The metabolic syndrome – What is it and how should it be managed?

A cluster of metabolic factors have been merged into an entity named the metabolic syndrome. Although the characteristics of this syndrome have varied over time the presently used definition was established in 2009. The presence of three abnormal findings out of five components qualifies a person for the metabolic syndrome: elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure and elevated fasting plasma glucose. Cut points have been defined for all components apart from waist circumference, for which national or regional values are used. The metabolic syndrome predicts cardiovascular disease and type 2 diabetes. This associated risk does not exceed its components whereof elevated blood pressure is the most frequent. A successful management should, however, address all factors involved. The management is always based on healthy lifestyle choices but has not infrequently to be supported by pharmacological treatment, especially blood pressure lowering drugs. The metabolic syndrome is a useful example of the importance of multiple targets for preventive interventions. To be successful management has to be individualized not the least when it comes to pharmacological therapy. Frail elderly people should not be over-treated. Knowledge transfer of how risk factors act should be accompanied by continuous trust building and motivation. In complex situations with a mix of biological risk factors, adverse social conditions and unhealthy lifestyle, everything cannot be changed at once. It is better to aim for small steps that are lasting than large, unsustainable steps with relapses to unhealthy behaviours. A person with the metabolic syndrome will always be afflicted by its components, which is the reason that management has to be sustained over a very long time. This review summarizes the knowledge on the metabolic syndrome and its management according to present state of the art.

Download Full-text

The Metabolic Syndrome and Risk of Chronic Kidney Disease: Pathophysiology and Intervention Strategies

Journal of Nutrition and Metabolism ◽

10.1155/2012/652608 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 5

Author(s):

Heather A. LaGuardia ◽

L. Lee Hamm ◽

Jing Chen

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Metabolic Syndrome ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Intervention Strategies ◽

Elevated Blood ◽

The Metabolic Syndrome ◽

Prevalence Of Obesity ◽

Complications And Mortality

Metabolic syndrome is characterized by a clustering of cardiovascular risk factors, including abdominal obesity, elevated blood pressure and glucose concentrations, and dyslipidemia. The presence of this clinical entity is becoming more pervasive throughout the globe as the prevalence of obesity increases worldwide. Moreover, there is increased recognition of the complications and mortality related to this syndrome. This paper looks to examine the link between metabolic syndrome and the development of chronic kidney disease.

Download Full-text

The Prevalence of the Metabolic Syndrome and Its Risk Factors in a Middle-Aged Swedish Population — Mainly a Function of Overweight?

European Journal of Cardiovascular Nursing ◽

10.1016/j.ejcnurse.2007.05.003 ◽

2008 ◽

Vol 7 (1) ◽

pp. 21-26 ◽

Cited By ~ 26

Author(s):

Gunilla Hollman ◽

Margareta Kristenson

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Metabolic Syndrome ◽

Risk Factor ◽

Waist Circumference ◽

Hdl Cholesterol ◽

Population Based ◽

Middle Aged ◽

Swedish Population ◽

The Metabolic Syndrome

Background: The prevalence of obesity, one risk factor for developing the metabolic syndrome (MS), has increased during the last decades. It has therefore been assumed that the prevalence of MS would also increase. Aims: The aim was to analyse the prevalence of MS and its risk factors in a middle-aged Swedish population. Methods: Data were obtained between 2003 and 2004 from a random population based sample of 502 men and 505 women, 45–69 years old. Measures of plasma glucose, serum lipids, blood pressure, weight, height, waist circumference and self-reported data concerning presence of disease, medication and lifestyle were obtained. Results: The prevalence of MS was 14.8% among men and 15.3% among women, with an increase by age among women only, 10% to 25% ( p = 0.029). Among individuals with MS the most frequent risk factor was large waist circumference, present in 85% of men and 99% of women, followed by high blood pressure, high triglycerides, high glucose and HDL cholesterol (38% and 47% respectively). Conclusion: The prevalence of MS was 15%, increasing with age only among women. Overweight was a dominant characteristic, and only half of the individuals with MS had glucose/HDL cholesterol levels beyond defined cut points of the syndrome.

