Metabolic syndrome
- is defined as a concomitant cluster of risk factors including
- T2DM/ impaired Gluocse tolerance- fasting glucose >5.5 mmol/L. /Insulin resistance
- Hypertension ≥130/85 mmHg, or drug treatment for hypertension
- Obesity- Elevated waist circumference Population specific
- TG ≥1.7 mmol/L OR HDL <1.0 mmol/L in men. 1.3 mmol/L in women or drug treatment for reduced HDL-C
- There is a significantly increased risk of macrovascular and microvascular disease seen in people with metabolic syndrome with no apparent symptomatology.
| Waist circumference thresholds for abdominal obesity | ||
|---|---|---|
| Recommended threshold in waist circumference for abdominal obesity (high risk) | ||
| Population | Men | Women |
| European/North American | ≥102 cm | ≥88 cm |
| Asian | ≥90 cm | ≥80 cm |
| Central and South American | ≥90 cm | ≥80 cm |
| Middle Eastern/Mediterranean | ≥94 cm | ≥80 cm |
| Sub-Saharan African | ≥94 cm | ≥80 cm |
risk of central obesity and insulin resistance.
- Medications
- psychotropic medications
- Long term use of antidepressants
- Anticonvulsants
- beta-blockers (notably propranolol)
- Polycystic ovary syndrome (PCOS)
- sleep apnoea
Key points
- Diagnosis of the MetSy is based on meeting three of five criteria (central adiposity, elevated plasma triglyceride, reduced high density lipoprotein cholesterol, hypertension and elevated fasting glucose).
- Measurement of waist circumference is a key part of the assessment.
- The MetSy conveys 2–3 times the risk of diabetes and CVD and 1.6 times the overall mortality.
- Prevention and treatment should focus firstly on increasing physical activity and reducing weight.
- Associated conditions such as PCOS and sleep apnoea need to be identified and managed, and the use of medications associated with weight gain modified where possible.
- There is no specific pharmacotherapy. Treatment should focus on management of individual risk factors such as lipids, blood pressure and glucose. However, care needs to be taken not to accelerate weight gain and reduce capacity for physical activity.
- Bariatric surgery may need to be considered to achieve sufficient weight loss, especially in patients with a body mass index greater than 35
- Gastric surgery has been demonstrated to reverse the MetSy in obese patients and prevent diabetes
- Improving access to affordable surgical interventions remains a challenge to our health systems.