Metabolic Syndrome

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Key points

  • Metabolic syndrome is a clustering of clinical findings made up of abdominal obesity, high glucose, high triglyceride, and low high-density lipoprotein cholesterol levels, and hypertension.

  • Several definitions of metabolic syndrome have been proposed, with varied requirements, including those by the International Diabetes Federation and the National Cholesterol Education Program Adult Treatment Panel III.

  • There is a proposed harmonized international definition that incorporates the criteria for

Definitions

Despite multiple labels in the past, the term MetS is now used universally. It was first formalized by use in a working definition proposed by a diabetes consultation panel for WHO in 1998 and finalized in 1999.10 The section on MetS is a small portion of a document primarily focused on the diagnosis and classification of type 2 diabetes mellitus (T2DM),10 but it provoked discussion and position statements such as from the European Group for the Study of Insulin Resistance (EGIR)11 and the

Epidemiology

The reported prevalence of MetS varies depending on the definition used, age, sex, socioeconomic status, and the ethnic background of study cohorts. However, from studies published in the last decade, an estimated one-quarter to one-third of adults meet MetS criteria in multiple ethnic backgrounds. Cross-sectional data from 1999 to 2010 from the National Health and Nutrition Examination Survey (NHANES) in the United States show that, in adults older than 20 years, the age-adjusted overall

Consequences of MetS

MetS, by definition, is not a disease, but is a clustering of individual risk factors for disease, drawing the attention of the clinician to the probable coexistence of multiple cardiometabolic risk factors in patients when one of the components is found.47 Therefore, a diagnosis of MetS could be expected to predict risk. The goal is to target the different components of MetS with lifestyle and pharmacologic therapies to prevent disease, particularly CVD and diabetes.

Among the differing MetS

Pathophysiology

With extra caloric intake and a sedentary lifestyle, the excess energy balance is stored as fat. Adipose tissue depots are not metabolically equal. Visceral fat, compared with subcutaneous fat,73, 74, 75 has distinct gene expression patterns and is associated with higher insulin resistance, smaller LDL-C and HDL-C particle size, and increased LDL-C and very low–density lipoprotein (VLDL) particle numbers.76 In susceptible individuals, the inability for the β cell to compensate for insulin

Treatment

The treatment of patients with MetS aims to decrease the risk for CVD and T2DM. Overall management involves (1) implementation of lifestyle and dietary changes for weight loss, (2) treatment of atherogenic dyslipidemia, and (3) treatment of hypertension. Many patients with MetS are overweight or obese, and weight reduction through lifestyle changes with caloric restriction and increased physical activity is an important part of the strategy.108 In a systematic review of 11 randomized controlled

Controversies

Multiple critiques have been leveled at the construct of the MetS over the last decade. A Joint Statement of the ADA and the European Association for the Study of Diabetes outlined several thoughtful and now famous concerns regarding MetS.127 Because it is a vehicle first proposed to identify individuals at high risk for CVD, one criticism is that obvious risk factors are not accounted for in the definitions, including age, sex, smoking history, and LDL-C. These additional risk factors may

Summary and future considerations

The definition of MetS has been harmonized to the NCEP definition and there are likely to be additional iterations and discussions of the syndrome in the future. The relationship of WC to cardiovascular risk in varied populations needs further research and refinement.17 The basic research focus will be on further elucidation of pathophysiology and the gene interactions that underpin the clustering of MetS components.

There is no doubt that the clinical use of MetS has had its controversies.

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