Metabolic syndrome

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 diabetes or CVD in obesity

Genetic predisposition

lack of exercise

body fat distribution

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 ?

Treatment

Modulating underlying mechanism

Treatment of components

Diet

the Mediterranean diet

High in fruits

Vegetables

Nuts

whole grains

olive oil

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

normal weight, metabolically obese

metabolic risk traits

liver markers

type 2 diabetes

coronary artery disease

increased visceral-to-subcutaneous

adipose tissue ratio