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Metabolic syndrome

Last updated: December 18, 2020

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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).

Metabolic syndrome

  • Presence of ≥ 3 of the following conditions (or already receiving medical treatment for them)

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:

References:[1][2][3][4]

  • 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

References:[1][5][6][7]

Metabolic syndrome is associated with increased risk of:

We list the most important complications. The selection is not exhaustive.

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  1. Wang SS. Metabolic Syndrome. In: Ali YS, Metabolic Syndrome. New York, NY: WebMD. http://emedicine.medscape.com/article/165124-overview. Updated: December 27, 2015. Accessed: February 9, 2017.
  2. Bray GA, Perreault L. Obesity in adults: Prevalence, screening, and evaluation. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/obesity-in-adults-prevalence-screening-and-evaluation?source=search_result&search=bmi&selectedTitle=1~150.Last updated: January 31, 2017. Accessed: February 9, 2017.
  3. Grundy SM, Brewer HB, Cleeman JI, et al. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation. 2004; 109 (3): p.433-438. doi: 10.1161/01.CIR.0000111245.75752.C6 . | Open in Read by QxMD
  4. Hyperuricemia, Gout, and the Metabolic Syndrome. https://www.medscape.com/viewarticle/573641. Updated: March 1, 2008. Accessed: November 4, 2017.
  5. Meigs JB. The metabolic syndrome (insulin resistance syndrome or syndrome X). In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/the-metabolic-syndrome-insulin-resistance-syndrome-or-syndrome-x?source=search_result&search=metabolic+syndrome&selectedTitle=1~150#H21.Last updated: January 13, 2017. Accessed: February 9, 2017.
  6. Heart-healthy eating. https://www.nhlbi.nih.gov/health/health-topics/topics/heart-healthy-lifestyle-changes/heart-healthy-eating. Updated: June 22, 2016. Accessed: February 9, 2017.
  7. Arterburn DE, Courcoulas AP. Bariatric surgery for obesity and metabolic conditions in adults. BMJ. 2014; 349 . doi: 10.1136/bmj.g3961 . | Open in Read by QxMD
  8. Bureau C, Laurent J, Robic MA, et al. Central obesity is associated with non-cirrhotic portal vein thrombosis. J Hepatol. 2016; 64 (2): p.427-432. doi: 10.1016/j.jhep.2015.08.024 . | Open in Read by QxMD