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Metabolic Syndrome

Prepared by Dr.Anees AlSaadiCommunity Medicine Residents

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• History and Definition.• Criteria of Diagnosis. • Epidemiology.• Risk Factors.• Complications • Etiology.• Group Exercise. • Prevention.

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Definition

Agr

eem

ent

on O

ne

crit

eria

His

tory

of

the

Dis

ease

s

Many Definitions.

Changing Diagnostic Criteria.

1988 Reaven

1998

WHO

1999 EGIR

2001 NCEP ATPIII

2005 AHA/NHLBI

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Definition

• Clustering of Risk Factors:– Impaired Glucose test.– Hyperinsulinemia.– High Triglycerides.– Low HDL.– HyperUricemia.– High PAI-1

Dr. Reaven “ Syndrome X” 1988

Coronary Heart Disease.DMII.Hypertension.

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Insulin Resistance.

BMI ≥ 30kg/m²

Hypertension 140/90mmHg

Microalbumineuria

• WHO 1998

Insulin Resistance Syndrome.

Excluding DMII. fasting Insulin.

Obesity By Waist Circumference.

Hypertension.

Dyslipidemia.

Coronary Heart Disease.

• European Group for the Study of Insulin Resistance 1999

Metabolic Syndrome.

• NCEP/ATPIII 2001• IDF/AHA/NHLBI

2005

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Definition

Metabolic Syndrome

Dyslipidemia

Diabetes Mellitus Hypertension

Central Obesity

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DefinitionCentral Obesity

Abdominal Waist Circumference

≥102 cm (40 in) in men

≥ 88 cm (35 in) in women

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DefinitionDyslipidemia

Serum Lipids• TG ≥ 150 mg/dl (1.7 mmol/L)

• HDL ˂ 40 mg/dl (1.03 mmol/L) in men

˂ 50 mg/dl (1.30 mmol/L) in women

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DefinitionDiabetes Mellitus

Fasting Glucose

≥ 100 mg/dl (5.6 mmol/L)

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DefinitionHypertension

Blood pressure

≥ 130 mm Hg systolic blood pressure.

≥ 85 mm Hg diastolic blood pressure.

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EpidemiologyInternational Burden

• U.S. prevalence adults (22% - 34.6%) [IDF 2006]• Sweden prevalence (24% m &19% f)[IDF 2007]• India prevalence of (19.52%) [ATPIII 2010]

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EpidemiologyRegional Burden

• Turkey 33.9% (28% m & 39.6% f) [ATP III/ 2007]• Iranian (34.7%m &37.4%f) [ ATPII, IDF/ 2007]• Tunisia (24.3%m, 45.5%f) [ ATPIII, IDF/2007]

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EpidemiologyRegional Burden

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EpidemiologyRegional Burden

• Jordan 37.4% (31.7% m & 41.0% f)[ATPIII/ 2007]

• Oman 21.0% [ATPIII/ 2003]

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Situation in Qatar

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EpidemiologySituation in Qatar

• Overall prevalence of among obese patients was 46.3%.

• The prevalence was higher in females (50%) than in males (42.4%).

• [IDF/ 2010]

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EpidemiologySituation in Qatar

• Overall prevalence 3.0% in children aged 6–12 years.

• The prevalence 9.5% in overweight and obese subjects.

• Increased TG frequent abnormality (28.4%) .

• Low HDL-C (19.4%) .

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Where Can You Find The Highest Metabolic

Syndrome ….?

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WHAT

ARE

THE

RISK FACTORS

FOR

METABOLIC SYNDROME?

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EpidemiologyRisk Factors

• Age.

• Gender.

• Race.

• More than 40% of individuals 60 years.

• Increasing prevalence among women.

• African American and Mexican American populations.

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5% Normal Weight.

60% Obese.

22% Overweight.

EpidemiologyRisk Factors

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EpidemiologyRisk Factors

• Low socioeconomic status.

• Lack of physical activity.

• High carbohydrate diet.

• No alcohol intake.

• Smoking.

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What are

the Complications of

Metabolic Syndrome?

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Complications

7 X DMII

2 X CVD

1.5 X Mortality

Metabolic Syndrome

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Complications

–Cognitive decline (elderly).– Fatty liver disease, –Polycystic ovary syndrome. –Obstructive sleep apnea.– Gout.–Chronic Kidney Disease.

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Etiology

Genetic Susceptibility

Environmental Factors

Metabolic Syndrome

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Prevention

Fighting

The Related

Risk Factors.

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Group Exercise

Outline

Prevention Program

For Obesity ….

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Pri

mar

y P

reve

ntio

n Promotion of Healthy Eating.

Promotion of Physical Activity

Healthy School Initiatives

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Sec

onda

ry P

reve

ntio

nScreening for

Obesity.

Management of Healthy life style

Medications/ Surgery

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Medications :

BMI ˃27 + comorbidity

OR

BMI ˃30

OR/and

If no weight loss after (3-6 months) of life style changes.

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Bariatric Surgery

BMI ˃35 + Co-morbidity.

BMI ˃ 40.

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References :• Study in Americans: • Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings

from the third National Health and Nutrition Examination Survey.J Am Med Assoc 2002;287(3):356–9.

•  • Maggi S, Noale M, Gallina P, et al. Metabolic syndrome, diabetes, and cardiovascular disease in an

elderly Caucasian cohort: the Italian longitudinal study on aging. J Gerontol A Biol Sci Med Sci 2006;61(5):505–10.

•  • Patel A, Huang KC, Janus ED, et al. Is a single definition of the metabolic syndrome appropriate? A

comparative study of the USA and Asia. Atherosclerosis 2006;184(1):225–32.•  • Study in Sweden:• Halldina M, Rosella M, de Fairea U, et al. The metabolic syndrome: prevalence and association to

leisure-time and work-related physical activity in 60-year-old men and women. Nutr Metab Cardiovasc Dis 2007;17(5):349–57.

•  • Study in Saudi Arabia:• Bahijri SM, Al Raddadi RM. The importance of local criteria in the diagnosis of metabolic syndrome

in Saudi Arabia. Saudi: Ther Adv Endocrinol Metab; 2013;4(2) 51–59. Available from: • http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632005/pdf/10.1177_2042018813483165.pdf

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References :

• Study in India:• Sawant A, Mankeshwar R, Shah S, Raghavan R, Dhongde G, Raje H, et al. Prevalence of

Metabolic Syndrome in Urban India. India: Hindawi Publishing Corporation; 2011. Available from:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114375/pdf/CHOL2011-920983.pdf

•  • South Asian Countries:• P. Nestel, R. Lyu, P. L. Lip et al., “Metabolic syndrome: recent prevalence in East and

Southeast Asian populations,” Asia Pacific Journal of Clinical Nutrition, vol. 16, no. 2, pp. 362–367, 2007.

•  • D. Eapen, G. L. Kalra, N. Merchant, A. Arora, and B. V. Khan, “Metabolic syndrome and

cardiovascular disease in South Asians,” Vascular Health and RiskManagement, vol. 5, pp. 731–743, 2009.

•  • Jordan Study:• Yasein N, Masa'd D. Metabolic syndrome in family practice in Jordan: a study of high-risk

groups. Jordan: East Mediterr Health J; 2011 Dec;17(12):943-8.

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Thank You