METABOLIC SYNDROME

BACKGROUND

The metabolic syndrome, also called insulin resistance syndrome or syndrome X, is not a disease but a group of characteristics. These characteristics include obesity, high blood pressure, elevated blood sugar levels, and high triglycerides (fat-like substances in the blood). Having a combination of these characteristics increases your risk of developing type 2 diabetes and heart disease. Keeping your weight, blood sugar, and cholesterol and triglyceride levels under control can help you to live longer and decrease your risk of heart attack and stroke.

DISEASE OCCURRENCE IN POPULATION:

This is a growing health issue in Pakistan among adults (man and women) and children. The burden of obesity is higher among females in all age groups as compare to males. The Global Burden of Disease Study published in The Lancet medical journal has placed Pakistan as the ninth most obese country in the world. The prevalence of metabolic syndrome in Pakistan according to different definitions is reported to be from 18% to 46%, comparable to the data from other South Asian countries.

RISK FACTORS:

WEIGHT: Increased body weight is a major risk factor for the metabolic syndrome. In National Health and Nutrition Examination Survey III (NHANES III), the metabolic syndrome was present in 5 percent of those at normal weight, 22 percent of those who were overweight, and 60 percent of those who were obese.

SOFT DRINK AND SUGAR-SWEETENED BEVERAGE: In the Framingham Heart Study, soft drink and sugar-sweetened beverage consumption was also associated with an increased risk of developing adverse metabolic traits and the metabolic syndrome.

USE OF ATYPICAL ANTIPSYCHOTIC MEDICATIONS: Use of atypical antipsychotic medications, especially clozapine, significantly increases risk for the metabolic syndrome.

OTHER FACTORS: In addition to age, race, and weight, other factors associated with an increased risk of metabolic syndrome in National Health and Nutrition Examination Survey (NHANES) included postmenopausal status, smoking, low household income, high carbohydrate diet, no alcohol consumption, and physical inactivity.

SIGN AND SYMPTOMS:

Most of the disorders associated with metabolic syndrome have no symptoms, although a large waist circumference is a visible sign. If your blood sugar is very high, you might have signs and symptoms of diabetes, including increased thirst and urination, fatigue, and blurred vision.

DIAGNOSTIC TEST:

According to guidelines from the National Heart, Lung, and Blood Institute (NHLBI) and the American Heart Association (AHA), metabolic syndrome is diagnosed when a patient has at least 3 of the following 5 conditions:

• Fasting glucose ≥100 mg/dL (or receiving drug therapy for hyperglycemia)
• Blood pressure ≥130/85 mm Hg (or receiving drug therapy for hypertension)
• Triglycerides ≥150 mg/dL (or receiving drug therapy for hypertriglyceridemia)
• HDL-C < 40 mg/dL in men or < 50 mg/dL in women (or receiving drug therapy for reduced HDL-C)
• Waist circumference ≥102 cm (40 in) in men or ≥88 cm (35 in) in women; if Asian American, ≥90 cm (35 in) in men or ≥80 cm (32 in) in women

TREATMENT OPTIONS:
Treatments include:

• Diet – Healthy diets that can help you lose weight include:
  • The Mediterranean diet – This diet is high in fruits, vegetables, nuts, whole grains, and olive oil. It can help to lower weight, blood pressure, lipids, and improve blood sugar levels.
  • The DASH (Dietary Approaches to Stop Hypertension) diet – This diet is low in salt and fat. It includes 4 to 5 servings each of fruits and vegetables and 2 to 3 servings of low-fat dairy products per day. This diet can lower blood pressure, weight, lipids, and blood sugar.
  • A high-fiber diet – Increasing dietary fiber (to at least 30 grams daily) can lower blood pressure and weight. Fiber is normally found in beans, grains, vegetables, and fruits. The nutrition label on packaged foods can show you how much fiber you are getting in each serving.
• Exercise: – Doctors recommend that people exercise at least 30 minutes a day, on 5 or more days of the week. If you can’t exercise for 30 minutes at a time, try to exercise for 10 minutes at a time, 3 or 4 times a day. Brisk walking is a good choice.
• Medicines: – Doctors often recommend medicines to lower blood pressure, blood lipids, and blood sugar.

PRECAUTIONS:

IMPROVE PHYSICAL ACTIVITIES: Sedentary life style is one of the leading factor contributing to Metabolic Syndrome. Adopt routine physical activities to your daily routine like walking jogging & exercise will decrease your risk of coronary artery disease, Hypertension, Diabetes and improve your quality of life.

QUIT SMOKING: Smoking cigarettes significantly increases the risk of coronary artery disease, and has many other health risks as well. You and your family are strongly advised to stop cigarette smoking.

REDUCE CHOLESTEROL: High levels of low-density lipoprotein (LDL) (bad) cholesterol increase the risk of coronary artery disease. In people with metabolic syndrome, an LDL level of less than 80 to 100 mg/dL is recommended.

REDUCE BLOOD PRESSURE: Keeping your blood pressure in a healthy range is an important goal, especially in people with the metabolic syndrome.

• High blood pressure is a blood pressure greater than 140/90
• Prehypertension is a blood pressure greater than 120 to 139/80 to 89

REFERENCES:

• http://www.pakistantoday.com.pk/2014/05/29/national/pakistan-ranked-9th-most-obese-country-as-new-study-shows-30-pc-of-world-is-now-fat/
• shttp://www.ncbi.nlm.nih.gov/pubmed/18699720
• Ford ES, Giles WH, Mokdad AH. Increasing prevalence of the metabolic syndrome among U.S. adults.Diabetes Care. 2004 Oct. 27(10):2444-9.
• Park YW, Zhu S, Palaniappan L, et al. The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988-1994. Arch Intern Med 2003; 163:427.
• Dhingra R, Sullivan L, Jacques PF, et al. Soft drink consumption and risk of developing cardiometabolic risk factors and the metabolic syndrome in middle-aged adults in the community. Circulation 2007; 116:480.
• Green AK, Jacques PF, Rogers G, et al. Sugar-sweetened beverages and prevalence of the metabolically abnormal phenotype in the Framingham Heart Study. Obesity (Silver Spring) 2014; 22:E157.
• Lamberti JS, Olson D, Crilly JF, et al. Prevalence of the metabolic syndrome among patients receiving clozapine. Am J Psychiatry 2006; 163:1273.
• Gennuso KP, Gangnon RE, Thraen-Borowski KM, Colbert LH. Dose-response relationships between sedentary behaviour and the metabolic syndrome and its components. Diabetologia 2015; 58:485.