Metabolic Syndrome

Living organisms live because of the chemical processes happening in their body. These chemical processes are collectively called metabolism. When there is something wrong with the metabolism, the correct functioning of the organism’s body is hampered resulting in diseases. This is particularly true of human beings and one of the changes that happen in the body is called metabolic syndrome.

A Journalist Reveals contacted Dr. Harshad Limaye Consultant Physician from Nanavati Super Speciality Hospital, Vile Parle, Mumbai to explain to us about metabolic syndrome.

Characteristics: Metabolic Syndrome is also known as Insulin Resistance Syndrome or Syndrome X. It is not a disease by itself, but rather a group of characteristics that often occur together.

These include:

• Obesity, especially in the abdominal area, based on waist size greater than 102 cm in men, or greater than 88 cm in women.
• Impaired fasting glucose, based on fasting blood sugar, greater than 100 mg/dl.
• Increased blood pressure, based on blood pressure of 130/85 mm Hg or higher, or the need for medications for high blood pressure.
• Increased fasting levels of triglycerides, based on levels greater than 150 mg/dl, low fasting levels of HDL cholesterol below 40 mg/dl in men and below 50 mg/dl in women, or the need to take medicines for high triglycerides or low HDL cholesterol.

Having three or more of these characteristics may be labelled as Metabolic Syndrome and it causes resistance to the action of insulin in the body, in this way increasing the risk for:

• Type 2 diabetes (relative risk increased between 2.1 to 3.6 fold).
• Cardiovascular disease, including coronary artery disease leading to heart attacks and cerebrovascular disease which may lead to strokes (relative risk increased between 1.53 to 2.18 fold).

While the clustering of these characteristics had been observed and described many years back, it was first described as Syndrome X in the 1980s and has become commonly known more recently. In one study performed between 1999 and 2002, more than 34% of participants were identified with “Metabolic syndrome”.

Risk Factors: Age-dependent, increases in prevalence rates are known to occur; likewise, there are racial differences in occurrence too.

The following factors increase the risk of developing Metabolic Syndrome:

• Being overweight.
• Menopause (in women).
• Eating a high carbohydrate diet.
• Lack of physical activity.
• Family history of diabetes or Metabolic Syndrome.
• Smoking
• Some drugs, such as the anti-psychotic medication clozapine.

Diagnosis: The diagnosis of Metabolic Syndrome is on the basis of physical examination and blood tests (fasting sugar, cholesterol and triglyceride levels). Some studies have shown increase in other blood markers, but there is no consensus regarding the value of these other markers in diagnosis, as yet.

Managing Metabolic Syndrome: Management of Metabolic Syndrome is based on two major therapeutic goals:

• Treatment of underlying causes (e.g., overweight/ obesity and physical inactivity).
• Treatment of cardiovascular risk factors if they persist in spite of lifestyle modifications.

Weight reduction is optimal when managed with a multi-modality approach including exercise, diet and potential pharmacologic therapy.

• Several dietary approaches have been advocated. Dietary modification is often helpful. Some persons prefer specific diets. e.g., the Mediterranean diet is high in whole grains, nuts, vegetables, fruits and olive oil; the DASH diet requires one to eat no more than 2400 mg of sodium per day, 4-5 servings of fruits, 4-5 servings of vegetables, 2-3 servings of low-fat dairy products and all foods must contain <25% total fat per serving.
• At least 30 minutes of moderate practical physical activity (like brisk walking) on maximum days of the week is advised.
• Removal of abdominal fat by liposuction has not shown to help reduce the risk.

Other lifestyle modifications such as quitting smoking are also beneficial.

High blood pressure, high blood sugar levels and high triglyceride levels may need to be treated with medications, if lifestyle modifications do not bring these under control. The aim of pharmacologic therapy would be:

• Target LDL cholesterol level of <80-100 mg/dl.
• BP of <140/90 mm Hg, maybe even 130/80 mm Hg.
• Target blood sugar levels below 100 mg/dl.

In summary, while experts debate over whether Metabolic Syndrome should be a diagnosis by itself or not, there is no doubt that the cluster of characteristics described above does increase the risk of type 2 diabetes and cardiovascular complications and, therefore, interventions such as lifestyle modifications and if needed medications, are of value.