Download Full-text

Evaluation of Metabolic Syndrome among Locomotive Drivers

Occupational Medicine ◽

10.18502/tkj.v11i3.2588 ◽

2020 ◽

Author(s):

M Saraei ◽

A Najafi ◽

E Heidarbagi ◽

A Rahimi-Golkhandan

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Metabolic Syndrome ◽

Waist Circumference ◽

Cross Sectional Study ◽

Cross Sectional ◽

High Waist Circumference ◽

The Metabolic Syndrome ◽

High Prevalence ◽

Train Drivers

Introduction: Screening of risk factors for metabolic syndrome among commercial and train drivers that are considered safety sensitive jobs, is an important issue in safety of transportation system. Metabolic syndrome is consisted of disturbed lipid profile, high blood pressure, and high waist circumference. It can lead to decrease the quality of life and higher health associated costs for these patients. This study aimed to assess risk factors for metabolic syndrome among train drivers. Methods: This cross-sectional study was conducted on 281 train drivers referred to their annual health examinations to Occupational Medicine Clinic of Baharloo Hospital, Tehran University of Medical Sciences. Demographic characteristics of participants were recorded. Blood pressure, body mass index and waist circumference of drivers were measured. Participants’ blood sample for fasting blood sugar, triglyceride, high and low density lipoproteins were collected. Metabolic syndrome was defined according to the NCEP ATP III criteria. Results: All of the participants were males. Their mean age and BMI was 43±10 year and 26.60±3.67 Kg/m2, respectively. Fifty three (21%) of the participants were diagnosed with metabolic syndrome. The more frequent risk factor for metabolic syndrome was triglyceride more than 150mg/dl. Conclusion: Findings of the present study revealed high prevalence of metabolic syndrome among train drivers. Further studies are needed for screening the metabolic syndrome in this occupational group as it is a sensitive occupation.

Download Full-text

Association between the sympathetic firing pattern and anxiety level in patients with the metabolic syndrome and elevated blood pressure

Journal of Hypertension ◽

10.1097/hjh.0b013e3283350ea4 ◽

2010 ◽

Vol 28 (3) ◽

pp. 543-550 ◽

Cited By ~ 61

Author(s):

Elisabeth Lambert ◽

Tye Dawood ◽

Nora Straznicky ◽

Carolina Sari ◽

Markus Schlaich ◽

...

Keyword(s):

Blood Pressure ◽

Metabolic Syndrome ◽

Firing Pattern ◽

Anxiety Level ◽

Elevated Blood Pressure ◽

Elevated Blood ◽

The Metabolic Syndrome

Download Full-text

Association between 24 h urinary sodium and potassium excretion and the metabolic syndrome in Chinese adults: the Shandong and Ministry of Health Action on Salt and Hypertension (SMASH) study

British Journal Of Nutrition ◽

10.1017/s0007114514003833 ◽

2015 ◽

Vol 113 (6) ◽

pp. 996-1002 ◽

Cited By ~ 20

Author(s):

Zeng Ge ◽

Xiaolei Guo ◽

Xiaorong Chen ◽

Junli Tang ◽

Liuxia Yan ◽

...

Keyword(s):

