Metabolic syndrome: Difference between revisions
No edit summary |
No edit summary |
||
| Line 41: | Line 41: | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
==Associated Conditions== | ==Associated Conditions== | ||
Revision as of 18:10, 27 September 2011
For patient information click here
|
Metabolic syndrome Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Metabolic syndrome On the Web |
|
American Roentgen Ray Society Images of Metabolic syndrome |
Template:DiseaseDisorder infobox
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]
Synonyms and Keywords: Metabolic syndrome X, Insulin resistance syndrome, Reaven's syndrome or CHAOS (Australia)
Overview
Historical Perspective
Pathophysiology
Epidemiology & Demographics
Risk Factors
Screening
Causes of Metabolic syndrome
Differentiating Metabolic syndrome from other Diseases
Natural History, Complications & Prognosis
Diagnosis
History & Symptoms | Physical Examination | Lab Tests | Electrocardiogram | Chest X Ray | MRI | CT | Echocardiography or Ultrasound | Other Imaging Findings | Other Diagnostic Studies
Treatment
Dietary Therapy | Medical Therapy | Surgery | Primary Prevention|Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies
References
Associated Conditions
- Polycystic ovarian syndrome
- Hemochromatosis(iron overload)
Diagnosis
Physical Examination
Vitals
Skin
- Acanthosis nigricans (a skin condition featuring dark patches)
Abdomen
- Central obesity (also known as visceral, male-pattern or apple-shaped adiposity), overweight with fat deposits mainly around the waist;
Laboratory Studies
- Fasting hyperglycemia — diabetes mellitus type 2 or impaired fasting glucose, impaired glucose tolerance, or insulin resistance
- Decreased HDL cholesterol
- Elevated triglycerides
- Elevated uric acid levels
- Fatty liver (especially in concurrent obesity), progressing to non-alcoholic fatty liver disease,
Diagnostic Criteria
There are currently two major definitions for metabolic syndrome provided by 1) International Diabetes Federation[1] and 2) the revised National Cholesterol Education Program, respectively. The revised NCEP and IDF definitions of metabolic syndrome are very similar and it can be expected that they will identify many of the same individuals as having metabolic syndrome. The two differences are that IDF excludes any subject without increased waist circumference, while in the NCEP definition metabolic syndrome can be diagnosed based on other criteria and the IDF uses geography-specific cut points for waist circumference, while NCEP uses only one set of cut points for waist circumference regardless of geography. These two definitions are much closer to each other than the original NCEP and WHO definitions.
WHO
The World Health Organization criteria (1999) require presence of diabetes mellitus, impaired glucose tolerance, impaired fasting glucose or insulin resistance, AND two of the following:
- blood pressure: ≥ 140/90 mmHg
- dyslipidaemia: triglycerides (TG): ≥ 1.695 mmol/L and/or high-density lipoprotein cholesterol (HDL-C) ≤ 0.9 mmol/L (male), ≤ 1.0 mmol/L (female)
- central obesity: waist:hip ratio > 0.90 (male), > 0.85 (female), and/or body mass index > 30 kg/m2
- microalbuminuria: urinary albumin excretion ratio ≥ 20 mg/min or albumin:creatinine ratio ≥ 30 mg/g
EGIR
European Group for the Study of Insulin Resistance (1999) requires insulin resistance defined as the top 25% of the fasting insulin values among non-diabetic individuals AND two or more of the following:
- central obesity: waist circumference ≥ 94 cm (male), ≥ 80 cm (female)
- dyslipidaemia: TG ≥ 2.0 mmol/L and/or HDL-C < 1.0 mg/dL or treated for dyslipidaemia
- hypertension: blood pressure ≥ 140/90 mmHg or antihypertensive medication
- fasting plasma glucose ≥ 6.1 mmol/L
NCEP
The National Cholesterol Education Program Adult Treatment Panel III (2001) requires at least three of the following:[2]
- Central obesity: waist circumference ≥ 102 cm or 40 inches (male), ≥ 88 cm or 36 inches(female)
- Dyslipidemia: TG ≥ 1.695 mmol/L (150 mg/dl)
- Dyslipidemia: HDL-C < 40 mg/dL (male), < 50 mg/dL (female)
- Blood pressure ≥ 130/85 mmHg
- Fasting plasma glucose ≥ 6.1 mmol/L (110 mg/dl)
American Heart Association/Updated NCEP
There is quite a bit of confusion about whether AHA/NHLBI intended to create another set of guidelines or simply update the NCEP ATP III definition. According to Scott Grundy, University of Texas Southwestern Medical School, Dallas, Texas, the intent was just to update the NCEP ATP III definition and not create a new definition.[3]:
- Elevated waist circumference: Men — Equal to or greater than 40 inches (102 cm) Women — Equal to or greater than 35 inches (88 cm)
- Elevated triglycerides: Equal to or greater than 150 mg/dL
- Reduced HDL (“good”) cholesterol: Men — Less than 40 mg/dL Women — Less than 50 mg/dL
- Elevated blood pressure: Equal to or greater than 130/85 mm Hg or use of medication for hypertension
- Elevated fasting glucose: Equal to or greater than 100 mg/dL (5.6 mmol/L) or use of medication for hyperglycemia
Treatment
The goal is to get the LDL down to < 100 mg/dl. The first line treatment is change of lifestyle (i.e., caloric restriction and physical activity). However, drug treatment is frequently required. Generally, the individual diseases that comprise the metabolic syndrome are treated separately (e.g. diuretics and ACE inhibitors for hypertension). Cholesterol drugs may be used to lower LDL cholesterol and triglyceride levels, if they are elevated, and to raise HDL levels if they are low. Use of drugs that decrease insulin resistance e.g., metformin and thiazolidinediones is controversial and not FDA approved.
