Metabolic Disorders 2024-01.pdf

Metabolic Syndrome Created by: Dr. Gabriela P Garcia Modified by Dr. Guzman and Dr. Ortiz Objectives 1 To know the definition & mayor features of metabolic syndrome 2 Understand the epidemiology and risk factor associated with metabolic syndrome 3 Correlate the clinical manifestations with the patho...

Metabolic Syndrome Created by: Dr. Gabriela P Garcia Modified by Dr. Guzman and Dr. Ortiz Objectives 1 To know the definition & mayor features of metabolic syndrome 2 Understand the epidemiology and risk factor associated with metabolic syndrome 3 Correlate the clinical manifestations with the pathogenesis of the disease 4 Identify the different criteria to diagnose metabolic syndrome 5 Comprehend overall approach to patients with metabolic syndrome 6 Know different therapeutic approaches for this patients Definition Some of the features of the metabolic syndrome include: -Obesity, especially accumulation of abdominal fat -Fasting hyperglycemia -Insulin resistance -Hypertension -Lipid abnormalities, such as increased blood triglycerides and decreased blood high-density lipoprotein-cholesterol Alternate names… Metabolic syndrome Syndrome X Insulin resistance syndrome Deadly quartet Reaven’s syndrome Epidemiology Prevalence increases with age Greater in industrialized and urban areas. Increase in waist circumference is found predominantly in women. Fasting TG>150 mg/dl and hypertension more likely in men. Prevalence of obesity: Adult: ∼ 40% Adolescents (12–19 yrs): ∼ 20% Risk Factors Postmenopausal status Smoking Low household income High carbohydrate diet FAMILY HISTORY ✓Predictors of CVD events and associated mortality ✓Associated with HIGH TG’s, low HDL, HIGH BP Overweight/ obesity- central (key feature) Ethnicity Sedentary lifestyle Lipodystrophy Insulin resistance Diabetes mellitus- approx. 75% of T2DM or IGT have metabolic syndrome Coronary heart disease- 50% of CAD patients have metabolic syndrome Clinical features Usually ASYMPTOMATIC → high index of suspicion is needed for diagnosis Physical Examination: ✓Increased waist circumference ✓Increased blood pressure ✓Lipoatrophy ✓Acanthosis nigricans/skin tags ✓Increase BMI Should alert to search for other abnormalities Pathogenesis Central obesity is the key element that leads to: Insulin resistance and glucose intolerance Dyslipidemia Hypertension Various factors that are proinflammatory. Coronary Artery Disease Pathophysiology Other associated conditions 1) Cardiovascular disease increased risk for new onset CVD, ischemic stroke, Peripheral Vascular Disease 2) Nonalcoholic fatty liver disease (NAFLD) / Carcinoma 3) Hyperuricemia 4) PCOS- prevalence 40-50% 5) Obstructive Sleep Apnea- commonly associated with obesity, hypertension & insulin resistance (CPAP improves insulin sensitivity) 6) Chronic Kidney disease Type 2 diabetes mellitus increased risk by 3-5 folds Obesity: An excessive accumulation of fat tissue that results in increased health risks. The relation between an individual's height and weight is commonly assessed using the Body Mass Index (BMI) *Individuals with a normal BMI may still have elevated body fat content and therefore be at increased risk for metabolic comorbidities Diagnosis International Diabetes Federation Adult Treatment Panel III Laboratory investigations: ✓Fasting lipid profile and fasting glucose ✓CRP, fibrinogen, uric acid, urinary microalbumin ✓Liver Function Test for NAFLD (Nonalcoholic Fatty Liver Disease) ✓Sleep study for OSA ✓Testosterone, FSH, LH for PCOS Diagnosis - ATP III criteria ≥100 mg/dL (5.6 mmol/L) Diagnosis - IDF criteria: *Diagnosis is established when 3 of these risk factors are present. †Abdominal obesity is more highly correlated with metabolic risk factors than is BMI. ‡Some men develop metabolic risk factors when the circumference is only marginally increased. Treatment Treat underlying causes (overweight/obesity and physical inactivity) by intensifying weight management and increasing physical activity. Treat cardiovascular risk factors if they persist despite lifestyle modification. Aggressive lifestyle modification focused on weight reduction and increased physical activity. Dietary changes Calorie restriction: 1200–1500 kcal per day in women; 1500–1800 kcal per day in men. Diet low in carbohydrates, sodium, cholesterol, saturated fats, and trans fats. Consumption of fruit, vegetables, low-fat dairy, fish, and whole grains. Physical activity Aggressive lifestyle modification focused on weight reduction and increased physical activity is the primary therapy for the management of metabolic syndrome. Most patients: at least 30 minutes of moderate aerobic activity 5–7 times per week (e.g., brisk walking) High-risk patients (e.g., history of cardiovascular disease, congestive heart failure): medically supervised exercise programs. Triglycerides A fasting triglyceride value of 10% is necessary to lower fasting triglycerides. A fibrate (gemfibrozil or fenofibrate) is the drug of choice to lower fasting triglycerides and typically achieves a 35– 50% reduction. Other drugs that lower triglycerides include statins, nicotinic acid, and high doses of omega-3 fatty acids. Cholesterol For a rise in HDL cholesterol, weight reduction is an important strategy Nicotinic acid is the only currently available drug with predictable HDL cholesterol-raising properties Statins, fibrates, and bile acid sequestrants have modest effects (5–10%), and there is no effect on HDL cholesterol with ezetimibe or omega-3 fatty acids. For patients with metabolic syndrome and diabetes, LDL cholesterol should be reduced to