Blood Pressure ◽

Metabolic Syndrome ◽

Central Obesity ◽

Hdl Cholesterol ◽

Elevated Blood Pressure ◽

Potassium Excretion ◽

Elevated Blood ◽

Chinese Adults ◽

The Metabolic Syndrome ◽

Low Hdl

The association of 24 h urinary Na and potassium excretion with the risk of the metabolic syndrome (MetS) has not been studied in China. The aim of the present study was to examine this association by analysing the data from 1906 study participants living in north China. To this end, 24 h urine samples were collected. Of the 1906 participants, 471 (24·7 %) had the MetS. The mean urinary Na and K excretion was 228·7 and 40·8 mmol/d, respectively. After multivariate adjustment, the odds of the MetS significantly increased across the increasing tertiles of urinary Na excretion (1·00, 1·40 and 1·54, respectively). For the components of the MetS, the odds of central obesity, elevated blood pressure and elevated TAG, but not the odds of low HDL-cholesterol and elevated fasting glucose, significantly increased with the successive tertiles of urinary Na excretion. Furthermore, for every 100 mmol/d increase in urinary Na excretion, the odds of the MetS, central obesity, elevated blood pressure and elevated TAG was significantly increased by 29, 63, 22 and 21 %, respectively. However, urinary K excretion was not significantly associated with the risk of the MetS. These findings suggest that high Na intake might be an important risk factor for the MetS in Chinese adults.

Download Full-text

Regular consumption of pulses for 8 weeks reduces metabolic syndrome risk factors in overweight and obese adults

British Journal Of Nutrition ◽

10.1017/s0007114512000712 ◽

2012 ◽

Vol 108 (S1) ◽

pp. S111-S122 ◽

Cited By ~ 50

Author(s):

R. C. Mollard ◽

B. L. Luhovyy ◽

S. Panahi ◽

M. Nunez ◽

A. Hanley ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Metabolic Syndrome ◽

Waist Circumference ◽

Energy Intake ◽

Oral Glucose ◽

Glucose Load ◽

C Peptide ◽

The Metabolic Syndrome ◽

Frequent Consumption

Pulses are low in energy density, supporting their inclusion in the diet for the management of risk factors of the metabolic syndrome (MetSyn). The aim of the present study was to describe the effects of frequent consumption (five cups/week over 8 weeks) of pulses (yellow peas, chickpeas, navy beans and lentils), compared with counselling to reduce energy intake by 2093 kJ/d (500 kcal/d), on risk factors of the MetSyn in two groups (nineteen and twenty-one subjects, respectively) of overweight or obese (mean BMI 32·8 kg/m2) adults. Body weight, waist circumference, blood pressure, fasting blood parameters and 24 h food intakes were measured at weeks 1, 4 and 8. Blood glucose, insulin, C-peptide, glucagon-like peptide-1 (GLP-1) and ghrelin were measured after a 75 g oral glucose load at weeks 1 and 8. At week 8, both groups reported reductions in energy intake, waist circumference, systolic blood pressure, glycosylated Hb (HbA1c) and glucose AUC and homeostasis model of insulin resistance (HOMA-IR) following the glucose load (P < 0·05). However, HDL, fasting C-peptide and insulin AUC responses were dependent on diet (P < 0·05). HDL and C-peptide increased by 4·5 and 12·3 %, respectively, in the pulse group, but decreased by 0·8 and 7·6 %, respectively, in the energy-restricted group. Insulin AUC decreased in both females and males on the energy-restricted diet by 24·2 and 4·8 %, respectively, but on the pulse diet it decreased by 13·9 % in females and increased by 27·3 % in males (P < 0·05). In conclusion, frequent consumption of pulses in an ad libitum diet reduced risk factors of the MetSyn and these effects were equivalent, and in some instances stronger, than counselling for dietary energy reduction.

Download Full-text

The metabolic syndrome: setting the scene. The cons

Diabetes and Vascular Disease Research ◽

10.3132/dvdr.2007.018 ◽

2007 ◽

Vol 4 (2_suppl) ◽

pp. S4-S6 ◽

Cited By ~ 2

Author(s):

Naveed Sattar

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Risk Assessment ◽

Metabolic Syndrome ◽

Elevated Blood ◽

Diabetes Screening ◽

Cvd Risk ◽

Treatment Benefit ◽

The Metabolic Syndrome

Conclusion: Metabolic syndrome is conceptually useful. It has encouraged thought about the pathology of diabetes and cardiovascular disease, has facilitated research and has brought together cardiologists and diabetologists. But the criteria are neither needed nor additive for CVD risk assessment or diabetes screening or prediction. Neither are they needed to determine treatment benefit. Better options would be to measure and target established risk factors such as lipids, smoking and elevated blood pressure. We should also be thinking about obesity and its prevention, and to do this we need changes in food, activity and fiscal environments.

