Metabolic syndrome

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Overview

The underlying etiology of metabolic syndrome is extra weight, obesity, lack of physical activity, and genetic predisposition. The crux of the syndrome is a buildup of adipose tissue and tissue dysfunction that in turn leads to insulin resistance. Proinflammatory cytokines such as tumor necrosis factor, leptin, adiponectin, plasminogen activator inhibitor, and resistin, are released from the enlarged adipose tissue, which alters and impacts insulin handling adversely. Insulin resistance can be acquired or may be due to genetic disposition. Impairment of the signaling pathway, insulin receptor defects, and defective insulin secretion can all contribute towards insulin resistance. Over time, the culmination of this cause development of metabolic syndrome that presents as vascular and autonomic damage.

The distribution of body fat is also important, and it is known that upper body fat plays a strong role in developing insulin resistance. Fat accumulation can be intraperitoneal (visceral fat) or subcutaneous.  Visceral fat may contribute to insulin resistance more strongly than subcutaneous fat. However, both are known to play a role in the development of the metabolic syndrome. In upper body obesity, high levels of nonesterified fatty acids are released from the adipose tissue causing lipid to accumulate in other parts of the body such as liver and muscle, further perpetuating insulin resistance.

Symptoms

These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.Having high blood pressure, high triglycerides, and being overweight or obese may be signs of metabolic syndrome. People with insulin resistance may have acanthosis nigricans. This is darkened skin areas on the back of the neck, in the armpits, and under the breasts.

Causes

The exact cause of metabolic syndrome is not known. Many features of the metabolic syndrome are associated with "insulin resistance." Insulin resistance means that the body does not use insulin efficiently to lower glucose and triglyceride levels. A combination of genetic and lifestyle factors may result in insulin resistance. Lifestyle factors include dietary habits, activity and perhaps interrupted sleep patterns (such as sleep apnea).

Risk factors

Metabolic syndrome is a group of five risk factors, that when left untreated, increase the likelihood of developing heart disease, diabetes, and stroke. It may also be called syndrome X or insulin resistance syndrome.

The five risk factors are:

high blood pressure, including taking medicine to lower your blood pressure

high blood sugar levels (insulin resistance), or taking medication to lower your blood sugar

excess fat around the waist

high triglyceride levels, or taking medicine to lower your levels

low levels of good cholesterol or HDL, or taking medicine to manage low HDL

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Complications

If symptoms are managed, people with metabolic syndrome can reduce their risks of developing serious health problems such as heart attack or stroke. The condition may be able to be reversed with weight loss or managed with a combination of diet, exercise, and medication.

Although symptom management will reduce health complications, most people with this condition have a long-term risk of cardiovascular disease. If you develop this condition, you may need to be monitored by your doctor to help prevent serious health problems such as heart attack and stroke.

Prevention

Since physical inactivity and excess weight are the main underlying contributors to the development of metabolic syndrome, exercising, eating healthy and, if you are currently overweight or obese, attempting to lose weight can help reduce or prevent the complications associated with this condition. Your doctor may also prescribe medications to manage some aspects of your problems associated with the metabolic syndrome. Some of the ways to reduce your risk:

Healthy eating and attempting to lose weight if currently overweight or obese: Healthy eating and moderate weight loss, in the range of 5 percent to 10 percent of body weight, can help restore your body’s ability to recognize insulin and greatly reduce the chance that the syndrome will become a more serious illness. This can be done through diet, exercise, or even with help from weight-loss medications if recommended by your doctor.

Exercise: Increased activity alone can improve your insulin sensitivity. Aerobic exercise such as a brisk 30-minute daily walk can promote weight loss, improved blood pressure and triglycerides levels and a reduced risk of developing diabetes. Most healthcare providers recommend 150 minutes of aerobic exercise each week. Exercise may reduce the risk for heart disease even without accompanying weight loss. Any increase in physical activity is helpful, even for those unable to perform 150 minutes of activity per week.

Dietary changes: Maintain a diet that keeps carbohydrates to no more than 50 percent of total calories. The source of carbohydrates should be from whole grains (complex carbohydrates), such as whole grain bread (instead of white) and brown rice (instead of white). Whole grain products along with legumes (for example, beans), fruits and vegetables allow you to have a higher dietary fiber. Eat less red meats and poultry. Instead, eat more fish (without the skin and not fried). Thirty percent of your daily calories should come from fat. Consume healthy fats such as those in canola oil, olive oil, flaxseed oil and tree nuts.