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34. Metabolic syndrome

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Metabolic syndrome is a serious health condition where a person has three or more of the following measurements:

  • Abdominal obesity (increased waist circumference)
  • Hypertriglyceridaemia
  • Low HDL
  • Hypertension – above 130/85 mmHg
  • Insulin resistance – fasting glucose > 100 mg/dL

A person with metabolic syndrome has drastically increased risk for several health problems, like cardiovascular disease, type 2 diabetes and non-alcoholic steatohepatitis. About 23 % of adults are affected by metabolic syndrome.

Hypertension was described in pathophysiology 1 and will not be repeated here.

Abdominal obesity

Abdominal obesity, or central obesity, is defined as a waist circumference of more than 102 cm in men and 88 cm in women. Obesity in general is a known risk factor for many diseases, but abdominal obesity is an even higher risk factor.

This type of obesity is due to an excess of visceral fat, which is located inside the peritoneal cavity and surrounds the abdominal organs.

It’s not well-known what causes abdominal obesity instead of regular obesity, but alcohol and meat consumption may be involved. Hypercortisolism, as seen in Cushing syndrome, has abdominal obesity as a consequence.

The treatment of any type of obesity is the same and was described in topic 33.

Treatment

The cause of metabolic syndrome is a calorie-filled, unhealthy diet with too little exercise, so the treatment involves changing these lifestyle factors. Dietary modifications and physical exercise are the first-line treatment.

The diet should be changed to include:

  • Calorie restriction
  • More fruits and vegetables
  • More proteins
  • More unsaturated fats
  • Less saturated fats
  • Less sodium

The exact amount of physical activity to prescribe depends on the patients, but a minimum of 30 minutes moderate exercise per day is a good place to start.

If lifestyle changes don’t work can medications be used. Antihypertensive drugs and anti-hyperlipidaemic drugs may be effective.

Bariatric surgery may be performed in severe cases. More about this can be studied in topic 33.