Common Name/Other Name
Syndrome X; insulin resistance syndrome (Eng.)
Metabolic syndrome is a group of conditions that increase the risk of cardiovascular disease (CVD) and diabetes mellitus. The major conditions that contribute in having metabolic syndrome include central obesity, hypertriglyceridemia, low high-density lipoprotein (HDL), hyperglycemia, and hypertension. Existence of three or more of the conditions qualifies an individual in having metabolic syndrome
The most possible cause of metabolic syndrome is insulin resistance or the inability of the body cells to respond to the action of insulin. A contributing factor in insulin resistance is the excess of fatty acids in the bloodstream. These fatty acids prevent the entry of glucose into the cells and eventually accumulate as triglycerides in the skeletal and cardiac muscles. High triglyceride levels reduce HDL cholesterol and increase low-density lipoprotein (LDL) levels. These factors contribute to the increased risk of formation of fatty plaques in the arteries.
There are no characteristic signs and symptoms of metabolic syndrome. During physical examination, patients commonly present with increased waist circumference and high blood pressure. These should signal the physician to conduct laboratory tests.
Standard symptoms on physical examination:
Central obesity with waistline of greater than 40 inches in men and 35 inches in women
High blood pressure – at least 130 mmHg systolic or at least 85 mmHg diastolic
Laboratory results show:
High triglyceride levels – at least 150 mg/dL
Low HDL cholesterol – below 40 mg/dL in men and 50 mg/dL in women
High fasting blood sugar level – at least 100 mg/dL or previously diagnosed with type 2 diabetes mellitus
Commonly Prescribed Drugs
For obese patients with a BMI of at least 30 kg/m2, anti-obesity medications can be prescribed:
- Appetite-suppressing drugs or anorexiants affect the feeling of fullness after a meal or satiety as well as the need to eat or hunger. Anorexiants increase satiety and decrease hunger to reduce the intake of food in an obese individual. It targets regions in the central nervous system and affects the release of several hormones.
- Classic sympathomimetic adrenergic agents include benzphetamine, phendimetrazine, diethylpropion, mazindol, and phentermine. These drugs increase the level of norepinephrine by stimulating its release or inhibiting its reuptake. Norepinephrine increases satiety of an individual.
- Sibutramine increases the levels of serotonin and norepinephrine by inhibiting their reuptake. This is the only anorexiant approved for long-term use. Weight loss can be maintained for up to 2 years. However, a dose-related increase in blood pressure and heart rate have been observed requiring close monitoring within 1 month of starting therapy. Patients with heart disorders should not receive this medication.
- Peripherally acting medications affect the body’s absorption of fats. Orlistat inhibits the absorption and digestion of 30% of dietary fats into the absorbable fatty acid and monoacylglycerol. The unabsorbed fat is passed into the stool resulting in flatus with discharge, oily stool and increased passing of stool. Supplementation of fat-soluble vitamins like vitamin D, E and β-carotene are recommended to avoid deficiencies.
Treatment and Management
Weight reduction is the primary management of metabolic syndrome and the conditions that contribute to it.
A diet targeted for weight reduction is important. Patients should realize that reducing weight through diet does not occur quickly. Maintaining the prescribed diet is more important than the type of diet chosen. A high-quality diet is composed of fruits, vegetables, whole grains, lean meat, and fish.
Exercises are important to maintain the weight loss through diet. Patients should be evaluated before starting an exercise program to avoid any risk. Gradual increases in the intensity of the activity should be observed to improve adherence and reduce injuries. At least 30 minutes per day of moderate-intensity physical activity is beneficial.
Surgery is considered for obese patients with a BMI (body mass index) of at least 40 kg/m2 or those with serious medical conditions.
- Restrictive surgeries control the amount of food that the stomach contains and decrease the rate of the stomach’s emptying into the small intestines. These surgeries only affect the amount of food intake, but do not upset the body’s normal digestion.
- Laparoscopic adjustable silicone gastric banding (LASGB) is the most commonly performed restrictive surgery. A ring is placed below the junction of the esophagus and the stomach. It includes an inflatable balloon that can contain varying volumes of saline to adjust the size of the opening.
- Restrictive-malabsorptive bypass surgeries combine the elements of gastric restriction and macronutrient malabsorption. This type of surgery includes Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion (BPD), and biliopancreatic diversion with duodenal switch (BPDDS).
- Roux-en-Y gastric bypass (RYGB) is the most commonly performed bypass surgery. It is mainly a restrictive surgery with varying amounts of nutrient malabsorption. A small stomach pouch is made and attached to the esophagus. It can hold around 20 to 30 mL of food leading to less food intake. This stomach pouch is connected to the jejunum, the second part of the intestine to reduce absorption of calories and nutrients.