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Know more on Metabolic Syndrome

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Metabolic Syndrome

Know more on Metabolic Syndrome

Dr Vivek Mittal
Senior Consultant-Interventional Cardiologist
Cardiac Sciences, Cardiology

MetS, popularly known as Metabolic Syndrome, is often associated with obesity, low birth weight, increased gain in body mass in early childhood, decreased pubertal insulin sensitivity and clinical markers of insulin resistance. The development of insulin resistance, as a consequence of obesity can be demonstrated in childhood, which has a pivotal role in the pathomechnaism of syndrome.

According to the International Diabetes Federation (IDF), MetS in children and adults is defined by: for children in age 6 to <10years and age 10 to <16 years, obesity is defined as ≥90th percentile of waist circumference, for adults criteria is based on triglycerides, high-density lipoprotein cholesterol (HDL-C), blood pressure, and glucose and for youth ≥16 years of age, the panel recommends to use the IDF criteria.

How can Obesity Affect you?

Obesity increases cardiometabolic risk especially when adiposity is centrally distributed. A Framingham Heart Study among overweight and obese individuals revealed that there is an increasing prevalence of hypertension, dyslipidemia, impaired fasting glucose, and increased visceral adipose quartiles, which are assessed by multidetector computed tomography. It has an adverse effect on public health due to its increasing prevalence and poor prognosis.

On using the Adult Treatment Panel III diagnostic system for children and adolescents, it revealed that 4.2% suffered from the syndrome. While components syndrome was: 9.8-17.9% for abdominal obesity, 21.0-23.4% for elevated triglyceride, 18.3-23.3% for reduced high-density lipoprotein-cholesterol, 4.9-7.1% for elevated blood pressure and 0.8-1.7% for impaired fasting glucose.

However, not all patients with insulin resistance develop MetS, there are other metabolic and pathological factors ((inflammatory factors, adipocytokines, cortisol, oxidative stress, vascular factors, heredity, and lifestyle factors) that are operative.

Know the Other Factors

Insulin Resistance

Fasting hyperinsulinemia, an indication of insulin resistance is associated with atherosclerosis and cardiovascular morbidity. Hence, insulin directly promotes cardiovascular pathology and leads to development of MetS.

Obesity

Both men and women are at an increasing risk of cardiovascular diseases due to increasing weight. Childhood obesity has been associated with elevated blood pressure, elevated triglycerides, low HDL-C, abnormal glucose metabolism, insulin resistance, inflammation, and compromised vascular function.

Inflammatory Mediators

Elevated levels of circulating inflammatory cytokines have been shown to be associated with the atherosclerotic process, and CRP is one of the most sensitive indicators. CRP has been localized to atherosclerotic plaques and infarcted myocardium, where it promotes activation of complement. Obesity in adults is strongly associated with CRP.

Oxidative Stress

Reactive nitrogen and oxygen species causes macromolecular damage and also promote the development of diabetes.

Cortisol

MetS causes stress, depression and cortisol and increases the risk of myocardial infarction in adults. Hypercortisolemia leads to visceral obesity and accelerates the cardiovascular mortality of Cushing’s syndrome.

Hypertension

Hypertension is an integral component of the MetS. Increased sympathetic tone has been associated with obesity in adolescents and insulin appears to have a direct effect on sympathetic nervous system activity.

Lipid Abnormalities

Abnormal lipid profiles also are found in children with obesity and insulin resistance. Overweight children have significantly higher levels of total cholesterol, LDL cholesterol, and triglycerides and lower HDL-C levels than normal-weight children.

Glucose Intolerance: T2DM

Diabetes Mellitus is a metabolic disease that is characterized by hyperglycemia. It is often associated with accelerated development of vascular disease. Its progression can be witnessed from insulin resistance and impaired carbohydrate metabolism to T2DM in both children and adults. The fasting glucose range in obese children should be within 100 to 126 mg/dl because appropriate management may decrease the progression to T2DM. However, American Diabetes Association recommends routine testing in obese children >10 years as they are prone to additional risk factors for T2DM.

What are the Risk Factors for MetS?

1. Heredity

Children of parents who have MetS are at a higher risk of developing cardiovascular diseases because of shared genetic and environmental factors.  

2. Lifestyle Behaviors
(A) Television-Watching Habits

Watching television is one of the factors associated with overweight children and adults. However, this does not contribute to the development of insulin resistance and inflammation. For each hour of television watched per day, the likelihood of a child being overweight increased 2%; overweight parents watched more television than normal-weight parents.

(B) Physical Activity

Being physically active has proven to be beneficial in the management and prevention of obesity in children and adults and decreased the level of inflammatory cytokines and markers of oxidative stress. In addition, it also leads to decreased insulin levels in adolescents and improves endothelial function and HDL-C.

(C) Dietary Intake

Increased consumption of whole grain foods decreases the development of coronary heart disease as well as diabetes and improves insulin sensitivity and inflammation in adults.

What are the Treatment Options?

The components of MetS can improve with a combination of dietary and physical activity interventions. A comprehensive behavioral modification in overweight children reduces body weight, body composition, and improves the components of MetS within 3 months. Therefore, it is reasonable that early intervention for managing obesity reduces the risk of MetS.

A 10-15% weight control in adults improves glucose tolerance, insulin sensitivity and promotes endothelial vascular function beyond the benefits of glycemic control, and reduces blood pressure in adults and children.