Metabolic Syndrome
Also known as: Syndrome X, Insulin resistance syndrome
Metabolic syndrome is a cluster of conditions that occur together and raise your risk of heart disease, stroke and type 2 diabetes. It is usually diagnosed when you have three or more of the following: a large waist, high blood pressure, high blood sugar, high triglycerides and low HDL ('good') cholesterol. Each is a risk factor in its own right, but together they multiply the danger. The underlying driver is typically insulin resistance related to excess abdominal fat and inactivity. Metabolic syndrome has become very common as rates of obesity have risen. The most effective treatment is lifestyle change, which can improve all five components at once, supported by medication for individual factors where needed.
At a Glance
- Common symptoms
- A large waist circumference, with fat concentrated around the abdomen, Usually no other obvious symptoms, Signs of high blood sugar such as increased thirst, frequent urination, fatigue or blurred vision in some people
- Main treatments
- Weight loss of 5 to 10 percent through diet and exercise, which improves every component of the syndrome, At least 150 minutes a week of moderate aerobic activity plus strength training, A heart-healthy eating pattern such as the Mediterranean or DASH diet
- Category
- Metabolic · Very common; affects roughly a third of adults in the United States and a rising proportion worldwide
- See a doctor if
- You are carrying excess weight around your middle and have not had your blood pressure, blood sugar and cholesterol checked
Symptoms
Causes
- Insulin resistance, which disrupts how the body handles glucose and fats
- Excess visceral fat around the abdominal organs, which releases inflammatory substances and fatty acids
- Physical inactivity
- Diets high in calories, sugar, refined carbohydrates and saturated fat
- Genetic factors and ageing
- Hormonal conditions such as polycystic ovary syndrome, and chronic sleep deprivation
Risk Factors
- Obesity, particularly abdominal obesity
- Age; risk rises steadily with each decade
- A family history of type 2 diabetes or early heart disease
- Diabetes, prediabetes or gestational diabetes
- Polycystic ovary syndrome, fatty liver disease or sleep apnea
- Smoking and a sedentary lifestyle
Diagnosis
- Measurement of waist circumference (commonly 40 inches/102 cm or more in men, 35 inches/88 cm or more in women, with lower cut-offs for some ethnic groups)
- Blood pressure measurement (130/85 mmHg or higher, or taking blood pressure medication)
- Fasting blood glucose (100 mg/dL or 5.6 mmol/L or higher) or HbA1c
- Fasting lipid panel showing triglycerides of 150 mg/dL (1.7 mmol/L) or more, or low HDL cholesterol
- Diagnosis when three or more of the five criteria are present
Treatment
- Weight loss of 5 to 10 percent through diet and exercise, which improves every component of the syndrome
- At least 150 minutes a week of moderate aerobic activity plus strength training
- A heart-healthy eating pattern such as the Mediterranean or DASH diet
- Blood pressure medication if lifestyle measures do not bring pressure to target
- Statins or other lipid-lowering drugs to reduce cardiovascular risk when indicated
- Metformin or other glucose-lowering medications if diabetes develops, and in some high-risk people with prediabetes
- Supportive: stopping smoking, limiting alcohol, treating sleep apnea and improving sleep
Prevention
- Keep your waist size within a healthy range
- Exercise most days and reduce sitting time
- Eat a diet rich in vegetables, fruit, whole grains, legumes, fish and healthy fats
- Limit sugary drinks, refined carbohydrates and processed meat
- Do not smoke and keep alcohol to moderate levels
- Have regular checks of weight, blood pressure, blood sugar and cholesterol
When to See a Doctor
- You are carrying excess weight around your middle and have not had your blood pressure, blood sugar and cholesterol checked
- You have been told you have any one of the five risk factors, to check for the others
- Chest pain, shortness of breath or sudden weakness, numbness or trouble speaking (seek emergency care)
- Increased thirst, urination or unexplained fatigue
- You want help with a structured plan for weight loss or exercise
Frequently Asked Questions
Related Conditions
Lab tests that relate to metabolic syndrome
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