The Metabolic Syndrome By

Alicia Rodriguez

The Metabolic Syndrome

• Formerly called Syndrome X

• Associated with abdominal obesity

• Clustering of a group of risk factors for chronic diseases

– CVD

– CKD

– Type 2 DM

Insulin Resistance

Glucose Intolerance

Hyperinsulinemia

High TG

Low HDL-C

Hypertension

Features of the Metabolic Syndrome

• Central adiposity

• ↑ plasma triglycerides

• ↓ HDL cholesterol

• Hyperglycemia

• Hypertension

• Smaller LDL-C particles

• Abnormal clotting

• Abnormal inflammatory markers

Criteria for Clinical Diagnosis • A syndrome is a set of

symptoms rather than a

disease

• Developed by NCEP

ATP III

• Clinical diagnosis based

on any 3 of the 5

symptoms associated

with metabolic syndrome

Pathophysiology • Central adiposity is related to high amounts of fat in

visceral compartments

• Visceral fat sites are composed of large insulin resistant adipocytes

• Present in adipocytes is the hormone adiponectin which: – Stimulates glucose uptake and fatty acid oxidation in muscle

– Increases insulin sensitivity in liver

– Reduces monocyte adhesion and formation of foam cells

• As visceral fat increases, the presence of this hormone decreases leading to: – Increased insulin resistance

– Formation of plaque in the wall of blood vessels

Pathophysiology • Increased size of fat cells:

– Raises levels of circulating free fatty acids

– Increases levels of circulating cytokines

• Increased lipolysis leads to:

– Increased synthesis of LDL-C and VLDL-C in the liver

– Increased levels of triglycerides and cholesterol in blood plasma

Copyright ©2008 American Heart Association

Kotronen, A. et al. Arterioscler Thromb Vasc Biol 2008;28:27-38

Schematic representation of how components of the metabolic syndrome relate to fat accumulation in the liver

Copyright ©2008 American Heart Association

Kotronen, A. et al. Arterioscler Thromb Vasc Biol 2008;28:27-38

NAFL and MetS predicts type 2 diabetes, advanced forms of liver, and cardiovascular disease

Populations at Risk • Males and post menopausal women

• Some ethnic groups – Mexican Americans

– Caucasians

– African Americans

– South Asians

• Additional risk factors – Sedentary lifestyle

– Abdominal obesity

– Family history of diabetes or heart disease

– Personal history of diabetes or heart disease

– Polycystic ovarian syndrome

– Non-alcoholic fatty liver disease

40–49

Prevalence of the NCEP Metabolic Syndrome: NHANES III by Age

Ford ES et al. JAMA 2002. Used with permission of the American Medical Association.

Pre

vale

nce,

%

20–70+

Age, years

20–29 30–39 50–59 60–69 70

Men

Women

24% 23%

8% 6%

44% 44%

0%

10%

20%

30%

40%

50%

0%

10%

20%

30%

40%

Prevalence of the NCEP Metabolic Syndrome: NHANES III by Sex and Race/Ethnicity

Pre

vale

nce,

%

Men Women

White

African American

Mexican American

Other

25%

16%

28%

21% 23%

26%

36%

20%

Ford ES et al. JAMA 2002. Used with permission of the American Medical Association.

Treatment of the Metabolic Syndrome • All obese individuals, especially those with central adiposity

should be identified and treated for weight loss

• Strategies include

– Lifestyle changes

• Weight Loss

– Reduction in energy intake

– Increase in physical activity

• Other dietary changes

– Fish oil and omega 3 fatty acids?

–Diacylglycerol (DGA) oil?

–Alcohol?

–DASH eating plan

– Pharmacotherapy

– Surgery

The Effect of Fish Oil /N3 Fatty Acids

The Effect of Fish Oil /N3 Fatty Acids

The Effect of Diacylglycerol (DGA) Oil

Treatment of the Metabolic Syndrome The ABCDE approach • Acronym stands for:

– Assessment – Blood pressure – Cholesterol – Diabetes prevention and diet – Exercise

• Multidisciplinary team includes: – Physicians – Health educators – Nurses – Registered dietitians – Exercise physiologists

Focal Points

• The metabolic syndrome increases the risk for diabetes and cardiovascular disease

• Most individuals with metabolic syndrome have insulin resistance and obesity

• Initial therapy for the metabolic syndrome should consist of weight loss through increased physical activity and calorie restriction

• More research needs to be conducted to standardize definition and treatment plan

• Recognizing and treating metabolic syndrome in an early stage could save health care dollars