Summary
Metabolic syndrome describes a constellation of medical conditions which increase the risk for several health problems, primarily cardiovascular disease, type 2 diabetes, and fatty liver.These conditions include insulin resistance (considered the main risk factor), hypertension, dyslipidemia, and abdominal obesity. The primary goal in treating metabolic syndrome is therefore to initiate lifestyle changes, which include dietary modifications and physical exercise. These measures often result in lowered blood pressure and triglyceride levels, as well as increased insulin sensitivity. Symptoms that do not respond sufficiently to these changes, such as persistent hypertension or hyperglycemia, are treated with drugs (e.g., ACE inhibitors, metformin).
Definition
Metabolic syndrome
-
Presence of ≥ 3 of the following conditions (or already receiving medical treatment for them)
- Insulin resistance: fasting glucose ≥ 100 mg/dL
- Elevated blood pressure: ≥ 130/85 mm Hg
- Elevated triglycerides: ≥ 150 mg/dL
- Low HDL-C; : in men < 40 mg/dL; in women < 50 mg/dL
- Abdominal obesity: waist circumference ≥ 102 cm in men; ≥ 88 cm in women
Obesity
| Weight Status | Body Mass Index (BMI) |
|---|---|
| Underweight | < 18.5 |
| Normal or Healthy Weight | 18.5–24.9 |
| Overweight | ≥ 25–29.9 |
| Class I Obesity | 30–34.9 |
| Class II Obesity | 35–39.9 |
| Class III Obesity | ≥ 40 |
Morbid obesity is diagnosed when the patients meet ≥ 1 of the following criteria:
- ≥100 pounds over the ideal body weight
- BMI ≥ 40
- BMI ≥ 35 and health conditions related to obesity (e.g., hypertension, diabetes)
References:[1][2][3][4]
Treatment
-
First-line: lifestyle modifications
- Dietary changes: calorie restriction, healthy foods (e.g., fruit/vegetables, protein-rich, unsaturated fats, sodium-restricted)
- Physical activity: minimum of 30 minutes moderate exercise per day (2.5 hours per week) , which increases insulin sensitivity, lowers blood pressure, and promotes weight loss
- Medical therapy: treat hypertension (e.g., ACE inhibitors), diabetes mellitus, and dyslipidemia (e.g., with statins)
-
Bariatric surgery: if BMI ≥ 40 and no success with dietary and lifestyle changes
- Sleeve gastrectomy (most common): large part of the greater curvature is removed, so that the remaining stomach resembles a sleeve
- Roux-en-Y gastric bypass (2nd most common): Roux-en-Y
References:[1][5][6][7]
Complications
Metabolic syndrome is associated with increased risk of:
- Cardiovascular disease
- Type 2 diabetes
- Non-alcoholic steatohepatitis; → ↑ risk of developing liver cirrhosis and hepatocellular carcinoma
- Portal vein thrombosis [8]
We list the most important complications. The selection is not exhaustive.
Related One-Minute Telegram
- One-Minute Telegram 15-2020-2/4: What is the risk factor in COVID-19: obesity or its comorbidities?
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