Metabolic Syndrome Edited

8/8/2019 Metabolic Syndrome Edited

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Metabolic Syndrome

Group 1 Biochemistry


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Carleen Nicole Araos

Olivia VictoriaCalaguas


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ObjectivesAt the end of the conference, the student should be able to

Define metabolic syndrome

Describe the epidemiology of metabolic syndrome

Describe the pathophysiology of the disease

Identify the diagnostic criteria for the disease

Describe clinical features of the disease

Describe the treatment modalities used to manage the disease


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Metabolic Syndrome

Also known as Insulin Resistance Syndrome orSyndrome X or Dysmetabolic Syndrome

Cluster of metabolic abnormalities or risk factorsleading to future cardiovascular diseases (CVD) anddiabetes mellitus (DM)


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Metabolic Abnormalities

Abdominal obesity: a waist circumference over 102 cm(40 in) in men and over 88 cm (35 inches) in women

Serum triglycerides 150 mg/dl or above

HDL cholesterol 40mg/dl or lower in men and 50mg/dlor lower in women

Blood pressure of130/85 or more

Fasting blood glucose of110 mg/dl or above (Somegroups say100mg/dl)


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Why such a concern?

People with metabolic syndrome have

Twice the risk for cardiovascular disease A four times greater risk for developing diabetes


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Sunil Basnet

Olivia VictoriaCalaguas


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Epidemiology Prevalence varies across the globe, in part reflecting theage and ethnicity of the populations studied and thediagnostic criteriaapplied

In general, the prevalence of Metabolic Syndromeincreases with age

Approximately 20%-30% of the population inindustrialized countries have metabolic syndrome

The highest recorded prevalence worldwide is in NativeAmericans, with nearly 50-75 million in US alone


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Epidemiology Greater industrialization worldwide is associated with

rising rates of obesity, which is anticipated todramatically increase prevalence of the Metabolic

Syndrome, especiallyas the population ages

Moreover, the rising prevalence and severity of obesityin children is initiating features of the Metabolic

Syndrome in a younger population


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Epidemiology The frequency distribution of the five components of the Syndrome for the

U.S. population (NHANES III) is summarized in the following chart:

Increases in waist circumference predominate in women whereas fasting triglycerides

>150 mg/dL and hypertension are more likely in men


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Christian Jerome Carreon

KristelAnunciacion


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Patient Profile JLW

Female patient, 54 y/o, Caucasian

G2P2 gynecologist who comes in to discuss weight loss

Been obese since her teens, with maximum weight of289 lbs

Average adult body mass index (BMI) has been 40

Tried various weight loss plans, fad diets, andexercise programs without success


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Patient Profile contd

At age 36,underwent stomach stapling, leaving herstomach with a capacity ofabout 125 cc, also without

success

She heard about something called Insulin ResistanceSyndrome (IRS), and attended a complementaryand

alternative medicine program to learn about it


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Medications

Atenolol, hydrochlorothiazide/ triamterene

Past Med Hx

Hypertension-stage II, pernicious anemia


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Family Hx

Obesity, DM-2, hypertension, coronaryarterydisease

Physical Exam

BP 130/80, weight 270 pounds, height 510 BMI = 40

Waist Circumference = 85


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Prior Biochemical Exam

Fasting blood glucose = 110 mg/dl (N.V: 70 to 99 mg/dL); Cholesterol = 245 mg/dl (N.V: 40 mg/dl),

Triglycerides = 290 mg/dl (N.V:


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PrajwolBhurtel

Tristan Angelo Calaquian


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The Role of Insulin

Insulin is a hormone that is central to regulating

carbohydrate and fat metabolism in the body. It is a 5.8 kd polypeptide composed of 51 aminoacid produced by the cells of the islet oflangerhans in the pancreas and is released in

response to increased blood glucose levels. It controls the cellular uptake ofglucose via the

GLUT4 transporter found in the adipose andstriated muscles


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Effect of insulin on glucose uptake and metabolism. Insulinbinds to its receptor (1), which in turn starts many proteinactivation cascades (2). These include: translocation of Glut-4transporter to the plasma membrane and influx ofglucose (3),glycogen synthesis (4), glycolysis (5) and fattyacid synthesis (6).


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Overabundance of Free Fatty AcidsCauses Insulin Resistance Free fattyacids are derived from the TAG contained

inside the adipocytes

Free fattyacids causes insulin resistance byimpairingglucose uptake via the GLUT4 transporterfound in the striated muscles and adipose tissue

Unable to enter the adipose and muscle tissue,glucose accumulates in the blood and causeshyperglycemia which causes the cells to producemore insulin, causing hyperinsulinemia.