Download Full-text

The human microbiota is associated with cardiometabolic risk across the epidemiologic transition

10.1101/595934 ◽

2019 ◽

Author(s):

Na Fei ◽

Beatriz Peñalver Bernabé ◽

Louise Lie ◽

Danny Baghdan ◽

Kweku Bedu-Addo ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Blood Glucose ◽

Waist Circumference ◽

Microbial Diversity ◽

Elevated Blood Pressure ◽

Oral Microbiota ◽

Elevated Blood ◽

African Origin ◽

Cut Points

AbstractOral and fecal microbial biomarkers have previously been associated with cardiometabolic (CM) risk, however, no comprehensive attempt has been made to explore this association in minority populations or across different geographic regions. We characterized gut- and oral-associated microbiota and CM risk in 655 participants of African-origin, aged 25-45, from Ghana, South Africa, Jamaica, and the United States (US). CM risk was classified using the CM risk cut-points for elevated waist circumference, elevated blood pressure and elevated fasted blood glucose, low high-density lipoprotein (HDL), and elevated triglycerides. Gut-associated bacterial alpha diversity negatively correlated with elevated blood pressure and elevated fasted blood glucose. Similarly, gut bacterial beta diversity was also significantly differentiated by waist circumference, blood pressure, triglyceridemia and HDL-cholesterolemia. Notably, differences in inter- and intra-personal gut microbial diversity were geographic-region specific. Participants meeting the cut-points for 3 out of the 5 CM risk factors were significantly more enriched with Lachnospiraceae, and were significantly depleted of Clostridiaceae, Peptostreptococcaceae, andPrevotella. The predicted relative proportions of the genes involved in the pathways for lipopolysaccharides (LPS) and butyrate synthesis were also significantly differentiated by the CM risk phenotype, whereby genes involved in the butyrate synthesis via lysine, glutarate and 4-aminobutyrate/succinate pathways and LPS synthesis pathway were enriched in participants with greater CM risk. Furthermore, inter-individual oral microbiota diversity was also significantly associated with the CM risk factors, and oral-associatedStreptococcus, Prevotella, andVeillonellawere enriched in participants with 3 out of the 5 CM risk factors. We demonstrate that in a diverse cohort of African-origin adults, CM risk is significantly associated with reduced microbial diversity, and the enrichment of specific bacterial taxa and predicted functional traits in both gut and oral environments. As well as providing new insights into the associations between the gut and oral microbiota and CM risk, this study also highlights the potential for novel therapeutic discoveries which target the oral and gut microbiota in CM risk.

Download Full-text

Cross-talk between ANGPTL4 gene SNP Rs1044250 and weight management is a risk factor of metabolic syndrome

Journal of Translational Medicine ◽

10.1186/s12967-021-02739-z ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Zhoujie Tong ◽

Jie Peng ◽

Hongtao Lan ◽

Wenwen Sai ◽

Yulin Li ◽

...

Keyword(s):