A recent study indicated that cardiovascular exercise was therapeutic in approximately 31% of cases. The most probable benefit was to triglyceride levels, with 43% showing improvement; conversely 91% of test subjects did not exhibit a decrease in fasting plasma glucose or insulin resistance.[4] Many other studies have supported the value of increased physical activity along with restricted calories in metabolic syndrome.
Primary and Secondary Prevention
Various strategies have been proposed to prevent the development of metabolic syndrome. These include increased physical activity (such as walking 30 minutes every day),[5] and a healthy, reduced calorie diet.[6] There are many studies that support the value of a healthy lifestyle as above. However, one study stated that these measures are effective in only a minority of people.[4] The International Obesity Taskforce states that interventions on a sociopolitical level are required to reduce development of the metabolic syndrome in populations.[7]
A 2007 study of 2,375 male subjects over 20 years suggested that daily intake of a pint of milk or equivalent dairy products more than halved the risk of metabolic syndrome.[8] Other studies both support and dispute the authors' findings.[9]
See also
References
- ↑ The IDF consensus worldwide definition of the metabolic syndrome. PDF
- ↑ Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001;285:2486-97. PMID 11368702.
- ↑ Grundy SM, Brewer HB, Cleeman JI, Smith SC, Lenfant D, for the Conference Participants. Definition of metabolic syndrome: report of the National, Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation. 2004;109:433-438.
- ↑ 4.0 4.1 Katzmaryk,, Peter T (October 2003). "Targeting the Metabolic Syndrome with Exercise: Evidence from the HERITAGE Family Study". Med. Sci. Sports Exerc. 35 (10): 1703–1709. Retrieved 2007-06-24. Unknown parameter
|coauthors=ignored (help); Check date values in:|date=(help) - ↑ Lakka TA, Laaksonen DE (2007). "Physical activity in prevention and treatment of the metabolic syndrome". Applied physiology, nutrition, and metabolism = Physiologie appliquée, nutrition et métabolisme. 32 (1): 76–88. doi:10.1139/h06-113. PMID 17332786.
- ↑ Feldeisen SE, Tucker KL (2007). "Nutritional strategies in the prevention and treatment of metabolic syndrome". Appl Physiol Nutr Metab. 32 (1): 46–60. doi:10.1139/h06-101. PMID 17332784.
- ↑ James PT, Rigby N, Leach R (2004). "The obesity epidemic, metabolic syndrome and future prevention strategies". Eur J Cardiovasc Prev Rehabil. 11 (1): 3–8. PMID 15167200.
- ↑ Elwood, PC (2007). "Milk and dairy consumption, diabetes and the metabolic syndrome: the Caerphilly prospective study". J Epidemiol Community Health. 61 (8): 695–698. doi:10.1136/jech.2006.053157. PMID 17630368. Unknown parameter
|coauthors=ignored (help) - ↑ Snijder MB, van der Heijden AA, van Dam RM; et al. (2007). "Is higher dairy consumption associated with lower body weight and fewer metabolic disturbances? The Hoorn Study". Am. J. Clin. Nutr. 85 (4): 989–95. PMID 17413097.
de:Metabolisches Syndrom ko:대사증후군 nl:Metabool syndroom fi:Metabolinen oireyhtymä sv:Metabolt syndrom