Metabolic Syndrome

What are the consequences of metabolic syndrome? All the information about this disorder: causes, symptoms, and treatments.

Symptoms and Causes

Metabolic syndrome refers to a group of physiological, biochemical, and metabolic disorders that collectively increase the risk of heart disease, stroke, and type 2 diabetes. It is also known as Reaven’s syndrome, metabolic syndrome X, or insulin resistance syndrome.

The disorders that make up metabolic syndrome include:

Central obesity: excess fat concentrated in the abdominal area (commonly referred to as an apple-shaped body).
High blood pressure.
Dyslipidemia.
Hyperglycemia, usually associated with insulin resistance.

Metabolic syndrome is an increasingly common condition that is becoming a serious public health issue.

Symptoms

Metabolic syndrome does not always present visible symptoms beyond excess abdominal fat. However, it does show clear signs in a clinical analysis:

Waist circumference: equal to or greater than 102 cm (40 inches) in men and 88 cm (35 inches) in women.
High blood pressure: readings equal to or greater than 130/85 mmHg.
Elevated triglyceride levels: from 150 mg/dL and above.
Elevated low-density lipoprotein (LDL) levels: equal to or greater than 100 mg/dL.
Low high-density lipoprotein (HDL) levels: below 40 mg/dL in men and below 50 mg/dL in women.
Elevated glucose levels: equal to or greater than 100 mg/dL while fasting. If levels are very high, some symptoms may appear:
- Blurred vision.
- Increased thirst.
- Increased urination, especially at night.
- Fatigue and weakness.

Causes

Metabolic syndrome is associated with two main interrelated factors: overweight and hyperinsulinemia (insulin resistance). The body's fat cells, particularly those in the abdomen, increase the concentration of free fatty acids, whose excess interferes with the insulin response. Insulin is the hormone responsible for glucose absorption by cells to use as an energy source. When cells develop insulin resistance, the body needs to produce more insulin for glucose absorption and to lower blood sugar levels. However, excessive insulin in the bloodstream can elevate LDL cholesterol and triglycerides, reduce HDL cholesterol, hinder fat elimination from the blood, increase blood pressure, and promote clotting.

Additionally, excess fat cells cause the immune system to release certain proteins that trigger an inflammatory response in the body. This inflammation, in turn, leads to insulin resistance, narrowing of blood vessels, arterial plaque formation, and high blood pressure.

Risk Factors

The likelihood of developing metabolic syndrome increases in the following cases:

Family history of metabolic syndrome, diabetes, or overweight.
Age: risk increases with age.
Gender: more common in women, especially after menopause.
Gestational diabetes: often leads to fetal macrosomia, meaning a newborn with a size significantly larger than normal. This increases the risk of developing metabolic syndrome in childhood.
High-calorie diet rich in fats and cholesterol.
Sedentary lifestyle.
Excessive alcohol consumption.
Smoking.
Sleep disorders: apnea, insomnia, or circadian rhythm disturbances.
Polycystic ovary syndrome.
Immune system disorders.
Non-alcoholic fatty liver disease.
Chronic kidney disease.
Chronic stress.

Complications

As mentioned, metabolic syndrome is a major risk factor for developing severe diseases. Insulin resistance associated with the syndrome can lead to type 2 diabetes, while high cholesterol and hypertension contribute to arterial plaque formation. This plaque can narrow, harden, or even obstruct arteries, disrupting blood flow and potentially causing a heart attack or stroke—both of which pose serious health risks.

Prevention

The most effective way to prevent metabolic syndrome is to adopt a healthy lifestyle:

Engage in regular physical activity, preferably daily.
Limit or avoid saturated fats, trans fats, sugar, and salt.
Increase the intake of fruits, vegetables, lean proteins, legumes, and whole grains.
Avoid smoking.
Limit alcohol consumption.

Which Doctor Treats Metabolic Syndrome?

Metabolic syndrome is evaluated and treated by specialists in internal medicine, cardiology, and endocrinology.

Diagnosis

The diagnosis of metabolic syndrome involves a clinical examination where the patient’s waist circumference is measured, a blood test is conducted, and blood pressure is taken. To confirm the syndrome, at least three of the following criteria must be met:

Waist circumference equal to or greater than 102 cm (40 inches) in men and 88 cm (35 inches) in women.
Blood pressure equal to or greater than 130/85 mmHg.
Triglyceride levels equal to or greater than 150 mg/dL.
HDL cholesterol lower than 40 mg/dL in men and lower than 50 mg/dL in women.
Fasting glucose levels equal to or greater than 100 mg/dL.

Treatment

The treatment of metabolic syndrome has two complementary approaches:

Lifestyle changes: adopting lifelong habits to lose weight and reduce cardiovascular risk. The key elements include:
- Heart-healthy diet.
- Physical exercise.
- Quitting smoking.
- Stress management.
- Sufficient and quality sleep.
Pharmacological treatment: if a healthy lifestyle is not enough, specific medications may be needed:
- Antihypertensives, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers: these dilate blood vessels and lower blood pressure. They also increase insulin sensitivity, reducing circulating glucose levels.
- Medications to regulate dyslipidemia, such as statins and niacin: these lower triglyceride levels and increase HDL cholesterol levels.
- Antidiabetic medications, such as metformin or thiazolidinediones: these enhance insulin sensitivity, lowering blood glucose levels, and help reduce cholesterol and triglyceride concentrations.