CONCISE REVIEW FOR CLINICIANSThe Metabolic Syndrome: Concepts and Controversy
Section snippets
DEFINITIONS
The World Health Organization (WHO) first defined the syndrome in 19983 and called it the metabolic syndrome, a term that had been used by Zimmet4 in 1991 to describe this cluster of findings. The WHO criteria for the metabolic syndrome required the presence of diabetes mellitus (DM), impaired fasting glucose, impaired glucose tolerance, or insulin resistance (assessed by the euglycemic insulin clamp technique) plus 2 additional factors. In 1999, the European Group for the Study of Insulin
CLINICAL IMPORTANCE
The pandemic of obesity, metabolic syndrome, and diabetes has sparked a tremendous interest in the medical literature. A MEDLINE search limited to English-language articles with the terms metabolic syndrome, insulin resistance syndrome, or syndrome X in the title returned 4024 articles published during the past 5 years, 1408 of which were published in the 12 months ending in March 2006.
Using measured heights and weights, results from the National Health and Nutrition Examination Survey indicate
PATHOGENESIS
The prevailing theory is that in most people with the metabolic syndrome, the development of obesity and physical inactivity leads to insulin resistance and compensatory hyperinsulinemia. Most insulin-resistant individuals are able to maintain the degree of hyperinsulinemia required to prevent decompensation of glucose homeostasis. If pancreatic insulin secretion fails to increase adequately, impaired glucose tolerance or DM develops. Genetic factors probably play a role in the varied clinical
RECENT CONTROVERSY
The ADA and the European Association for the Study of Diabetes (EASD) recently published a joint statement questioning the clinical value of the metabolic syndrome.20 Their concerns were as follows: (1) the criteria for the diagnosis of metabolic syndrome are ambiguous, and the rationale for thresholds is ill defined; (2) the value of including DM in the definition of metabolic syndrome is questionable; (3) the validity of using insulin resistance as the unifying etiology is uncertain; (4)
DISCUSSION
The NCEP ATP III criteria have definite flaws. First, the 5 criteria and the cutoffs appear to be arbitrary and not evidence based. Second, the risk factor values are continuous and must be considered as such, not just as present or absent. The fact that CVD risk increases with increasing blood glucose levels, systolic blood pressure, and LDL cholesterol values has been well documented. Third, important risk factors such as LDL cholesterol, cigarette smoking, family history, and age are not
CONCLUSION
Whether the constellation of vascular risk factors is called metabolic syndrome, insulin resistance syndrome, syndrome X, increased cardiometabolic risk, or another name is of limited clinical importance. The fact is that physicians are seeing increasing numbers of persons, including children, with obesity and varying combinations of glucose intolerance or DM, hypertension, and dyslipidemia. Simple solutions for the public health issue of obesity and lack of exercise are not available and will
Questions About Metabolic Syndrome
- 1.
Which one of the following is the correct current estimated prevalence of obesity (BMI, ≥30 kg/m2) in US adults aged 20 to 74 years?
- a.
10%
- b.
20%
- c.
31%
- d.
65%
- e.
90%
- a.
- 2.
Which one of the following is not a NCEP ATP III criterion for diagnosis of the metabolic syndrome?
- a.
Increased WC
- b.
Blood pressure ≥130/85 mm Hg
- c.
Elevated uric acid
- d.
Triglycerides ≥150 mg/dL
- e.
Fasting plasma glucose ≥100 mg/dL
- a.
- 3.
The lipid pattern observed in individuals with the metabolic syndrome is characterized by which one of the
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A review of the effectiveness of hibiscus for treatment of metabolic syndrome
2021, Journal of EthnopharmacologyCitation Excerpt :Individuals must meet these criteria for at least three indicators to be diagnosed with MetS (Huang, 2009). Although there has been controversy surrounding the use of these criteria for diagnosing MetS, they positively correlate with surges in cardio-metabolic diseases (Johnson and Weinstock, 2006; Huang, 2009; Bi et al., 2015). Hypertension, hyperglycemia, physical inactivity, overweight and obesity and high cholesterol rank among the ten leading risk factors for death globally (World Health Organization, 2020).
Metabolic Syndrome: Preventive Effects of Dietary Flavonoids
2018, Studies in Natural Products ChemistryCitation Excerpt :Furthermore, the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) arranged and simplified the criteria for metabolic syndrome to make it easier for practitioners to utilize [31]. A comparison of the various criteria is shown in Table 1.2 [32]. As shown, NCEP ATP III required risk factors, such as abnormal waist circumference, high fasting plasma glucose levels, low high-density lipoprotein (HDL) cholesterol levels, high triglyceride levels, and high blood pressure.
Metabolic syndrome and in-hospital outcomes among pancreatic cancer patients
2017, Diabetes and Metabolic Syndrome: Clinical Research and ReviewsMetabolic syndrome and its components in postmenopausal women living in southern Italy, Apulia region
2017, Diabetes and Metabolic Syndrome: Clinical Research and ReviewsCitation Excerpt :Visceral fat produces free fatty acids and inflammatory cytokines, draining into portal vein, so determining metabolic relation with the liver [38,39]. Central obesity is associated with increased very low-density lipoprotein level (elevated triglyceride, low HDL-cholesterol level, and small dense LDL cholesterol particles) [40]. Increased level of small dense-LDL-cholesterol affects endothelium of the arterial wall leading to arterial stiffness and atherosclerosis [41] often present in MetS patients.
A question-and-answer section appears at the end of this article.