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What is the metabolic syndrome? The was first described in 1988 by Gerald Reavson It was originally described as the clustering of four conditions These conditions when present together, increased the risk of CVD The four conditions were: 1. Glucose intolerance 2. Hypertension 3. Dyslipidemia 4. Central Obesity
1. Glucose intolerance Glucose intolerance means that glucose metabolism in that individual is impaired The simple way to test for this is to measure fasting blood glucose Fasting blood glucose is considered abnormal when it is higher than 5.6 mmol/litre Glucose intolerance = Fasting blood glucose >5.6 mmol/l
2. Hypertension The level at which one is considered to be hypertensive has changed over the years Blood pressure levels that were once considered acceptable are now considered to be too high Current status Blood pressure now considered to be raised if Systolic BP > 130 Diastolic BP >85
3. Dyslipdemia The abnormalities associated with the can consist of either: Low HDL cholesterol or Raised triglycerides A raised triglyceride level is one that is > 1.7 mmol/l A reduced HDL-cholesterol level is one < 1.03 mmol/l (in males) or <1.29 mmol/l (in females)
3. Central Obesity Central obesity describes the accumulation of excess fat around the waist or abdominal region Abdominal fat is a reflection of the visceral fat metabolically active fat produces inflammatory hormones promote plaque formation and thrombosis in the blood vessels. releases free fatty acids which predispose to fatty liver Central obesity is considered to be present if: Waist circumference is greater than 80 cm. (in women) Waist circumference is greater than 94 cm. (in men)
Central Obesity and Ethnicity Acceptable waist circumference varies according to ethnicity The 80 cm for females and 94 cm for males is only correct for Caucasians For people of South Asian and Chinese descent, the acceptable measurements are lower central obesity is considered to be present if: waist circumference is >90 cm. (in men) waist circumference is >80 cm. (in women)
has been described by many other names The four conditions that constitute the syndrome were initially referred to, in medical circles, as the Deadly Quartet because they significantly increase the risk of developing cardiovascular disease Another very popular alternative name is Syndrome X
Further research into this syndrome has found other abnormalities in patients who have the These conditions include: Elevated Uric Acid levels Hyperfibrinogenemia with increased tendency of the blood to clot Increase in the small, dense LDL particles Disorders of endothelial function
There are various accepted definitions of the metabolic syndrome 1. The WHO (World Health Organisation) definition 2. The IDF (International Diabetes Federation) definition 3. The NCEP/ATP (National cholesterol Education Program/Adult Treatment Panel) III definition
World Health Organisation (WHO) definition in order to make a diagnosis of metabolic syndrome it is necessary to have: at least 3 of the 4 possible original conditions or 2 of the major and 2 of the secondary abnormalities Major: Glucose intolerance Hypertension Dyslipidemia Central Obesity Minor: Elevated Uric Acid levels Hyperfibrinogenemia Increase in small dense LDL particles Disorders of endothelial function
International Diabetes Federation Definition The latest classification is the one described by the IDF Its main focus is central obesity In order diagnose one needs the following: 1. Central obesity As well as any two of the following: Raised blood pressure Raised serum triglyceride levels Reduced HDL-cholesterol levels Impaired fasting blood sugar levels
Why is this diagnosis important? Knowing that you have metabolic syndrome is important because it increases the risk of cardiovascular disease increases the risk of diabetes A Finnish study reported in JAMA showed risk of death from coronary heart disease increased X 3 risk of developing Type 2 Diabetes increased X 5 Diagnosis suggests careful assessment of related co-morbidities If identified early, it is possible to treat and prevent many of the risk factors
Epidemiology and Prevalence Metabolic syndrome affects at 13%-22% of adults in Australia (2007 AusDiab study) Metabolic syndrome affects >33% of adults in the USA (2009 United states National Health and Nutrition examination Survey) Metabolic syndrome increases with age Metabolic syndrome is fuelled by central obesity
There is a common underlying abnormality in all cases of Metabolic syndrome Insulin Resistance
Insulin Resistance The function of insulin is to assist the movement of glucose into cells Cell membranes are usually impermeable to glucose Insulin works like a key that opens the door for glucose to get through the cell membrane In some people the cell membranes do not respond to the body s own insulin as effectively as they should As a result, a standard amount of insulin does not achieve the expected effect on glucose into the cell This causes the blood sugar levels stay elevated This decrease in the efficacy of insulin is called Insulin Resistance
Insulin Resistance The body tries to drive blood sugar levels down to normal levels It does this by increasing pancreatic insulin release Increased production of insulin compensates for the insulin resistance pushing more glucose into the cells This causes higher levels of insulin to circulate in the blood stream The higher insulin levels cause unwanted side effects Major side effect is the impact on fat metabolism Increased triglyceride formation Increased fat storage Decreased fat utilization Subsequent weight gain
Causes of insulin resistance Genetics Excess Weight Visceral fat Inactivity Diet Age Two other factors can aggravate insulin resistance - pregnancy and oral contraceptives
Metabolic effects of Insulin Resistance Hypertension High levels of triglycerides Low HDL Increased LDL Increased blood viscosity Increased uric acid Microalbuminuria Premature atherosclerosis. Left ventricular hypertrophy Stimulation of ovarian and adrenal male hormone production Increased risk of miscarriage
How to improve insulin resistance? Lose weight Reduce abdominal fat Exercise Eat less refined carbohydrates Eat less saturated fat Eat more fish