What is metabolic syndrome?

From the Guidelines

Metabolic syndrome should be managed primarily through lifestyle modifications, including a balanced diet and regular physical activity, to reduce the risk of developing type 2 diabetes and cardiovascular disease. The diagnosis of metabolic syndrome is made when a person has at least three of the following five conditions: central obesity, hypertension, low HDL cholesterol, raised triglycerides, and raised blood sugar 1. According to the European Guidelines on cardiovascular disease prevention in clinical practice, the management of metabolic syndrome should focus on professionally supervised lifestyle changes, particularly efforts to reduce body weight and increase physical activity 1.

Key Components of Metabolic Syndrome

• Central obesity: waist circumference >102 cm in men, >88 cm in women
• Elevated triglycerides: ≥1.7 mmol/L (≥150 mg/dL)
• Low HDL cholesterol: <1.03 mmol/L (<40 mg/dL) in men, <1.29 mmol/L (<50 mg/dL) in women
• Raised blood pressure: systolic BP ≥130 mmHg and/or diastolic BP ≥85 mmHg
• Impaired fasting glycaemia: fasting plasma glucose ≥6.1 mmol/L (≥110 mg/dL) or previously diagnosed type 2 diabetes

Treatment and Management

The 2007 guidelines for the management of arterial hypertension recommend a reduction in body weight by low caloric diet and physical exercise as the first and main treatment strategy in subjects with the metabolic syndrome 1. A realistic goal is to reduce body weight by 7–10% over 6 to 12 months via a relatively modest reduction of caloric intake. Nutritional therapy also calls for low intake of saturated fats, trans-fatty acids, cholesterol, and simple carbohydrates, and an increased consumption of fruits, vegetables, and whole grains. Regular physical activity of at least 30 minutes of daily moderate exercise is also essential.

Medications

Medications may be prescribed to address specific components of metabolic syndrome, such as metformin for blood sugar control, statins for cholesterol management, and antihypertensives like ACE inhibitors for blood pressure 1. Classes to be considered are angiotensin receptor antagonists or ACE inhibitors, which are associated with a lower incidence of diabetes compared to other antihypertensive drugs and can also have a favourable effect on organ damage.

Importance of Lifestyle Modifications

Lifestyle modifications have been shown to have a protective effect, reducing the progression to type 2 diabetes by almost 60% 1. The prevalence of the metabolic syndrome decreased over 3.2 years from 51–43% in the lifestyle intervention group, whereas in the conventional care group, an increase from 55–61% was observed. Therefore, lifestyle modifications should be the primary focus of treatment for metabolic syndrome, with medications used to address specific components as needed.

From the Research

Definition and Risk Factors of Metabolic Syndrome

• Metabolic syndrome is defined as a condition characterized by a set of clinical criteria: insulin resistance, visceral obesity, atherogenic dyslipidemia, and hypertension 2.
• The major risk factors leading to the epidemic of this syndrome are visceral obesity, physical inactivity, and an atherogenic diet 2.
• Metabolic syndrome increases the risk of developing cardiovascular disease and type 2 diabetes mellitus 3.

Treatment and Management of Metabolic Syndrome

• The first step in management of patients with metabolic syndrome should be focused on lifestyle modifications, such as weight loss and physical activity 2, 3.
• A realistic goal for weight reduction should be 7% to 10% over 6 to 12 months 2, 4.
• The general dietary recommendations include low intake of saturated fats, trans fats, and cholesterol, and diets with low glycemic index 2.
• Physical activity is associated with successful weight reduction, and these therapeutic lifestyle changes can reduce by half the progression to new-onset diabetes in patients with metabolic syndrome 2.
• Medication therapy is a critical step in the management of patients with metabolic syndrome when lifestyle modifications fail to achieve the therapeutic goals 2, 5.

Lifestyle Modification and Adherence

• Team-based, interactive approaches with high-frequency contact with patients who are motivated made the largest and most lasting impact on lifestyle change 6.
• Technology was found to be a useful tool in achieving lifestyle change, but ineffective when compared with personal contact 6.
• Patient motivation leading to improved lifestyle adherence is a key factor in achieving reduction in metabolic syndrome components 6.
• Use of technologies such as mobile and Internet-based communication can increase the effectiveness of lifestyle change in metabolic syndrome, but should not replace personal contact as the cornerstone of therapy 6.

Pharmacologic Treatment

• Atherogenic dyslipidemia should be controlled with statins if there is concomitant increase in low-density lipoprotein cholesterol and if indicated with combination therapy, including fibrates, nicotinic acid, bile acid-binding resins, or ezetimibe 2.
• Drugs such as thiazolidinediones and renin-angiotensin system blockers are a few of the available agents in this category 2.
• Angiotensin-converting enzyme inhibitors and beta blockers are more beneficial for treatment of hypertension in patients with metabolic syndrome 2, 5.