The metabolic syndrome (insulin resistance syndrome, syndrome X) is an important risk factor for cardiovascular disease and type 2 diabetes; it consists of a constellation of metabolic abnormalities that includes central obesity, insulin resistance, hypertension, and dyslipidemia, high triglycerides, and low HDL. The prevalence of metabolic syndrome varies among ethnic groups; it increases with age, degree of obesity, and propensity to type 2 diabetes.
Overweight/obesity (especially central adiposity), sedentary lifestyle, increasing age, and lipodystrophy are all risk factors for the metabolic syndrome. The exact cause is not known and may be multifactorial. Insulin resistance is central to the development of the metabolic syndrome. Increased intracellular fatty acid metabolites contribute to insulin resistance by impairing insulin-signaling pathways and accumulating as triglycerides in skeletal and cardiac muscle, while stimulating hepatic glucose and triglyceride production. Excess adipose tissue leads to increased production of proinflammatory cytokines.
There are no specific symptoms of the metabolic syndrome. The major features include central obesity, hypertriglyceridemia, low HDL cholesterol, hyperglycemia, and hypertension (Table 118-1). Associated conditions include cardiovascular disease, type 2 diabetes, nonalcoholic fatty liver disease, hyperuricemia/gout, polycystic ovary syndrome, and obstructive sleep apnea.
TABLE 118-1NCEP:ATPIIIa 2001 AND HARMONIZING DEFINITION CRITERIA FOR THE METABOLIC SYNDROME |Favorite Table|Download (.pdf) TABLE 118-1NCEP:ATPIIIa 2001 AND HARMONIZING DEFINITION CRITERIA FOR THE METABOLIC SYNDROME
|NCEP:ATPIII 2001 ||Harmonizing Definitionb |
Three or more of the following:
• Central obesity: waist circumference >102 cm (M), >88 cm (F)
• Hypertriglyceridemia: triglyceride level ≥150 mg/dL or specific medication
Low HDLc cholesterol: <40 mg/dL and <50 mg/dL for men and women, respectively, or specific medication
• Hypertension: blood pressure ≥130 mmHg systolic or ≥85 mmHg diastolic or specific medication
• Fasting plasma glucose level ≥100 mg/dL or specific medication or previously diagnosed type 2 diabetes
|Three of the following: |
Waist circumference (cm)
|Men ||Women ||Ethnicity |
|≥94 ||≥80 ||Europid, sub-Saharan African, Eastern and Middle Eastern |
|≥90 ||≥80 ||South Asian, Chinese, and ethnic South and Central American |
|≥85 ||≥90 ||Japanese |
Fasting triglyceride level >150 mg/dL or specific medication
HDL cholesterol level <40 mg/dL and <50 mg/dL for men and women, respectively, or specific medication
Blood pressure >130 mm systolic or >85 mm diastolic or previous diagnosis or specific medication
Fasting plasma glucose level ≥100 mg/dL (alternative indication: drug treatment of elevated glucose levels)