metabolic syndrome
syndrome X
insulin resistance syndrome
deadly quartet
obesity dyslipidemia syndrome
Hyperinsulinemia
Hyperglycemia
Adipokines
vascular endothelial
dysfunction
abnormal lipid profile
hypertension
vascular inflammation
CVD
abdominal obesity insulin resistance
National Cholesterol Education
Program/ATP III 2005 Abdominal obesity, waist circumference in men
>102 cm ,in women >88 cm
triglycerides ≥150 mg/dL or drug treatment for elevated triglycerides
HDL cholesterol <40 mg/dL in men ,<50 mg/dL in women or drug treatment for low HDL-C
Blood pressure ≥130/85 mmHg or drug treatment for elevated blood pressure
Fasting plasma glucose (FPG) ≥100 mg/dL or drug treatment
Metabolic syndrome = 3 of above
International Diabetes
Federation 2006 Increased waist circumference (ethnic –specific
cutpoint)
◦ ≥ 94cm for Europid men and ≥ 80cm for Europid women,
PLUS any two of the following:
Triglycerides >150 mg/dL or treatment for elevated triglycerides
HDL cholesterol <40 mg/dL in men or <50 mg/dL in women, or treatment for low HDL
Systolic blood pressure >130, diastolic blood pressure >85, or treatment for hypertension
Fasting plasma glucose >100 mg/dL or previously diagnosed type 2 diabetes
Alberti & Zimmet WHO 1998 Diabetic Medicine.
IGT/IFG or
type 2 diabetes
Central Obesity
WHR > 0.9 men
> 0.8 women
or BMI > 30 kg/m²
Microalbuminuria
UAE 20 µg min
Insulin resistance
(glucose uptake below
lowest quartile)
Triglycerides 1.7 mmol/l
& HDL-Ch < 0.9 mmol/l
Blood pressure
140/90 mmHg
METABOLIC SYNDROME
The Metabolic Syndrome:
WHO criteria
Prevalence (USA)
NHANES III, 1988 to 1994: 22 %
In normal weight: 5 %
In overweight : 22 %
In obese: 60 %
Higher in Mexican-Americans
NHANES 1999 to 2002 : 34.5 %( ATP III
criteria )
Tehran Lipid and Glucose Study
10,368 men and women aged ≥20 years
prevalence of MES :
◦ 32.1% (31.2–33.0) by the IDF definition
◦ 33.2% (32.3–34.1) by the ATPIII
◦ 18.4% (17.6–19.2) by the WHO definition
2007 on 3,024 Iranians 25–64 years
urban and rural areas
all 30 provinces in Iran
◦ 34.7% (95% CI 33.1–36.2) based on the ATP III
◦ 37.4% (35.9–39.0%) based on the IDF
◦ 41.6% (40.1–43.2%) based on the ATP III/AHA/NHLBI criteria
higher in women, in urban areas, and in the 55- to 64-year
cutoff point of waist circumference
◦ 89 cm for men and 91 cm for women
Isfahan Healthy Heart Program
12,514 adults (≥ 19 years) living in urban
and rural areas of 3 cities in Iran
prevalence of Met S was 23.3%, with a
higher prevalence in women compared to
men (35.1% vs. 10.7%, P < 0.05)
Nizal SarrafzadeganaMetabolic syndrome: An emerging public health problem in Iranian Women: Isfahan
Healthy Heart Program.International Journal of Cardiology ,Volume 131, Issue 1, 17 December 2008, Pages 90–96
2752 adults (1046 men)
two or more of risk factors from the IDF criteria
WC cut-off yielding maximum sensitivity plus specificity for predicting the presence of multiple risk factors was 91.5 cm in men and 85.5 cm in women
MetS prevalence was estimated to be approximately 27% in Tehran.
Waist circumference cut-off points for the diagnosis of metabolic
syndrome in Iranian adults.Diabetes Research and Clinical Practice.Volume 82, Issue 1, October 2008, Pages 104–107
risk factors of metabolic syndrome
age, race, and weight
postmenopausal status
Smoking
low household income, high carbohydrate diet, soft drink consumption
physical inactivity
Clozapine
poor cardiorespiratory fitness
Risk of type 2 diabetes
meta-analysis of 16 multi-ethnic cohort studies
RR of developing diabetes :3.53 to 5.17
the risk increased with increasing number of components of the metabolic syndrome
metabolic syndrome
proinflammatory, prothrombotic state
elevated levels of C-reactive protein
(CRP), interleukin (IL)-6, and plasminogen
activator inhibitor (PAI)-1
Risk of CVD
Three meta-analyses
RRs for developing CVD :1.53 to 2.18
RRs of all cause mortality:1.27 to 1.60
The Framingham Risk Score was a better
predictor of CHD and stroke than
metabolic syndrome
Other associations
Fatty liver disease Hepatocellular and intrahepatic
cholangiocarcinoma
Chronic kidney disease (CKD) (GFR< 60 mL/min per 1.73 m2) ,microalbuminuria
Polycystic ovary syndrome
obstructive sleep apnea
Hyperuricemia and gout
cognitive decline and dementia ?
comparing the Mediterranean diet with a
low-fat prudent diet
Mediterranean diet group had greater
weight loss, lower blood pressure,
improved lipid profiles, improved insulin
resistance, and lower levels of markers of
inflammation and endothelial dysfunction
The Dietary Approaches to Stop Hypertension (DASH) diet (daily sodium intake limited to 2400 mg, and higher in dairy intake than the Mediterranean diet), compared to a weight reducing diet emphasizing healthy food choices, resulted in greater improvements in triglycerides, diastolic blood pressure, and fasting glucose, even after controlling for weight loss
A high fiber diet (≥30 g/day) resulted in
similar weight loss as compared with a
more complex diet recommended by the
American Heart Association (fruits,
vegetables, whole grain, high fiber, lean
animal and vegetable proteins, reduction
in sugar-sweetened beverages, moderate
to no alcohol intake)
Exercise
practical, regular, and moderate regimens
for exercise
minimum of 30 minutes of moderate-
intensity such as brisk walking
Removal of abdominal adipose tissue with
liposuction does not improve insulin sensitivity
or risk factors for coronary heart disease