Metabolic Syndrome Overview

Metabolic Syndrome (MeS)

• Definition: A cluster of cardiovascular disease risk factors linked to insulin resistance.

• Historical Context:

  • Early associations (1920s) between diabetes, gout, and hypertension.
  • 1990s: Recognition of visceral obesity as a key component of insulin resistance syndrome (also known as Syndrome X or the Deadly Quartet).

• Definitions:

  • ATP III (2005): Requires any 3 of the following 5 criteria:
    • Obesity: Waist circumference
      • Men: ≥ 102 cm
      • Women: ≥ 88 cm
    • Glucose: Fasting glucose ≥ 5.6 mmol/L or known diabetes.
    • Lipids:
      • Triglycerides: ≥ 1.7 mmol/L
      • HDL: Men ≤ 1 mmol/L; Women ≤ 1.3 mmol/L.
    • Blood Pressure: ≥ 130/85 mm Hg or known hypertension.
  • IDF (2006): Requires visceral obesity + 2 or more criteria from above.

Associated Conditions

• Polycystic ovarian disease
• Fatty liver disease
• Chronic kidney disease
• Obstructive sleep apnoea
• Hyperuricemia/gout
• Low-grade inflammation and endothelial dysfunction

Pathophysiology of MeS

• Visceral Obesity: Central to the development of MeS; fat cells secrete hormones that disrupt insulin action
• Insulin Resistance: Impairs glucose uptake and promotes lipolysis, leading to increased free fatty acids (FFAs).
• Neurohormonal Activation: Adipose tissue secretes hormones like Angiotensin II, contributing to hypertension.
• Chronic Inflammation: Adipocytokines (e.g., TNFα, IL-6) lead to endothelial dysfunction and vascular disease.
• Dysglycemia: Impaired glucose homeostasis; pre-diabetes is a significant risk factor for Type 2 diabetes.
• Dyslipidaemia: Characterized by high triglycerides and VLDL, low HDL, and small dense LDL particles.
• Hypertension: Resulting from insulin resistance and activation of the Renin-Angiotensin System (RAS).
• Endothelial Dysfunction: Increases risk of atherosclerosis and thrombotic events.

Management of MeS

• Recognition: Identify patients with visceral obesity and associated metabolic abnormalities.
• Lifestyle Interventions:
  • Diet and weight reduction.
  • Regular exercise
  • Smoking cessation
• Pharmacological Therapy: Treat each risk factor if lifestyle changes are insufficient (e.g., glucose abnormalities, hypertension, dyslipidaemia).

Explore the critical aspects of Metabolic Syndrome (MeS), including its definition, historical context, and diagnostic criteria established by ATP III and IDF. This quiz also highlights associated conditions that can arise from MeS, providing a comprehensive understanding of this health issue.