Lifestyle diseases 2 - Metabolic Syndrome: Must read

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Lifestyle diseases 2 - Metabolic Syndrome: Must read

What is Metabolic Syndrome (MS)?

Metabolic syndrome, also called the Syndrome X is a disorder of energy utilization and storage, diagnosed by a co-occurrence of three out of five of the following conditions:

1. Abdominal (central) obesity 2. Elevated blood pressure 3. Elevated fasting plasma glucose 4. High serum triglycerides and 5. Low high-density cholesterol (HDL) levels.

For example, high blood pressure alone is a serious condition, but when a patient has high blood pressure along with high fasting glucose levels and abdominal obesity, this patient may be diagnosed with metabolic syndrome. There is a greater chance this patient will have cardiovascular problems because of the combination of risk factors.

Metabolic syndrome is also associated with a generalized metabolic disorder called insulin resistance, which prevents people from using insulin efficiently. Therefore, metabolic syndrome is also sometimes called insulin resistance syndrome.

How common ismetabolic syndrome?

MS is much more common than we can imagine. In the USA, the prevalence is estimated 34% (one in three) of the adult population and the prevalence increases with age.

Prevalence of MS has reached epidemic proportions in India in recent years. Reported prevalence of MS in some regions of the country ranges from 23.2 to 41.1 per cent because of the high prevalence of prehypertension, overweight/obesity and adverse lipid profiles. The high cardiovascular death (CVD) risk of this apparently healthy adult population has important implications that should alarm the public health authorities of the country.

What are the causes of metabolic syndrome?

Most patients are older, obese, sedentary, and have a degree of insulin resistance. Stress can also be a contributing factor. The most important factors are genetics, aging, diet (particularly sugar-sweetened beverage consumption), sedentary behaviour or low physical activity, disrupted chronobiology/sleep, mood disorders/psychotropic medication use, and excessive alcohol use. A number of markers of systemic inflammation, including C-reactive protein, are often increased.

Recent research indicates prolonged chronic stress can contribute to metabolic syndrome by disrupting the hormonal balance of the hypothalamic-pituitary-adrenal axis (HPA-axis).

Lifestyle diseases 2 - Metabolic Syndrome: Must read

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• Obesity/overweight: Obesity is an important potential cause of metabolic syndrome. Excessive fat in and around the abdomen is most strongly associated with metabolic syndrome. However, the reasons abdominal obesity and metabolic syndrome seem to be linked are complex and not fully understood.

• Insulin resistance: Metabolic syndrome is closely associated with a generalized metabolic disorder called insulin resistance, in which the body cells can't use insulin efficiently. This leads to development of type 2 diabetis, as pancreas cannot produce more and more insulin. Some people are genetically predisposed to insulin resistance.

• Race and gender: When they have the same body mass index (BMI), Asians are at an increased risk than Caucasians, and Caucasians are at a greater risk for developing metabolic syndrome than African Americans. Men are more likely than women to develop metabolic syndrome.

How is metabolic syndrome diagnosed?

The principal symptom of metabolic syndrome is central obesity (also known as visceral, male-pattern or apple-shaped adiposity), overweight with adipose tissue accumulation mainly around the waist and trunk.

Other signs of metabolic syndrome include: High blood pressure, decreased fasting serum HDL cholesterol, elevated fasting serum triglyceride level (VLDL triglyceride), impaired fasting glucose, insulin resistance, or prediabetes.