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Overabundance of Free Fatty AcidsCauses Insulin Resistance The liver, which utilizes GLUT2 glucose transporter

which is not insulin dependent, diverts the excessglucose for biosynthesis of fattyacids

Hyperinsulinemia promotes the biosynthesis ofmore fattyacids, thus perpetuatinga vicious cycle.

Since visceral (central) fat is more metabolicallyactive, central obesity causes the release of morefree fattyacids than subcutaneous fat leading toinsulin resistance.


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Risk Factors

* characterized byabnormal or degenerative conditions of the body's adiposetissue. May be congenital (congenital generalized lipodystrophy) oracquired as in repeated insulin injections or antiretroviral therapy

Stress

Central Obesity/Accumulation ofAdipose Tissue

SedentaryLifestyle

Type 2 DM

Lipodystrophy*

Increased CortisolSecretion


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Increased AdiposeTissue

Mass/Visceral Fat

IncreasedCirculating Free

Fatty Acids

Increased TAGsynthesis in the

liver

Increased VLDLDecreased HDL

Increased LDL (small,

dense type)

Impairment ofglucose

uptake in the skeletalmuscles and adiposetissue


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Impairment ofglucoseuptake in the skeletalmuscles and adipose

tissue

Hyperglycemia

CompensatoryMechanism: Increased

Insulin Secretion

Downregulationof insulinreceptors

Hyperinsulinemia

Insulin Resistance /Impaired Glucose Tolerance


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Hyperinsulinemia

Increased Na

reabsorption

Hypertension


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Opal Balajadia

Tristan Angelo Calaquian


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How to diagnose?

Measuring waist circumference

Measuring blood pressure

Lipid profile

Fasting blood glucose measurement


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US National Cholesterol Education ProgramAdult Treatment Panel III (2001


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International Diabetes Foundation


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World Health Organization

Waist hip ratio > 0.85 in women and > 0.9 in menor Body mass index of > 30 kg/m2

Triglycerides > 150 mg% and/or HDL cholesterol< 35 mg% (men) or < 40 mg% (women)

Blood pressure > 140/90 mm Hg

Increased albumin secretion in the urine


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National Institutes ofHealth

Abdominal obesity: waist circumference > 35 inchesin women or 40 inches in men

Triglycerides > 150 mg%

HDL-cholesterol < 50 mg% in women or < 40 mg% in

men

Blood pressure > 130/85 mm Hg

Fasting plasmaglucose > 110 mg%


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PrajwolBhurtel

KristelAnunciation


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Signs and Symptoms

Expanded Waist Circumference Hypertension Decreased HDL cholesterol Elevated TAG levelsAcanthosis Nigricans*

*brown to black, poorly defined, velvety hyperpigmentation of the skinusually found in body folds,[1] such as the posterior and lateral foldsof the neck, the axilla, groin, umbilicus, forehead, and other areas


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Associated Diseases

Cardiovascular Disease

Type II Diabetes Mellitus Non alcoholic fatty liver disease

Hyperuricemiadue to enhanced tubularreabsorption of uric acid by insulin

Polycystic Ovary Syndrome (PCOS)womenwith PCOS are 2 4 times more likely to havemetabolic syndrome

Obstructive Sleep Apnea


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Jennifer Bonifacio

Anne Balingit


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The diagnosis of the Metabolic Syndrome relieson satisfying the criteria listed using tools at the

bedside and in the laboratory. Because theNCEP:ATPIII and IDF criteriaare similar, eithercan be used.


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The medical history should include

Evaluation of symptoms for OSA

PCOS in premenopausal women

Family history for determining risk for CVD andDM


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Sunil Basnet

Anne Balingit


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Lifestyle

Primaryapproach: weight reduction achieved by

Caloric restriction, exercise and behaviormodification

Diet modification which includes

Restriction of carbohydrate intake as well assaturated fats for those at risk ofCVD


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Lifestyle

A diet enriched with fruits, vegetables, wholegrains and lean poultryand fish

Restriction on sodium intake

Increased physical activity


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Pharmacologic Used only when lifestyle change is ineffective

Weight loss drugs such as appetitesuppressants (ex. Phentermineand sibutramine)and absorption inhibitors (ex. Orlistat)

LDL lowering drugs statins, bile acid

sequestrants (ex. Cholestyramine andcholestipol), absorption inhibitor (ex. Ezetimibe)

Antihypertensives ACE inhibitors, angiotensinII receptor blocker


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Pharmacologic Glycemic control Metformin

Biguanides, thiazolidinediones increaseinsulin sensitivity


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Are you Apple or Pear-shaped?

Apple shaped: carrying excess fat around abdomen (usuallymen)

Pear shaped: carrying excess fat around hip and buttocks(usually women)

Excess of this (apple) shaped body

usuallyassociated with metabolic

syndrome..!!!

So Be Careful What You Eat


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THANK YOU

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Metabolic Syndrome Edited

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