Metabolic syndrome

Metabolic syndrome is a cluster of conditions that increase the risk of heart disease, stroke, and type 2 diabetes. These conditions include elevated blood sugar, high cholesterol and triglyceride levels, increased blood pressure, and excess body fat around the waist. It is associated with the development of atheromatous plaques, which raise the risk of coronary artery disease and stroke.

It is also referred to as insulin resistance syndrome.

Metabolic syndrome is commonly associated with being overweight or obese, particularly with excess fat around the abdomen. It is often accompanied by elevated blood sugar levels due to the body's reduced ability to respond to insulin (insulin resistance).

In insulin resistance, the body's cells do not effectively absorb sugar (glucose) from the blood. As a result, the pancreas produces more insulin to compensate, leading to elevated levels of both blood sugar and insulin. Over time, this can impair kidney function and cause other metabolic disturbances. Additionally, levels of blood fats, such as triglycerides and cholesterol, often rise, further increasing the risk of cardiovascular disease.

Metabolic syndrome is more common in older adults, especially those with a genetic predisposition to type 2 diabetes and a sedentary lifestyle.

There are several conditions that can increase the risk of developing metabolic syndrome, including:

• Non-alcoholic fatty liver disease (NAFLD).
• Elevated uric acid levels (gout).
• Polycystic ovary syndrome (PCOS).
• Obstructive sleep apnea.

People with metabolic syndrome are at increased risk of developing a variety of serious health conditions, including:

• Type 2 diabetes.
• Coronary heart disease.
• Stroke.
• Heart failure.
• Erectile dysfunction (sexual impotence).
• Reduced immune function, which can increase susceptibility to infections.
• Damage to organs, such as the liver, kidneys, and pancreas.
• Gallstones.
• Pregnancy complications, including preeclampsia, eclampsia, and gestational diabetes.
• Cognitive impairments, such as dementia and memory issues.
• Certain cancers associated with obesity, such as breast, colon, and endometrial cancer.

The symptoms of metabolic syndrome vary from person to person, depending on which underlying condition is most prominent.

• If high blood sugar is the predominant issue, symptoms may include excessive thirst, frequent urination, increased hunger, and dizziness.
• If cholesterol and triglyceride levels are elevated, there may be no noticeable symptoms.
• High blood pressure often does not produce symptoms early on but may later lead to issues such as headaches or chest pain, indicating potential complications.

Because many aspects of metabolic syndrome, such as high blood pressure or elevated cholesterol, can be symptomless in the early stages, it’s important to regularly monitor your weight, blood pressure, and get preventive laboratory tests. Don’t wait until you experience noticeable symptoms to consult your doctor.

Metabolic syndrome is diagnosed if three or more of the following health conditions occur:

1. Increase in waist circumference measurement also known as abdominal obesity. This measurement changes in each country, but in general, in Europe a waist circumference greater than 94 cm in men and 80 cm in women is considered abnormal. In USA the values of 102 cm for men and 88 cm for women, recommended as cutoff points.
2. Elevated blood sugar (glucose): More than 100 mg/dL.
3. Increased blood pressure: Systolic pressure greater than 130 mm Hg and diastolic pressure greater than 85 mm Hg.
4. High triglycerides: More than 150 mg/dL.
5. Low HDL ("good") cholesterol: Less than 40 mg/dL.

If only one or two of these alterations occur, intervention must also be made to normalize them because they still increase the risk of suffering from serious diseases in the future.

Treating metabolic syndrome is crucial to reducing the risk of cardiovascular diseases and type 2 diabetes. If these conditions are already present, the goal of treatment is to minimize the risk of serious complications, such as heart attacks and strokes, which can lead to premature death.

The treatment approach combines various strategies to address the different aspects of metabolic syndrome:

• Diet: Reduce the intake of saturated fats, limit carbohydrates, and increase fiber consumption.
• Weight loss: Losing about 10% of body weight, especially by following a Mediterranean diet rich in fiber and omega-3 fatty acids, significantly improves insulin resistance.
• Physical activity: Engage in at least 30 minutes of moderate-intensity physical activity on most days of the week.
• Quit smoking: Quitting smoking is essential to reduce cardiovascular risk.

When lifestyle changes alone are not sufficient to achieve treatment goals, medications may be prescribed:

• Statins or fibrates to lower high cholesterol and triglycerides.
• Antihypertensive medications to control high blood pressure.
• Orlistat for weight management in obesity.
• Metformin or other antidiabetic drugs to manage high blood sugar.