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Metabolic syndrome is a condition that includes the presence of a cluster of risk factors specific for cardiovascular disease. Metabolic syndrome significantly raises the risk of developing diabetes, heart disease, and/or stroke.
Most people who have metabolic syndrome have insulin resistance. The body makes insulin to move glucose (sugar) into cells for use as energy. Obesity, commonly found in people with metabolic syndrome, makes it more difficult for cells in the body to respond to insulin. If the body can’t make enough insulin to override the resistance, the blood sugar level increases, and type 2 diabetes can result. Metabolic syndrome may be a beginning of the development of type 2 diabetes.
Because the population of the United States is aging, and because metabolic syndrome prevalence increases with age, the American Heart Association has estimated that metabolic syndrome soon will become the primary risk factor for cardiovascular disease, ahead of cigarette smoking. Increasing rates of obesity are also thought to be related to the increasing rates of metabolic syndrome.
The cluster of metabolic factors involved, according to the National Heart, Lung, and Blood Institute (NHLBI), includes:
The NHLBI and AHA recommend a diagnosis of metabolic syndrome when three or more of these factors are identified.
Because of the involvement of several interconnected factors in metabolic syndrome, the direct cause is not clearly understood. The rise in obesity, coupled with a sedentary lifestyle, contributes to risk factors for metabolic syndrome, such as high cholesterol, insulin resistance, and high blood pressure. These risk factors may lead to cardiovascular disease and type 2 diabetes.
Because metabolic syndrome and insulin resistance are closely associated, many health care professionals believe that insulin resistance may be a cause of metabolic syndrome. However, a direct link between the two conditions has not been established. Others believe that hormone changes, caused by chronic stress, lead to the development of abdominal obesity, insulin resistance, and elevated blood lipids (triglycerides and cholesterol).
Other factors that are thought to contribute to the development of metabolic syndrome include genetic variations in a person's ability to break down lipids (fats) in the blood, older age, and abnormalities in the distribution of body fat.
A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases have different risk factors.
Knowing your risk factors for any disease can help to guide you to take the appropriate actions, including changing behaviors and being monitored by your doctor for the disease.
Risk factors most closely associated with metabolic syndrome include:
Having high blood pressure, elevated triglycerides, and being overweight or obese may be signs of metabolic syndrome. People with insulin resistance may have acanthosis nigricans, which is darkened skin areas on the back of the neck, in the armpits, and under the breasts. In general, however, people do not directly experience symptoms of metabolic syndrome.
The indications of metabolic syndrome may resemble other conditions. Consult your health care provider for a diagnosis.
The National Cholesterol Education Program's Adult Treatment Panel III, the World Health Organization, and the American Association of Clinical Endocrinologists have each developed a set of criteria to be used as an aid in diagnosing metabolic syndrome. Criteria for diagnosing metabolic syndrome include:
Each organization has its own guidelines for using the above criteria to establish a diagnosis of metabolic syndrome.
Specific treatment will be determined by your health care provider based on:
Because metabolic syndrome increases the risk for the development of more serious, chronic conditions, such as cardiovascular disease and type 2 diabetes, treatment for metabolic syndrome is important. Other conditions that may develop as a result of metabolic syndrome include:
Here are the types of treatment that may be recommended for metabolic syndrome.
A program of weight loss, behavioral counseling (such as working with a dietitian for nutritional support), and exercise provide the foundation of treatment for metabolic syndrome. Weight loss increases HDL cholesterol (the "good" cholesterol) and decreases the harmful type of LDL cholesterol and triglycerides. Weight loss can also reduce the risk of type 2 diabetes.
Even a modest weight loss can lower blood pressure and increase sensitivity to insulin, as well as reduce central obesity. Together, diet, behavioral counseling, and exercise decrease risk factors more than diet alone.
Other lifestyle management factors include smoking cessation and limiting alcohol consumption.
Changes in dietary habits are important in the treatment of metabolic syndrome. According to the AHA, treatment of insulin resistance is necessary to achieve the greatest benefit for modifying metabolic risk factors. In general, the best way to treat insulin resistance is through weight loss and increased physical activity. Incorporating multiple methods, such as making diet changes and maintaining a regular amount of moderate to vigorous physical activity, may be beneficial.
Exercise benefits people who are overweight or obese by helping to keep and add lean body mass, or muscle tissue, while losing fat. It also helps to increase the rate at which weight is lost if a person is eating healthy food according to a meal plan because muscle tissue has a higher rate of metabolism, thus burning calories faster.
People who have metabolic syndrome and who are at risk may be candidates for medication therapy, especially if other measures, such as dieting and lifestyle changes, have failed to produce acceptable results with weight loss, decreased blood pressure, lowered cholesterol levels, and/or decreased insulin resistance. Medications may be prescribed to help lower blood pressure, improve insulin metabolism, lower LDL cholesterol and raise HDL cholesterol, and/or increase weight loss.
Weight-loss surgery (bariatric surgery) is the only option today that effectively treats morbid obesity in people for whom more conservative measures, such as diet, exercise, and medication, have failed.
Metabolic syndrome significantly raises the risk of developing diabetes, heart disease, and/or stroke.
The best way to prevent metabolic syndrome is to maintain a healthy weight, eat a healthy diet that minimizes the use of salt, sugars, solid fats, and refined grains, and stay physically active.
Metabolic syndrome is a lifelong condition that will require changes in your lifestyle. If you already have heart disease and/or diabetes, follow your health care provider’s recommendations for managing these conditions.
Lifestyle changes involved in managing metabolic syndrome include:
Tips to help you get the most from a visit to your health care provider:
Bayhealth is Southern Delaware’s healthcare leader with hospitals in Dover and in Milford. Bayhealth provides a wide range of medical services, including cardiovascular, cancer, orthopaedics and rehabilitation, pediatrics, respiratory care, sleep care, surgical weight loss and women’s services.