Blood Pressure ◽

Metabolic Syndrome ◽

Risk Factor ◽

Waist Circumference ◽

Weight Management ◽

Independent Risk Factor ◽

The Body ◽

Elevated Blood Pressure ◽

Elevated Blood

Abstract Background The prevalence of metabolic syndrome (Mets) is closely related to an increased incidence of cardiovascular events. Angiopoietin-like protein 4 (ANGPTL4) is contributory to the regulation of lipid metabolism, herein, may provide a target for gene-aimed therapy of Mets. This observational case control study was designed to elucidate the relationship between ANGPTL4 gene single nucleotide polymorphism (SNP) rs1044250 and the onset of Mets, and to explore the interaction between SNP rs1044250 and weight management on Mets. Methods We have recruited 1018 Mets cases and 1029 controls in this study. The SNP rs1044250 was genotyped with blood samples, base-line information and Mets-related indicators were collected. A 5-year follow-up survey was carried out to track the lifestyle interventions and changes in Mets-related indicators. Results ANGPTL4 gene SNP rs1044250 is an independent risk factor for increased waist circumference (OR 1.618, 95% CI [1.119–2.340]; p = 0.011), elevated blood pressure (OR 1.323, 95% CI [1.002–1.747]; p = 0.048), and Mets (OR 1.875, 95% CI [1.363–2.580]; p < 0.001). The follow-up survey shows that rs1044250 CC genotype patients with weight gain have an increased number of Mets components (M [Q1, Q3]: CC 1 (0, 1), CT + TT 0 [− 1, 1]; p = 0.021); The interaction between SNP rs1044250 and weight management is a risk factor for increased systolic blood pressure (β = 0.075, p < 0.001) and increased diastolic blood pressure (β = 0.097, p < 0.001), the synergistic effect of weight management and SNP rs1044250 is negative (S < 1). Conclusion ANGPTL4 gene SNP rs1044250 is an independent risk factor for increased waist circumference and elevated blood pressure, therefore, for Mets. However, patients with wild type SNP 1044250 are more likely to have Mets when the body weight is increased, mainly due to elevated blood pressure.

Download Full-text

Effects of Cranberry Juice Supplementation on Cardiovascular Disease Risk Factors in Adults with Elevated Blood Pressure: A Randomized Controlled Trial

Nutrients ◽

10.3390/nu13082618 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2618

Author(s):

Chesney K. Richter ◽

Ann C. Skulas-Ray ◽

Trent L. Gaugler ◽

Stacey Meily ◽

Kristina S. Petersen ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Systolic Blood Pressure ◽

Vascular Function ◽

Elevated Blood Pressure ◽

Elevated Blood ◽

Lipoprotein Profile ◽

Cranberry Juice ◽

Central Systolic Blood Pressure

Emerging cardiovascular disease (CVD) risk factors, including central vascular function and HDL efflux, may be modifiable with food-based interventions such as cranberry juice. A randomized, placebo-controlled, crossover trial was conducted in middle-aged adults with overweight/obesity (n = 40; mean BMI: 28.7 ± 0.8 kg/m2; mean age: 47 ± 2 years) and elevated brachial blood pressure (mean systolic/diastolic BP: 124 ± 2/81 ± 1 mm Hg). Study participants consumed 500 mL/d of cranberry juice (~16 fl oz; 27% cranberry juice) or a matched placebo juice in a randomized order (8-week supplementation periods; 8-week compliance break), with blood samples and vascular measurements obtained at study entry and following each supplementation period. There was no significant treatment effect of cranberry juice supplementation on the primary endpoint of central systolic blood pressure or central or brachial diastolic pressure. Cranberry juice significantly reduced 24-h diastolic ambulatory BP by ~2 mm Hg compared to the placebo (p = 0.05) during daytime hours. Cranberry juice supplementation did not alter LDL-C but significantly changed the composition of the lipoprotein profile compared to the placebo, increasing the concentration of large LDL-C particles (+29.5 vs. −6.7 nmol/L; p = 0.02) and LDL size (+0.073 vs. −0.068 nm; p = 0.001). There was no effect of treatment on ex vivo HDL efflux in the total population, but exploratory subgroup analyses identified an interaction between BMI and global HDL efflux (p = 0.02), with greater effect of cranberry juice in participants who were overweight. Exploratory analyses indicate that baseline C-reactive protein (CRP) values may moderate treatment effects. In this population of adults with elevated blood pressure, cranberry juice supplementation had no significant effect on central systolic blood pressure but did have modest effects on 24-hr diastolic ambulatory BP and the lipoprotein profile. Future studies are needed to verify these findings and the results of our exploratory analyses related to baseline health moderators.

Download Full-text