What is Metabolic Syndrome?
Metabolic syndrome refers to a group of health conditions that increase a person’s risk for heart diseases, like heart attacks, strokes, and issues with the blood vessels in their arms and legs. It also raises the risk for insulin resistance, a state where the body does not use insulin effectively, leading to type 2 diabetes. The conditions that make up metabolic syndrome are obesity, particularly around the waist, insulin resistance, high blood pressure, and a type of condition called atherogenic dyslipidemia that changes the levels of cholesterol and other fats in your blood.
For a doctor to diagnose metabolic syndrome, a person needs to have three or more of these indicators:
* A waist size of 40 inches or more in men, or 35 inches or more in women.
* A blood test showing fats called triglycerides at 150 mg/dL or above.
* A type of “good” cholesterol, known as high-density lipoprotein cholesterol, under 40 mg/dL in men or under 50 mg/dL in women.
* A blood sugar level over 100 mg/dL after fasting.
* Blood pressure resulting in 130 mm Hg (systolic) or above, or 85 mm Hg (diastolic) or above.
People with metabolic syndrome are approximately two times more susceptible to develop heart diseases and five times more prone to develop diabetes, compared to the general public. Metabolic syndrome is also linked to the rapid development of heart disease-related illnesses and early onset type 2 diabetes. A lack of physical activity, together with overeating, has contributed to a sharp rise in obesity, which, in turn, is leading to more cases of metabolic syndrome.
Central obesity is the key component of metabolic syndrome, which can lead to insulin resistance, high blood pressure, and dyslipidemia. A person’s experience of metabolic syndrome can vary and it depends on the underlying heart disease they have. The common symptoms of metabolic syndrome include abdominal obesity, high blood pressure, and signs that the body is not using insulin properly. Metabolic syndrome poses serious health risks. Its prevalence is increasing, but with interventions like adopting a healthy lifestyle, the progress of the syndrome can be stopped and potentially even reversed.
What Causes Metabolic Syndrome?
Metabolic syndrome is a health condition that comes from a mix of different causes. In many cases, it’s due to a combination of genetics, key lifestyle choices, and other factors. These lifestyle factors include obesity, not getting enough physical activity, and not maintaining a healthy diet.
The main issue in metabolic syndrome is excess fat build-up, especially in the belly area. This leads to a condition known as insulin resistance, which is when your body doesn’t respond well to insulin (a hormone that helps control blood sugar levels). Fat cells in the body release harmful substances called proinflammatory cytokines (like tumor necrosis factor, leptin, adiponectin, plasminogen activator inhibitor, and resistin), which indirectly affect and impair insulin.
Insulin resistance can be something you’re born with (genetic predisposition) or develop later in life. It can happen due to various issues – interruption of the signaling pathway that coordinates body functions, defects in insulin receptors (parts of cells that respond to insulin), or faulty insulin secretion. The primary cause of insulin resistance is often excessive belly fat, which is primarily caused by consuming excessive calories. In the long run, such conditions lead to metabolic syndrome, which can harm your blood vessels and interfere with your body’s usual workings.
Even though the surroundings you live in and the lifestyle you live play significant roles in causing metabolic syndrome, it’s important not to ignore the role of genetics. Studies have shown that children of parents who are obese are often more at risk of obesity themselves compared to other people. There is evidence that the risk of disease as an adult can be influenced by the environment and nutrition during early life. Therefore, a mother’s lifestyle and the nutrition she provides during and after pregnancy can have a significant impact on the risk of metabolic syndrome in her children.
Risk Factors and Frequency for Metabolic Syndrome
Metabolic syndrome, a condition often related to obesity, is increasingly common worldwide. According to data from a 2012 U.S. health and nutrition survey, about a third of adults had metabolic syndrome, up from about a quarter. Remarkably, South Asian Americans were found to have a particularly high rate of metabolic syndrome, even though their obesity rate was lower than that of non-Hispanic white people. Interestingly, the start of the 21st century saw a peak in metabolic syndrome’s prevalence in the U.S. However, improvements in diagnosing and treating related conditions like imbalanced cholesterol levels and high blood pressure have led to a gradual decrease, despite a rise in obesity.
In 2012, the rate was found to be 22% for women and 24% for men. Roughly a quarter of people in Europe and Latin America have metabolic syndrome, while in China, the condition has become more common over the last 30 years, reaching an estimated 15.5% in 2017. Surprisingly, metabolic syndrome isn’t limited to adults. As of 2020, around 3% of children and 5% of teenagers worldwide were found to have metabolic syndrome, with slightly higher rates in low-income countries. This suggests that a country’s wealth doesn’t necessarily mean its people are less likely to have metabolic syndrome.
