What is the metabolic syndrome?

The term Metabolic Syndrome (also known as Syndrome X) describes a group of metabolic risk factors existing in a single individual. This association was noted in the 1980s and became a strong focus of attention in the 1990s. The main reason it has received so much attention is that persons with Metabolic Syndrome have an increased risk of heart disease and Diabetes. 

The main features of Metabolic Syndrome include insulin resistance, hypertension(high Blood Pressure),high triglycerides with or without high cholesterol and incresed LDL cholesterol(also known as "bad Cholesterol"), and an increased tendency to clotting. Patients are most often overweight with the main distribution of fat being in and around the central abdomen.

Insulin resistance refers to a reduced ability of cells to respond to the action of insulin. Insulin's main purpose in the body is to aid glucose across the cell's membrane into the cells where it is needed. Instead glucose builds up in the bloodstream while the cells lack glucose. The insulin levels in the bloodstream also rise as the body produces more insulin to try to get the glucose into the cells. Metabolic Syndrome is also known as Insulin Resistance Syndrome because of this. A Summary of the main diagnostic features of Metabolic Syndrome is:

1. Abdominal obesity (excess fat in and around the abdomen)

2. Atherogenic dyslipidaemia (abnormalities of cholesterol and fats in the blood which accelerate fat deposits in the walls of the arteries....aka atheromatous plaque..better thought of as thick, hard, fatty gunk building up on the walls of the arteries...on the inside)

3. Insulin resistance(as above with high blood glucose in a state where there is too much insulin and lack of response of the cells to insulin .

4. High Blood Pressure

5. Pro-inflammatory state( an increase in inflammatory proteins in the blood )

6. Pro-thrombotic state ( an increased tendency to form clots) 

Other conditions associated with Metabolic Syndrome include physical inactivity, aging, hormonal imbalance and genetic predisposition.

People with the metabolic syndrome are at increased risk of coronary heart disease and other diseases related to plaque buildups in artery walls (e.g., stroke and peripheral vascular disease) and type 2 diabetes. The metabolic syndrome has become increasingly common in the United States. It’s estimated that over 50 million Americans have it.

Some people are genetically predisposed to insulin resistance. Acquired factors, such as excess body fat and physical inactivity, can trigger insulin resistance and the metabolic syndrome in these people.

Atherogenic diet: Modern Western diets are very different in composition from traditional human diets. In particular, they are high in refined carbohydrates and refined vegetable oils; and low in omega-3 fatty acids, fresh fruit and vegetables. All these have a role in obesity, adverse lipid profiles and the metabolic syndrome.^7,Most people with insulin resistance have abdominal obesity. The biologic causes at the molecular level between insulin resistance and metabolic risk factors aren’t fully understood and appear to be complex.

How is the metabolic syndrome diagnosed?
There are no well-accepted criteria for diagnosing the metabolic syndrome. The criteria proposed by the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III), with minor modifications, are currently recommended and widely used.

The American Heart Association and the National Heart, Lung, and Blood Institute recommend that the metabolic syndrome be identified as the presence of three or more of these components:

• Elevated waist circumference:
  Men — Equal to or greater than 102 cm
• Women — Equal to or greater than 88 cm
• Elevated triglycerides:
  Equal to or greater than 1.7mmol/l
• Reduced HDL (“good”) cholesterol:
  Men — Less than 1.03 mmol/l
• Women — Less than 1.29mmol/l
• Elevated blood pressure:
  Equal to or greater than 130/85 mm Hg
• Elevated fasting glucose:
  Equal to or greater than 5.6mmol/l, or being actively treated for elevated blood glucose

AHA Recommendation for Managing the Metabolic Syndrome:
The main aim of treatment of the metabolic syndrome is to reduce the risk for cardiovascular disease and type 2 diabetes,to stop smoking and reduce LDL cholesterol, blood pressure and glucose levels to the recommended levels.

To reduce both long- and short-term risk, lifestyle therapies are the first-line interventions to reduce the metabolic risk factors. These lifestyle interventions include:

• Weight loss to achieve a desirable weight (BMI less than 25 kg/m²)
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• Increased physical activity, with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
  
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• Healthy eating habits that include reduced intake of saturated fat, trans fat and cholesterol