Metabolic syndrome


Also known as syndrome X and insulin resistance syndrome.

Syndrome manifested by insulin resistance with abdominal obesity, hypertension, hypercholesterolemia, and hypertriglyceridemia.

Refers to a set of conditions that include abdominal obesity, dyslipidemia, high blood pressure, insulin resistance, and increased risk of thrombosis.

The underlying condition is insulin resistance which produces alterations in adipose tissue and skeletal muscle that decrease the uptake of glucose, resulting in hyperglycemia

Increased risk for cardiovascular disease.

Associated with significant cardiovascular morbidity and mortality.

A multiplex risk factor that arises from insulin resistance accompanying abnormal adipose deposition and function.

A risk factor for coronary heart disease, diabetes, fatty liver, and several cancers.

Clinical manifestations of this syndrome may include hypertension, hyperglycemia, hypertriglyceridemia, a reduced high-density lipoprotein cholesterol (HDL-C) level, and abdominal obesity.

Metabolic syndrome is similarly prevalent in men (24%) and women (22%), after adjustment for age.

Unique to women with metabolic syndrome; these include pregnancy, use of oral contraceptives, and polycystic ovary syndrome.

Metabolic syndrome and polycystic ovary syndrome share the common feature of insulin resistance.

Thete is a modest association is apparent between metabolic syndrome and breast cancer, especially in postmenopausal women.

Fat that is visceral or intra-abdominal correlates with inflammation, whereas subcutaneous fat does not.

Omental fat is more resistant to insulin and may result in a higher concentration of toxic free fatty acids in the portal circulation.

Omental fat correlates with inflammation and is more strongly associated with metabolic syndrome than is visceral or intra-abdominal fat.

Metabolic health is not accurately predicted by BMI, as individuals can have a normal BMI and be metabolically unhealthy, and conversely, more than 50% of individuals with obesity are metabolically healthy.

Women of Asian dissent commonly have a lower BMI threshold for type two diabetes versus women of African and European dissent.

Usually asymptomatic with mild-appearing metabolic abnormalities.

Insulin resistant nondiabetic individuals are at much higher risk for developing type II diabetes then insulin sensitive persons.

In addition to diabetes patients at risk for elevated plasma triglycerides, lower HDL proteins, higher blood pressure-the metabolic syndrome-syndrome X.

Associated with elevated LDL, hyperuricemia, abdominal obesity, pro-thrombotic state with elevated plasminogen activator inhibitor 1, and pro-inflammatory state.

Criteria for diagnosis includes presence of three or more of the following: abdominal obesity with waist circumference of 40 inches or more in men and 35 inches or more in women, serum triglyceride levels 150 mg/dL or more or drug treatment for elevated triglyceride levels, serum high density cholesterol less than 40 mg/dL in men and less than 50 mg per dL in women or drug treatment for low HDL levels, blood pressure 130/85 millimeters Hg or more or drig treatment for elevated blood pressure, and fasting blood sugar level of 100 mg/dL or more or drug treatment for elevated blood glucose levels.

Waist circumference of greater than 102 cm in men and 88 cm in women, triglyceride level of 159 mg per dL or more and a high density (HDL) cholesterol level less than 40 mg per dL in men and 50 mg per dL in women, blood pressure of 130/85 mm Hg or more and a fasting glucose of 110 mg per dL or more fulfill diagnostic criteria.

Isolated metabolic syndrome is defined as a subset of patients that do not meet the diagnostic criteria for hypertension or diabetes and are not on drug treatment for them either.

Increased inflammatory and prothrombotic states and increased risk of atherosclerotic disease.

Visceral fat has more pro inflammatory cytokines than subcutaneous fat in obese patients.

Inflammatory markers C-reactive protein and tumor necrosis factor alpha have been linked to metabolic syndrome.22-24% of the population affected.

Part of the increased cardiovascular risk in metabolic syndrome is attributed to the changes in arterial parameters such as arterial stiffness and increase carotid intima-media thickness.

These changes reflect subclinical atherosclerosis or early vascular aging.which eventually leads to overt cardiovascular disease, cardiac events, and stroke.

An abnormal exercise ECG in men with MS associated with higher risk of all cause cardiovascular disease and coronary heart disease mortality (Lyerly GW).

Present in up to 40% of middle-aged patients.

Lower levels of education and socioeconomic status associated with increased risk.

Mexican-Americans have the highest prevalence and Caucasians the lowest.

Mexican-American women have a 26% higher prevalence than Mexican-American men.

African-American women have a 57% higher incidence of the syndrome than African-American men.

Affects 25% of Americans.

An abnormal exercise ECG in men with MS associated with higher risk of all cause cardiovascular disease and coronary heart disease mortality (Lyerly GW).

Women with gestational diabetes have a high risk of developing the process.

Increased risk of mortality from all causes.

Associated with a prothrombotic state with high fibrinogen and plasminogen activator inhibitor elevations in the blood.

A proinflammatory state.

Commonly associated with hypomagnesemia.

The metabolic syndrome is associated with a nearly twofold increased risk of Barrett’s esophagus.

The metabolic syndrome associated with Barrett’s esophagus is independent of reflux symptoms, may reflect a reflex independent pathway of Barrett’s esophagus pathogenesis (Leggett CL et al).

Increases the risk of polycystic ovarian disease, cholesterol gallstones, fatty liver, asthma, sleep disturbances and some types of cancer.

By increasing physical activity and a healthy diet can reduce the incidence of type 2 diabetes in those with impaired fasting blood glucose levels with a modest, 10%, total body weight loss.

Largely reversible in patients with class II to III obesity and it depends upon the percentage of excess weight loss.

Cardiorespiratory fitness has a strong inverse relationship with metabolic syndrome in both males and females, with the strongest single associated component being waist circumference (Earnest CP et al).

Metabolically obese normal weight individuals appear to be healthy but have a high risk of cardio metabolic disease, such as diabetes and coronary artery disease, and, possibly cancer.

About 23.5% of normal weight US adults ages 20 years or older are metabolically abnormal.

Patients who develop metabolic syndrome after hematopoietic stem cell transplant (HSCT) have an increased risk of cardiovascular (CV) events and second malignancies.

HSCT recipients had a higher prevalence of metabolic syndrome than the general population, and the incidence of metabolic syndrome increased with age.

Rates of metabolic syndrome after HSCT ranging from 31% to 49%.

The risk of cardiovascular hospitalizations and mortality is 3.6-fold higher in transplant patients vs the general population.

The prevalence of metabolic syndrome in this population was 30.4%.

There was no significant difference in metabolic syndrome prevalence between allogeneic and autologous HSCT recipients―29% and 35.6%, respectively.

There is a significant difference in metabolic syndrome prevalence with increasing age.

Among allogeneic HSCT recipients, no relationship exists between metabolic syndrome prevalence and the presence or degree of acute or chronic GVHD, current use of immunosuppressive therapy, or conditioning intensity.

There was a significantly higher prevalence of CV events in patients with metabolic syndrome than in patients without the syndrome―22.6% and 10.7%, respectively.

Increasing age influenced the prevalence of metabolic syndrome and CV events for patients older than 50, compared to patients in the 18-29 age group.

And CV events are associated with second malignancy.

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