Metabolic syndrome is a name for a group of risk factors that occur together and increase the risk for coronary artery disease, stroke, and type 2 diabetes. The primary components include insulin resistance, obesity, dyslipidemia, hypertension and central obesity. The two most important risk factors for metabolic syndrome are extra weight around the middle and upper parts of the body (central obesity). This is when the body may be described as “apple-shaped”, as well as insulin resistance, in which the body cannot use insulin effectively.
Other risk factors include: aging, genes that make you more likely to develop this condition, hormone changes and lack of exercise. The International Diabetes Federation and the revised National Cholesterol Education Program have recently set out a couple of sets of defining criteria for metabolic syndrome. These are very similar and they identify individuals with a given set of symptoms as having metabolic syndrome. International Diabetes Federation The IDF consensus worldwide definition of the metabolic syndrome (2006) Central obesity (defined as waist circumference# with ethnicity specific values) AND any two of the following:
* Raised triglycerides: > 150 mg/dL (1.7 mmol/L), or specific treatment for this lipid abnormality. * Reduced HDL cholesterol: < 40 mg/dL (1.03 mmol/L) in males, < 50 mg/dL (1.29 mmol/L) in females, or specific treatment for this lipid abnormality * Raised blood pressure: systolic BP > 130 or diastolic BP >85 mm Hg, or treatment of previously diagnosed hypertension. * Raised fasting plasma glucose :(FPG)>100 mg/dL (5.6 mmol/L), or previously diagnosed type 2 diabetes. If FPG >5.6 mmol/L or 100 mg/dL, OGTT Glucose tolerance test is strongly recommended but is not necessary to define presence of the Syndrome. # If BMI is >30 kg/m², central obesity can be assumed and waist circumference does not need to be measured The World Health Organization criteria (1999) require presence of one of: * Diabetes mellitus,
* Impaired glucose tolerance,
* Impaired fasting glucose or
* Insulin resistance;
AND two of the following:
* Blood pressure: ? 140/90 mmHg
* Dyslipidemia: triglycerides (TG): ? 1.695 mmol/L and high-density lipoprotein cholesterol (HDL-C) ? 0.9 mmol/L (male), ? 1.0 mmol/L (female)
* Central obesity: waist:hip ratio > 0.90 (male); > 0.85 (female), or body mass index > 30 kg/m2 * Microalbuminuria: urinary albumin excretion ratio ? 20 µg/min or albumin:creatinine ratio ? 30 mg/g
The European Group for the Study of Insulin Resistance (1999) requires insulin resistance defined as the top 25% of the fasting insulin values among non-diabetic individuals AND two or more of the following: * central obesity: waist circumference ? 94 cm (male), ? 80 cm (female) * dyslipidemia: TG ? 2.0 mmol/L and/or HDL-C < 1.0 mmol/L or treated for dyslipidemia * hypertension: blood pressure ? 140/90 mmHg or antihypertensive medication * fasting plasma glucose ? 6.1 mmol/L
The US National Cholesterol Education Program Adult Treatment Panel III (2001) requires at least three of the following: * central obesity: waist circumference ? 102 cm or 40 inches (male), ? 88 cm or 36 inches(female) * dyslipidemia: TG ? 1.7 mmol/L (150 mg/dl)
* dyslipidemia: HDL-C < 40 mg/dL (male), < 50 mg/dL (female) * blood pressure ? 130/85 mmHg
* fasting plasma glucose ? 6.1 mmol/L (110 mg/dl)
I believe that all of the above definitions and criteria can be used as predictive tools in diagnosing a person with metabolic syndrome. Some of the definitions for instance the NCEP and IDF do not require the measurement of insulin and could therefore be more useful in a clinical setting whereas the WHO and EGIR are dependent on insulin resistance. Obesity is the accumulation of excess body fat. I think that the most appropriate measurement of obesity is the measurement of the central obesity as this not only shows a person which body shape that they are, pear-shaped or apple-shaped, and therefore predict whether they are more at risk or not, but also physical measures your hip to waist ratio which should be in proportion to one another.
The BMI index is also appropriate however it cannot differentiate between muscle and fat and therefore a very muscular person could be seen as obese. Insulin is needed to help control the amount of sugar in the body. With insulin resistance, as a result, blood sugar and fat levels rise. Insulin résistance is seen to be associated with obesity and is there an appropriate measurement I think the two most important lifestyle changes that could be implemented in the Western Cape is that of healthy food and an increase in exercise. The amount of fast food consumed by people in the Western Cape is too high and people need to either start cooking healthier food at home or there needs to be healthier fast food outlets opened. One of the biggest problems with obesity is the lack of exercise. People need to learn to become less lazy and try and do at least an hour of exercise each day and try and implement this into their lifestyles.