The Metabolic Syndrome and Diabetes

The medical term syndromeis defined as a group of conditions persistently linked together in a particular disease and collectively presenting a characteristic picture of that disease or condition.[1] The term is not a new one. It first appeared in the English language as long ago as 1541. It recognized the ability to record several medical conditions present in the same person at the same time. The set of medical problems collectively became known as a specific syndrome.

What is a Metabolic Syndrome?    

What we now know as the Metabolic Syndrome was coined Syndrome X by Dr. George Reavens. The Metabolic Syndrome is sometimes referred to as dysmetabolic syndrome or as Syndrome X and sometimes as Insulin Resistance Syndrome. When Metabolic Syndrome is present, there is a higher risk of developing diabetes in addition to cardiac and vascular disease.

This syndrome is not considered one specific condition but rather a collective group. As such, it is characterized as a non-specific condition rather than a specific clinical disease diagnosis. It’s quite common which would be expected given the increasing rates of diabetes and cardiovascular disease.  It is estimated that 25 % of the population of the United States has Metabolic Syndrome. Also approximately half of the Latino population over age 40 has also been diagnosed with the same condition.

This is not a syndrome. It’s an epidemic!

Medical Conditions Associated with the Metabolic Syndrome

The use of the term Metabolic Syndrome began in earnest in the mid-1970’s when it was noted that certain medical conditions were commonly found to be present in a substantial number of middle aged diabetics. The original list of medical conditions that were said to indicate a high risk of developing diabetes, as noted by Reavens, included:

  • Obesity – excess body fat
  • Hyperglycemia – elevated blood glucose
  • Hyperlipidemia – elevated blood lipid (fat) levels
  • Atherosclerosis – hardening of the arteries
  • Hypertension – high blood pressure

Today, several other risk factors have been added:

  • Increase in insulin resistance
  • Elevation of serum uric acid
  • Increase in both very low density (VLDL) and low-density lipoproteins (LDL)
  • Decrease in high density lipoproteins (HDL)
  • Increase in plasmino-activator inhibitors[2]

Metabolic Syndrome is now considered to be a clinical presentation or something specifically diagnosed. Unfortunately, the various organizations (The American Heart Association (AHA), the European Group for the Study of Insulin Resistance (EGIR), International Diabetes Federation, The United States National Cholesterol Education Program (NCEP), the World Health Organization (WHO) and the American Diabetes Association) are still trying to define specific criteria for doctors to use during diagnosis. Currently there is no uniform agreement on the unacceptable levels leading to a diagnosis of Metabolic Syndrome, but the NCEP guidelies are most often accepted:

  • Abdominal obesity (waist circumference: >40 inches in men, >35 inches in women)
  • Elevated levels of triglycerides (>150mg/dL)
  • Low levels of high-density lipoprotein (HDL) cholesterol <40mg/dL for men, <50mg/dL for women
  • Elevated blood pressure (equal to or >130/85mmHg or use of blood pressure medications)
  • Evidence of insulin resistance (fasting glucose equal to or >110mg/dL).

Yet, the diagnosis of Metabolic Syndrome does have this one aspect in common: Obesity is present and so is the inevitability of the onset of degenerative medical conditions. The Australians have coined a term and an acronym for the syndrome which has a certain, blunt appeal. It is CHAOS. This stands for:

  • Coronary artery disease
  • Hypertension
  • Atherosclerosis
  • Obesity
  • Stroke

This sums up succinctly the risks and the deadly combination of factors that can result in death from cardiovascular disease or lead to diabetes.[3]

Metabolic Syndrome is commonly diagnosed in the developed nations. In fact, in the United States alone, reports indicate, dependent upon the specific definition applied, that either 1 in 3 or 1 in 5 adults currently have Metabolic Syndrome.[4]  A more sedentary lifestyle has contributed to the increase in numbers. The common factor in all of the conditions that form Metabolic Syndrome is insulin resistance.

Central Obesity – Definition

Central obesity does not refer to the fact that being obese is a major health problem. The word “central” rather refers to the positioning of the weight you carry – where it is situated on the body. In fact, it is not so much just fat that is significant and puts you at risk. Rather, the real culprit is the visceral fat, carried around the abdomen, mostly in an apron called the omentum. Visceral fat is adipose tissue that is found in the abdomen around the organs. Simply put, it is some of the most dangerous fat in terms of your health.

Subcutaneous fat or the fat underlying the skin is also harmful to health when excessive. Yet, it is the amount of visceral and not subcutaneous fat that really concerns doctors because of studies showing a relationship between visceral fat, metabolic syndrome, diabetes and cardiovascular disease.

The Index of Central Obesity

It was not until the past few years that a researcher came up with an alternative to waist measurement to provide a reliable measure of central obesity. In 2007, Parikh and his colleagues proposed a new approach. [5]  This has since become known as the index of central obesity. It is determined by using two figures; the body length and the waist circumference. This is now called the Waist to Height Ratio (WHtR). It has proven to be a superior means of describing the Metabolic Syndrome in terms of a specific number. In general, an increased risk of weight related disease development is predicted for a person who is not twice as long as the waist measurement.

Conclusion

Type 2 diabetes is associated with obesity. Obesity is considered an important indicator of the risk of developing diabetes and cardiovascular disease, and is one of the symptoms of Metabolic Syndrome.  The presence of visceral fat is particularly indicative of risk.

Only the actions of the individual who carries this excess fat can remove the threat of the Metabolic Syndrome leading to T2D or cardiac disease. An individual must consider the WHtR. It is certainly possible to lose weight and thus lower the risk of disease. With the help of a dietician, a doctor and other professionals, a person with Metabolic Syndrome may be able stop progress towards developing diabetes.

References

[1] Marcovitch, H (2006). Black’s Medical Dictionary 41st edition. Lantham, Maryland: Scarecrow Press.

[2] Guthrie, DW; and Guthrie, RA (2003). The Diabetes Source Book. New York: McGraw Hill.

[3] Ford,ES (2005). “Risks for All-Cause Mortality, Cardiovascular Disease, and Diabetes Associated with the Metabolic Syndrome: A Summary of the Evidence.” Diabetes Care, 28 (7): 1769-1778.

[4]Churilla, JR; and Fitzhugh, EC (2009). “Relationship between Leisure-Time Physical Activity and Metabolic Syndrome using Varying Definitions: 1999-2004 NHANES.” Diabetes and Vascular Disease Research, 6(2) 100–109.

[5] Parikh , RM; Joshi, SR; Menon, PS; and Shah, NS (2007).Index of Central Obesity – A Novel Parameter.” Medical Hypotheses, 68 (6): 1272-1275.

This article was originally published July 12, 2012 and last revision and update of it was 9/10/2015.