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 The Metabolic Syndrome describes a clustering of factors including dyslipidaemia, glucose intolerance and hypertension with central adiposity. The syndrome is increasing in prevalence worldwide as a consequence of increasing obesity prevalence. Metabolic syndrome is likely to have a marked impact on the prevalence of cardiovascular disease and type 2 diabetes worldwide in the next two decades.
According to the British Nutrition Foundation the metabolic syndrome is a public health time bomb. It may affect as many as 1 in 5 adults in some parts of Europe, greatly increasing the risk of developing heart disease and stroke. The metabolic syndrome is a ticking time bomb, and unless something is done about it, it will cost the European economy billions, and millions of people across Europe could die prematurely. Body weight plays an important role in the development of the metabolic syndrome and with obesity spiralling out of control (20% of men and 25% of women in some parts of Europe are obese) the problem is only set to get worse. Metabolic Syndrome is a combination of medical disorders that increase the risk of developing cardiovascular disease and diabetes. It affects a large number of people all round the world but more so in developed countries. 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
- Elevated triglycerides
Associated diseases and signs are: elevated uric acid levels, fatty liver (especially in concurrent obesity), progressing to non-alcoholic fatty liver disease, polycystic ovarian syndrome, hemochromatosis (iron overload); and acanthosis nigricans (a skin condition featuring dark patches). 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/or 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
Causes The cause of Metabolic Syndrome are unknown but research has shown that the people most likely to be affected and importantly are older people, obese, sedentary and those who have a low resistance to insulin, genetics and those with low physical activity. Waistlines over 40 inches for men and 35 for women, these people should be concerned especially if they suffer from the hypertension (blood pressure) levels abve those shown above. Not all doctors agree on the definition or cause of metabolic syndrome. The cause might be insulin resistance. Insulin is a hormone your body produces to help you turn sugar from food into energy for your body. If you are insulin resistant, too much sugar builds up in your blood, setting the stage for disease. Type 2 Diabetes Type 2 diabetes occurs when the pancreas does not produce enough insulin to meet the body's needs or the insulin is not metabolized effectively. Type 2 diabetes is usually treated through diet and exercise, although some people must also take oral medications or insulin. Treatment typically includes diet control, exercise, home blood glucose testing, and in some cases, oral medication and/or insulin. Approximately 40% of people with type 2 diabetes require insulin injections. Intervention It is important to intervene into metabolic syndrome at an early stage, reducing the risk of type 2 diabetes developing. Diet and exercise are the critical factors in solving this problem. Weight loss, increased exercise levels and a healthy diet are the primary tools in managing metabolic syndrome. Treatment The first line treatment is a 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 for 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. 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. Studies have also shown that Diuretics (water pills) have helped reduce incidence of cardio-vascular disease and to lower hypertension (blood pressure. They have been found to be preferable to other treatments like blood pressure medications including calcium channel blockers which relax blood vessels; ACE inhibitors that prevent the formation of a hormone which causes blood vessels to narrow; and alpha blockers that reduce nerve impulses that constrict vessels. What to do? More physical exercise, at least a fast walk for 30 minutes a day and avoidance of high fat, salt and sugar diets especially in ready made meals and fast food. Fresh fruit and vegetables must be made a high proirity in preparing meals and eating snacks. Last update : 09-05-2008 08:21
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