WHO definition

The World Health Organization criteria require the presence of any one of diabetes mellitus, impaired glucose tolerance, impaired fasting glucose or insulin resistance, AND two of the following:

• Blood pressure: ≥ 140/90 mmHg • Dyslipidemia: triglycerides (TG): ≥ 1.695 mmol/L and high-density lipoprotein cholesterol

(HDL-C) ≤ 0.9 mmol/L (male), ≤ 1.0 mmol/L (female) • Central obesity: waist:hip ratio > 0.90 (male); > 0.85 (female), or body mass index >

30 kg/m2 • Microalbuminuria: urinary albumin excretion ratio ≥ 20 µg/min or albumin:creatinine

ratio ≥ 30 mg/g

American Heart Association(AHA) criteria - To diagnose metabolic syndrome, most doctors should look for the presence of three or more of these components:

• Central or abdominal obesity (measured by waist circumference): o Men - 40 inches or above o Women - 35 inches or above

• Triglycerides greater than or equal to 150 milligrams per deciliter of blood (mg/dL)

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• HDL cholesterol: o Men - Less than 40 mg/dL o Women - Less than 50 mg/dL

• Blood pressure greater than or equal to 130/85 millimeters of mercury (mmHg) • Fasting glucose greater than or equal to 100 mg/dL

What are the risks of metabolic syndrome?

Individuals with metabolic syndrome have about a two-fold increase in risk for heart attack or stroke when compared with individuals who do not have metabolic syndrome.

• Atherosclerosis, peripheral vascular disease, and other diseases related to fatty build up in artery walls. These blockages narrow the arteries and restrict blood circulation throughout the body, but are especially dangerous when they affect the arteries leading to the brain, heart, kidneys and legs.

• Coronary heart disease and heart attack: When the arteries that supply blood to the heart become narrowed or blocked by fatty deposits called plaque, they decrease the amount of blood and oxygen reaching the heart, which can cause chest pain (angina) or a heart attack.

• Type 2 diabetes: Diabetes occurs when the body can no longer make enough insulin or is unable to use insulin properly. This causes sugars to build up in the blood and increases risks for kidney failure, eye diseases and cardiovascular disease.

• Stroke: A stroke occurs when the blood supply to a part of the brain is interrupted by a blocked or burst blood vessel, which deprives the brain of oxygen and nutrients. Within a few minutes, brain cells begin to die, resulting in brain damage, other complications, or death.

• Hormonal imbalance: Hormones also play a role. For instance,polycystic ovary syndrome (PCOS) -- a condition that affects fertility-- is related to hormonal imbalance and metabolic syndrome.

Is metabolic syndrome preventable?

Various strategies have been proposed to prevent the development of metabolic syndrome. These include increased physical activity (such as walking 30 minutes every day),and a healthy, reduced calorie balanced diet

Is there an effective treatment for metabolic Syndrome?

Metabolic syndrome can be treated and one can reduce risks for cardiovascular events by maintaining a healthy weight, eating a heart-healthy diet, getting adequate physical activity, and following your healthcare providers' instructions.

1. The first line treatment is change of lifestyle. However, if in three to six months of efforts at remedying risk factors prove insufficient, then drug treatment is frequently

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required. Generally, the individual disorders that compose the metabolic syndrome are treated separately.

2. Diuretics and ACE inhibitors may be used to treat hypertension. 3. Cholesterol drugs may be used to lower LDL cholesterol and triglyceride levels, if

they are elevated, and to raise HDL levels if they are low. 4. Use of drugs that decrease insulin resistance, e.g., metformin and thiazolidinediones,

is controversial; this treatment is not approved by the U.S. Food and Drug Administration (FDA).

5. Weight loss medications may result in weight loss.As obesity is often recognized as the culprit behind many of the additional symptoms, with weight loss and lifestyle changes in diet, physical activity, the need for other medications may diminish.

6. Diet: Restricting the overall dietary carbohydrate intake is more effective in reducing the most common symptoms of metabolic syndrome than the more commonly prescribed reduction in dietary fat intake.

Treating metabolic syndrome requires addressing several risk factors together. Following are the simple changes in lifestyle that one can do starting today:

• Eat better. Adopt a diet rich in whole grains, fruits, vegetables, lean meats and fish, and low-fat or fat-free dairy products and avoid processed food, which often contains partially hydrogenated vegetable oils, and is high in salt and added sugar.

