Medical staff health column

Metabolic syndrome is a group of five cardiovascular risk factors that increase the likelihood of developing heart disease, diabetes, and stroke.

The five risk factors are:

• Increased blood pressure (greater than 130/85 mmHg)
• High blood sugar levels (insulin resistance)
• Excess fat around the waist
• High triglyceride levels
• Low levels of good cholesterol, or HDL

Having one of these risk factors does not mean that you have metabolic syndrome. Having three or more of these factors will result in a diagnosis of metabolic syndrome and it will increase your risk of health complications.

Metabolic syndrome is also associated with a generalized metabolic disorder called insulin resistance, which prevents people from using insulin efficiently. Therefore, metabolic syndrome is also sometimes called insulin resistance syndrome.

About 23 percent of U.S. adults have metabolic syndrome. Although these risks are significant, there is good news. Metabolic syndrome can be treated and you can reduce your risks for cardiovascular events by maintaining a healthy weight, eating a heart-healthy diet, getting adequate physical activity, and following your healthcare providers' instructions.

What are the risk factors for metabolic syndrome?

The risk factors for metabolic syndrome are related to obesity. The two most important risk factors are defined by the National Heart, Lung, and Blood Institute as:

• Central obesity, or excess fat around the middle and upper parts of the body
• Insulin resistance, which makes it difficult for the body to use sugar

There are other factors that can increase your risk for metabolic syndrome. These include:

• Age
• Family history of metabolic syndrome
• Not getting enough exercise
• Women who have been diagnosed with polycystic ovary syndrome

How is metabolic syndrome diagnosed?

To diagnose metabolic syndrome, your doctor will need to perform several different tests. The results of these tests will be used to look for three or more signs of the disorder. Your doctor may check one or more of the following:

• Waist circumference
• Fasting blood triglycerides
• Cholesterol levels
• Blood pressure
• Fasting glucose level

Abnormalities noted on three or more of these tests will indicate the presence of metabolic syndrome.
It matters where you wear your fat when it comes to Metabolic Syndrome risk.

If you look more like an apple than a pear, your risk of developing metabolic syndrome is greater. In discussing your health plan, your doctor may not mention how fat that settles in your belly boosts health risks more than weight that sits in your butt.

"Reducing your waist circumference could have more of an impact on preventing and managing disease than medication," says Erin Palinski-Wade, RD, CDE, author of Belly Fat Diet for Dummies. Carrying weight around your middle, Palinski-Wade adds, "is an indication of excess visceral fat, a key risk factor for the development of metabolic syndrome, type 2 diabetes, heart disease and even certain cancers." Focus on reducing waist size even more than the numbers on the scale, she advises.

What are the complications of metabolic syndrome?

The complications that may result from metabolic syndrome are frequently serious and long-term (chronic). They include:

• Hardening of the arteries (atherosclerosis)
• Diabetes
• Heart attack
• Kidney disease
• Stroke
• Nonalcoholic fatty liver disease
• Peripheral artery disease
• Cardiovascular disease

If diabetes develops, you may be at risk for additional health complications, including:

• Eye damage (retinopathy)
• Nerve damage (neuropathy)
• Kidney disease
• Amputation of limbs

How is metabolic syndrome treated?

If you are diagnosed with metabolic syndrome, the goal of treatment will be to reduce your risk of developing further health complications. Your doctor will recommend lifestyle changes that may include losing between 7 and 10 percent of your current weight and getting at least 30 minutes of moderate to intense exercise five to seven days a week. They may also suggest that you quit smoking.

Your doctor may prescribe medications to reduce your blood pressure, cholesterol, and/or blood sugar. They may also prescribe low-dose aspirin to help reduce your risk of stroke and heart attack.

What is the outlook for patients with metabolic syndrome?

The outlook for people with metabolic syndrome can be quite good if symptoms are managed. People who take their doctor’s advice, eat right, exercise, stop smoking, and lose weight will reduce their chances of developing serious health problems such as a heart attack or stroke.

Although symptom management will reduce health complications, most people with this condition have a long-term risk of cardiovascular disease. If you develop this condition, you will need to be monitored by your doctor to help prevent serious health problems such as heart attack and stroke.

Preventing metabolic syndrome is certainly possible. Maintaining a healthy waist circumference and blood pressure and cholesterol levels reduce your risk for metabolic syndrome. Exercise and weight loss can aid in these efforts and decrease insulin resistance.

In particular, eat a healthy diet that includes fruits, vegetables and whole grains. Exercise is also important when it comes to preventing this condition. Regular physical activity will reduce your blood pressure, blood sugar and cholesterol levels. The key is to try to maintain a healthy weight. Talk to your doctor before beginning an exercise program or radically changing your diet.

Prevention of metabolic syndrome will also require that you have regular physical exams. Your doctor can measure your blood pressure and complete blood work that may indicate the early development of metabolic syndrome. Early diagnosis of the condition and treatment will reduce health complications over the long term.

The most current set of dietary guidelines for Americans encourages a diet that is plant-focused. Julie Upton, RD, of San Francisco, the cofounder of Appetite for Health, encourages a Mediterranean style of eating. The Mediterranean diet showcases fruits, veggies, whole grains, legumes and seafood but has less meat, cheese, sugars and sweets. Says Upton: "Not only is this plan helpful for your heart, but it also lowers risks for metabolic syndrome."