As people age, the chances of having metabolic syndrome increase. By people’s 60s, around 40% of them have metabolic syndrome. While both men and women can develop the condition, certain ethnic groups have seen slightly higher rates in women than men.
Signs and Symptoms of Metabolic Syndrome
Metabolic syndrome, a cluster of conditions that increase the risk of heart disease, stroke, and type 2 diabetes, is identified through a combination of physical exams and lab tests. However, understanding the patient’s history is crucial. This can include learning about their lifestyle, diet, and family health background. If there’s a history of early heart disease in the family, for example, this could prompt further investigation into the aspects of metabolic syndrome. Classic symptoms like excessive thirst, frequent urination, and increased hunger could indicate diabetes, a common component or consequence of metabolic syndrome.
Other details like social habits, such as smoking, are also gathered. This can highlight factors that can worsen cardiovascular complications tied to metabolic syndrome. Tools like physical exams and patient history are irreplaceable when it comes to identifying, treating, and preventing the disease.
When the patient is first examined, the doctor will evaluate their general appearance and vital signs. This basic check can already hint at the presence of metabolic syndrome. To confirm the diagnosis, more specifics are needed. For instance, the patient’s waist circumference should be measured. Other signs the doctor will look for during the physical exam include changes in skin color (acanthosis nigricans) which could suggest insulin resistance, and fat deposits under the skin (xanthomas) that could signify high lipid levels in the blood.
Testing for Metabolic Syndrome
When your doctor suspects you may have metabolic syndrome, they will undertake a series of tests. After asking you about your health history and doing a physical examination, they will prescribe a series of blood tests. These tests are important to measure the levels of specific chemicals in your blood that can indicate the presence of metabolic syndrome.
Typically, these tests will include measurements of fasting blood glucose and hemoglobin A1c to check for imbalances related to sugar processing and diabetes. Your doctor may also order a lipid panel, which is a type of blood test that measures fats in your blood. This can help assess if you have abnormally high levels of triglycerides, low levels of ‘good cholesterol’ (HDL), and high levels of ‘bad cholesterol’ (LDL).
In addition to these, a basic metabolic panel is also recommended to check kidney function. Depending on your specific case, your doctor might also request further tests including C-reactive protein, liver function tests, thyroid studies, and uric acid, to help understand whether you have any associated conditions. Some conditions, such as an underactive thyroid (hypothyroidism), can increase the risk of metabolic syndrome, and in people with metabolic syndrome, uric acid is often found to be high as it suggests a chronic inflammation in the body.
If metabolic syndrome is confirmed, the next step is to evaluate any possible complications. Current guidelines recommend assessing your risk of atherosclerotic cardiovascular disease (ASCVD), a condition where fatty deposits build up in your arteries that can lead to heart disease. If you are at high risk, or if someone in your family has had premature ASCVD, the doctor can decide to perform a coronary calcium score to further assess heart disease. This is a type of special X-ray test that provides pictures of your heart that can help your doctor detect and measure calcium-containing plaque in the arteries.
Further imaging tests might be required if you have symptoms related to your heart. These could include a cardiac stress test, which monitors your heart while you exercise; an electrocardiogram stress test, which measures your heart’s electrical activity; or stress echocardiography, which uses sound waves to produce images of the heart. In some cases, a stress single-photon emission computed tomography or myocardial perfusion imaging test might be used to visualize blood flow to your heart.
Treatment Options for Metabolic Syndrome
Metabolic syndrome is a worldwide health concern affecting a multitude of people across different regions. The main aim of treatment is to identify and address the risk factors, with the goal of lowering the risk of complications such as heart disease. There are two key ways to manage metabolic syndrome: through lifestyle changes and medical treatment.
Lifestyle Changes
As all elements of metabolic syndrome are connected to lifestyle, making healthy lifestyle changes is an effective way to manage the risk factors and prevent related heart disease. The main goal is to balance the calories you consume with the calories your body needs. Experts suggest that you should aim to reduce your baseline body weight by 7% to 10% over the course of a year, keeping active and consuming fewer calories to achieve this. The ultimate goal is to reach and sustain a body mass index (BMI) of less than 25 kg/m2, which is considered a healthy weight.
Organizations like the American Heart Association and the American College of Cardiology recommend at least 150 minutes of moderate exercise, or 70 minutes of high-intensity exercise per week. A healthy diet, which includes lots of fruits, vegetables, legumes, whole grains, nuts, and fish can also lower the risk of heart disease. It’s also recommended to avoid processed foods, foods high in saturated fats and sodium, and limit alcohol intake. Having a good sleep routine, avoiding tobacco, managing stress, and maintaining social connections are also important for maintaining a healthy lifestyle.
