Metabolic syndrome is defined as a cluster of conditions that increase the risk of cardiovascular disease and diabetes. It affects about 25% of US adults and prevalence increases with weight. The diagnostic criteria include central obesity plus two of the following: elevated triglycerides, low HDL cholesterol, high blood pressure, elevated fasting blood glucose. Central obesity, especially visceral fat, leads to insulin resistance which drives the pathogenesis. Treatment involves lifestyle modifications like diet, exercise and weight loss as well as medication for individual components such as hypertension and hyperlipidemia.

1. METABOLIC SYNDROME
Ramadhan K. Ahmed
KBMS/Family medicine
Nov. 2016

2. CONTENTS
Difintion
Epidemiology
Diagnostic criteria
Pathogenesis
Treatment

3. Syndrome X
Insulin resistance syndrome
Obesity dyslipidemia syndrome

4. METABOLIC S.
DIFINITION
 A cluster of physiological and biochemical abnormalities
associated with the development of cardiovascular disease
and type 2 diabetes.

5. EPIDEMIOLOGY
Affects close to 25% of U.S. adults
Prevalence increases with weight. Metabolic syndrome is
noted in 5% of normal weight, 22% of overweight, and
60% of obese individuals

6. Patients with the metabolic syndrome are :
 At twice the risk of developing cardiovascular Disease.
 Seven fold increase in risk for type 2 diabetes .
 1.5-fold increase in all-cause mortality compared to patients
without the syndrome.
EPIDEMIOLOGY

8. PREVALENCE OF METS IN MIDDLE
EASTERN POPULATIONS
0 10 20 30 40
Saudi Arabia, Females
Northern Jordan
Jerusalem
Iran
IDF
ATP3

9. 0
5
10
15
20
25
<28 >28-29 30-31 32-33 34-35 36-37 ≥38
RelativeRiskofDiabetes
Waist Circumference (in)
Abdominal Adiposity Is Associated
With Increased Risk of Diabetes
P value for trend <0.001
Carey VJ, et al. Am J Epidemiol. 1997;145:614-619

12. The new international Diabetes Federation (IDF) definition
According to the new IDF definition , for a person to be defined as having the metabolic syndrome he/she
must have :
Central Obesity ( defined as waist circumference * with ethnicity specific values )
plus any two of the following four factors :
150 mg/dL (1.7 mmol/L )
or specifc treatment for this lipid abnormality .
Raised
triglycerides
 40 mg/dl ( 1.03 mmol/L ) in males
50 mg/dL (1.29 mmol/L) in females
 or specific treatment for this lipid abnormality
Reduced HDL
Cholesterol
Systolic BP 130 or diastolic BP 85 mmHg
Or treatment of previously diagnosed hypertension
Raised blood
pressure
( FPG) 100 mg/dL (5.6 mmol/L)
or previously diagnosed type 2 diabetes
Raised fasting
plasma glucose

13. Ethnic specific values for waist circumference
Waist circumferenceCountry / Ethnic group
94 cm
80 cm
Male
Female
Europids*
In the USA, the ATP III values ( 102 cm male; 88
cm female) are likely to continue to be used for
clinical purposes
90 cm
80 cm
Male
Female
South Asians
Based on a Chinese , Malay and Asian-Indian
population
90 cm
80 cm
Male
Female
Chinese
90 cm
80 cm
Male
Female
Japanese**
Use South Asian recommendations until
more specific data are available
Ethnic South and Central Americans
Use European data until more specific data
are available
Sub-Saharan Africans
Use South Asian recommendations until
more specific data are available
EMME ( Arab) populations

14. Back
Visceral AT
Subcutaneous
Front
INTRA-ABDOMINAL (VISCERAL) FAT
THE DANGEROUS INNER FAT!

16. • Central obesity is the keystone for pathogenesis of “METABOLIC
SYNDROME”
• Central obesity leads to insulin resistance.
• Various factors that play a role in pathogenesis includes:
IL-1, IL-6, IL-18
Resistin
TNF-alpha
CRP
• Adiponectin an anti inflammatory cytokine is reduced in metabolic
syndrome.
PATHOGENESIS

17. Impaired insulin
mediated glucose
uptake
Toxic injury to
pancreatic islets
Increased insulin
resistance
Hyperglycemia Type 2 DM
Insulin resistance /fasting hyperinsulinemia
Lipolysis by LPL Abundance of FFA’s

18. The BP in these patients also increases because:
1-insulin stimulates increased sodium reabsorption .
2-there is reduced endothelial nitric oxide production .
3-there is increased vascular sympathetic tone.
Insulin-resistant adipose tissue is a potent source of Angiotensinogen.

21. DIFFERENTIAL DIAGNOSIS
Cushing’s syndrome
Hypothyroidism
familial hyperlipidemia
Hyperaldosteronism.

23. ABC'S FOR PROVIDERS
A A1c Target
Aspirin Daily
B Blood Pressure Control
C Cholesterol Management
Cigarette Smoking Cessation
D Diabetes and Pre-Diabetes
Management
E Exercise
F Food Choices

24. NONPHARMACOLOGIC THERAPY
• Lifestyle modification:
1. Dietary modifications aimed at weight loss
The American Heart Association (AHA) recommendations include
• Consuming vegetables and fruits
• Eating whole grains and high-fiber
foods (≥30 g/day)
• Eating fish twice weekly
• Consuming lean animal and vegetable proteins
• Reducing intake of sugary beverages
• Minimizing sugar and sodium intake
• Maintaining moderate to no alcohol intake.
• Consuming 50% to 55% of calories from carbohydrates, 15% to 20% of
calories from protein, and 30% to 35% of calories from fat.
2. Physical activity of moderate intensity (i.e., brisk walking): 30 min daily
3. Smoking cessation

25. • Consider bariatric surgery:
1. Body mass index (BMI) ≥40 kg/m2 in patients who have not responded
to diet and exercise (with or without drug therapy).
2. Individuals with BMI >35 kg/m2 and comorbidities (hypertension,
impaired glucose tolerance, diabetes mellitus, dyslipidemia, sleep apnea).

26. • Treat obesity :
Pharmacologic treatment: consider orlistat and other approved agents
(e.g., liraglutide, topiramate/ phentermine) in patients who have not
responded to diet and exercise if BMI >30 kg/m2 or a BMI of 27 to 30 kg/m2
with comorbid conditions.
Drug therapy still needs to be in conjunction with diet and exercise.
• Treat hypertension.
• Treat hyperlipidemia.

27. Thank you