• Get active. Incorporate at least 150 minutes of moderately vigorous physical activity into your weekly routine. Walking is the easiest place to start, but you may want to experiment to find something else you like to do that gets your heart rate up. If needed, break your exercise up into several short, 10-minute sessions throughout the day to reach your goal.

• Lose weight.Reduce your risk for heart disease by successfully losing weight and keeping it off. Learn your recommended calorie intake, the amount of food calories you're consuming, and the energy calories you're burning off with different levels of physical activity. Balance healthy eating with a healthy level of exercise to reach your goals.

• Take medications, if prescribed. When changes in lifestyle alone do not control the risk factors related to metabolic syndrome, your health practitioner may prescribe medications to control blood pressure, cholesterol, and other symptoms. Careful following your practitioner's instructions can help prevent many of the long term effects of metabolic syndrome. Every step counts and your hard work and attention to these areas will make a difference in your health!

Do you know what is “Prehypertension”

There is a strong linear relationship between high blood pressure (BP) levels and the risk of CVD. Though the terminology “prehypertension” (systolic BP 120-139 mm Hg and/ or diastolic BP 80-89 mm Hg) is known for many years, its global awareness increased recently.Individuals with prehypertension have two-fold higher risk of mortality associated with stroke and coronary artery disease when compared with normotensives (individuals with BP less than 120/80 mm Hg). In addition, prehypertensives are at higher risk of developing hypertension and CVD in their later lives.Co-existent CVD risk factors like

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dyslipidaemia, raised blood sugar levels and higher body weight are common among prehypertensives.

Many studies from different Indian States showed that the prevalence of prehypertension in India is about 40-50 per cent; a prevalence much higher than that in the West.

High dietary salt use was reported by about 42 per cent of participants of the study by Ray et al. Other Indian workers also reported high prevalence of prehypertension and hypertension among those who overuse salt in their diets. Dietary salt restriction is well known to reduce blood pressure and prehypertensives should be encouraged to lower their dietary salt consumption.

Overweight / Obesity and Metabolic Syndrome in India

Overweight/obesity is seen among 29.9 per cent of this physically active, relatively young adult population in India is also thought provoking. Nowadays a body mass index (BMI) cut-off of more than 23 kg/m2 is used to define overweight. Abdominal obesity and visceral adiposity are the key determinants of insulin resistance, an important component of metabolic syndrome (MS) – the major CVD risk factor in all populations. Even with lower BMI, Asians have higher visceral adiposity than Caucasian populations. For this reason, the international task force of World Health Organization (WHO) has set lower cut-off BMI values for Asians to define overweight and obesity (more than 23 and 25 kg/m2 respectively).

Management of dyslipidaemia is also primarily through dietary modifications and lifestyle changes like increasing physical activity. Dietary practices of different population subgroups in India are very diverse and processed food is consumed only by a minority of the population. Major chunk of Indians cook most of their food at home and ingredients of foodstuffs are decided by themselves. Therefore, restrictions on food products to encourage the population to adopt healthy dietary practices are undesirable in the Indian context, unlike in the developed countries. Campaigns through the audio-visual media, newspapers and health magazines might be useful strategies in the country.

Prevalence of overweight and obesity areincreasing in India in recent years even though under nutrition continues to be an important public health issue even in the 21st century. Despite the availability of a few therapeutic agents, the management of obesity is still mainly non-pharmacological. Physical activity and dietary modifications are the cornerstones of management of overweight and obesity. In morbid obesity, laparoscopic bariatric surgery is effective to reduce weight and lower the risk of Obesity and CVD.

Overall, encouragement of healthy lifestyles in the population should help to reduce the high burden of lifestyle diseases and MS in India. Governmental and non-governmental agencies of the country should work together to achieve this goal. Lifestyle interventions have shown definite benefit in the management and prevention of these diseases in large scale studies.