healthy lifestyle habits are the cornerstone of the management. Your doctor may advise you to modify your diet, mainly decreasing the number of carbohydrate food items and performing regular exercises to avoid obesity and related consequences.
• Medicines for insulin resistance: some studies have advocated the use of metformin to improve insulin sensitivity.
• Treatment of diabetes: If you have diabetes type 2, your doctor will prescribe some medications for the proper control of blood sugar levels. These medicines include biguanides (metformin), Thiazolidinediones (rosiglitazone), etc.
• Treatment of hypertension: if you have high blood pressure, your doctor will prescribe medicines for controlling blood pressure. These medicines include; Diuretics (thiazide) and ACE inhibitors (captopril, enalapril), etc.
• Management of increased cholesterol levels: you may be prescribed medicines to control the blood levels of triglycerides and cholesterol. These medicines include; Statins (atorvastatin, rosuvastatin), niacin, fenofibrates, etc.
• You may be guided about the management of Obstructive sleep apnea
• You may be given aspirin as primary prevention of cardiovascular risk factors 

Once the diagnosis is made, you must stay vigilant to manage your conditions. People who make lifestyle changes, take their medicines properly and are regular in their follow-ups have good control of the symptoms and the risk factors.

Untreated metabolic syndrome can lead to several complications like heart attack, atrial fibrillation, heart failure, stroke, diabetes type 2, nonalcoholic fatty liver disease, some cancers, pre-eclampsia, etc.

Diabetes mellitus and cardiovascular disease may co-exist and are leading causes of increased mortality among older adults. 

These are the prime components of metabolic syndrome management.

• Bodyweight should be maintained according to BMI by taking a balanced diet and regular exercise.
• Consuming a healthy diet rich in vitamins, minerals, omega 3 fatty acids, antioxidants and avoiding sugary, fatty, and fried food
• Employ regular exercises or a brisk walk for at least 30 minutes every day to improve muscular activity and overall functions of the body.
• Learn to manage stress using different strategies like meditation, yoga, or breathing exercises.
• Take regular treatment and follow-ups for diseases like diabetes, hypertension, hyperlipidemia.
• Get to know your family history and adopt healthy lifestyle changes from the beginning.
• Avoid drinking alcohol
• Avoid smoking.