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Metabolic syndrome
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Metabolic syndrome (also syndrome X, Reaven’s syndrome, CHAOS, or insulin resistance syndrome) is a set of disorders related to metabolismIts prevalence is increasing with time and studies show a prevalence of 20-25% among Americans. Metabolic syndrome increases the risk for diabetes and cardiovascular disorders. Its features include obesity with increased waist circumference, high blood pressure, dyslipidemia, and insulin resistance.
Causes and risk factors:
The underlying factor is insulin resistance and visceral fat development. Insulin is needed by body to use sugar. When insulin resistance develops the body tries to make more insulin to use sugar. Increased insulin levels in-turn increase triglycerides in the blood, lower HDL-cholesterols and stress the kidneys thus causing high blood pressure. Visceral fat has a role in increasing insulin resistance secondary to increased systemic inflammatory chemicals. Dietary fructose increases uric acid level which also contributes to resistance.
Following are known risk factors for metabolic syndrome
1. Overweight / obesity: Body Mass Index (BMI) greater than 25; abdominal obesity or apple shaped body (rather than pear shaped); increasing adiposity and waist circumference are all strong risk factors. Even some lean and normal weight persons can develop insulin resistance, but risk is greatest with obese people.
2. Sedentary life style and increased caloric intake: Physical inactivity due to work or habit increases adiposity, and increases risk for cardiovascular events, increases plasma lipid and glucose levels.
3. Age: Direct relationship exists with age. 44% people above 50years have metabolic syndrome in US, women more prevalent. But 1/8th of school children have also been found out to have 3 or 4 factors of metabolic syndrome, and decades later they get cardiovascular disease.
4. Diabetes mellitus: Type-2 diabetes patients have a 75% prevalence of metabolic syndrome. Even impaired glucose tolerance without diabetes is a strong risk factor for both cardiovascular disease and metabolic syndrome.
5. Coronary heart disease: 50% patients with known CHD have metabolic syndrome.
6. Lipodystrophy: Directly related to metabolic syndrome whether it is genetic or secondary acquired.
7. Race / genetics: Hispanics and Asians are at increased risk.
8. Other diseases: Diseases related to, or causing insulin resistance are risk factors for metabolic syndrome e.g. polycystic ovary disease. Moreover, diagnosis of high blood pressure or coronary heart disease itself is a risk factor.
Diagnosis:
• Elevated waist circumference: More than 35 inches in women and more than 40 inches in men; increased waist to hip ratio; or BMI above 30 kg/m2.
• Dyslipidemia: Elevated triglycerides and reduced HDL-cholesterol level in blood.
• High blood pressure
• Elevated fasting blood glucose level: A level higher than 110 mg/dl (100 mg/dl by NCEP) or a person already on treatment for diabetes.
Treatment:
It is obesity, increased caloric intake and physical inactivity that start the set of disturbances in first place. Thus alteration in these to healthier ways is the main treatment because focusing on each and every risk factor is tough. Mainstay of treatment is:
1: Exercise: Daily routine of 30-60 minutes of moderate intensity exercise.
2: Weight loss: Gradual steady weight loss reverses the scales from disease to health. Even as little as 5-10% decreased have significant improvement on metabolic syndrome parameters.
3: Healthy diet: Limit unhealthy fats and refined sugars; increase fibers, fish, fruits, and vegetables; and emphasize on whole grains.
4: Stop smoking: Smoking increases risk for insulin resistance.
5: Medical support: Work with your doctor for life style changes, diet and medication (if needed) for high blood pressure, dyslipidemia, cardiovascular disease or diabetes. Go for regular check-ups and follow-ups.
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