Medical Treatment
If lifestyle changes are not working, medication might be necessary. Medication is often used to treat dyslipidemia (high levels of fats in the blood), high blood pressure, and insulin resistance or diabetes, which are common in people with metabolic syndrome. Always remember, it’s important to keep taking the medication as prescribed by your doctor to manage these conditions.
Some patients might be advised to try plant-based treatments to help manage metabolic syndrome, but more research is needed to determine their effectiveness. In addition, people with metabolic syndrome may need to take multiple medications, so it’s important to follow treatment plans closely.
Surgery
For those with severe obesity, weight loss surgery, also known as bariatric surgery, can be beneficial and is often the most effective single treatment for metabolic syndrome. Common procedures include laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass, and laparoscopic sleeve gastrectomy. This type of surgery is mainly recommended for people with a BMI of over 40 kg/m2, or over 35 kg/m2 with other health issues. It’s important for patients to have regular follow-ups after surgery to minimize the risk of complications related to the surgery, nutrition and mental health.
What else can Metabolic Syndrome be?
Metabolic syndrome refers to a mix of health issues that increase the risk of heart disease and other health problems, such as diabetes and stroke. These health issues may have various causes which doctors need to understand to make the correct diagnosis.
The conditions that might cause metabolic syndrome can include:
- Diseases of the kidneys, or renal parenchymal diseases
- Diseases affecting the blood vessels in the kidneys, or renovascular diseases
- Conditions that relate to the glands of the body, or endocrine disorders
- Narrowing of the aorta in the heart, or coarctation of the aorta
- Underactive thyroid, or hypothyroidism
These conditions all could potentially lead to high blood pressure, unhealthy cholesterol levels, and obesity – these are the main problems in metabolic syndrome.
Physical conditions that might look similar to metabolic syndrome, but are different, include:
- A fertility problem in women, or polycystic ovarian syndrome
- A rare tumor that can cause high blood pressure, or pheochromocytoma
- A disorder causing weight gain and specific changes in the face, or Cushing syndrome
- An uncommon condition where the body produces too much growth hormone, or acromegaly.
These disorders must be correctly distinguished from metabolic syndrome, so the most effective treatment can be started.
What to expect with Metabolic Syndrome
The future health situation of people with metabolic syndrome is greatly influenced by how severe its components are and if they have complications related to the heart and blood vessels. Heart and blood vessel-related complications signal a more serious condition for people with metabolic syndrome. Their risk for these complications is suggested to increase due to the presence of multiple risk factors for ASCVD (a condition where the arteries are narrowed or blocked).
Studies have shown that individuals with metabolic syndrome are more than twice more likely to experience heart-related events compared to those without it, indicating a less favorable health outlook. Nevertheless, recent breakthroughs in treating ASCVD have greatly improved the health outcomes.
Possible Complications When Diagnosed with Metabolic Syndrome
People with metabolic syndrome often experience a variety of heart-related complications due to their related risk factors. In fact, research has shown that these patients have over twice the risk of events like heart attacks, strokes, and heart failure, and this is true regardless of the patient’s age, gender, or whether they have diabetes. Diabetes is another complication often seen in those with metabolic syndrome. Nearly all patients with metabolic syndrome eventually develop diabetes, which in turn increases their risk of heart disease and small blood vessel diseases.
In addition, those with metabolic syndrome who also struggle with obesity may face other complications. These can include sleep apnea (a condition where breathing stops and starts during sleep), pulmonary hypertension (high blood pressure affecting the arteries in the lungs and the right side of the heart) and osteoarthritis (a common form of arthritis that occurs when the protective cartilage that cushions the ends of your bones wears down over time).
Common Complications of Metabolic Syndrome:
- Increased risk of heart-related events (heart attacks, strokes, heart disease, etc.)
- Diabetes
- Sleep apnea
- Pulmonary hypertension
- Osteoarthritis
- Additional risks for those with obesity
Preventing Metabolic Syndrome
Here are some suggestions for people dealing with metabolic syndrome:
* Try to adopt a healthy lifestyle and aim for a Body Mass Index (BMI – a measure of body fat based on your weight and height) of less than 25 kg/m2.
* Regular physical activity can reduce your risk of heart diseases and increase your chances of living longer.
* Try to get at least 150 minutes of moderate-intensity exercise, like brisk walking, each week.
* Eat a diet filled with vegetables, fruits, legumes (like lentils and beans), whole grains, and fish.
* Try to avoid foods with refined carbohydrates (like white bread and pastries) and foods high in sodium (salt) and saturated fats.
* Quit smoking and limit your alcohol consumption.
* Make sure to get enough sleep and get treated for obstructive sleep apnea (a sleep disorder where your breathing starts and stops) if it’s a problem.
