Metabolic Disorders

Introduction
Signs and Symptoms
Causes
Risk Factors
Screening and Diagnosis
Treatment
Prevention

Metabolic syndrome is a cluster of conditions that occur together, increasing your risk for heart disease, stroke and diabetes. Having just one of these conditions - increased blood pressure, elevated insulin levels, excess body fat around the waist or abnormal cholesterol levels - contributes to your risk of serious disease. In combination, your risk is even greater.

Research into the complex underlying process linking this group of conditions is ongoing. As the name suggests, metabolic syndrome is tied to the body's metabolism, possibly to a condition called insulin resistance.

Not all experts agree on the definition of metabolic syndrome or whether it even exists as a distinct medical condition. Doctors have talked about this constellation of risk factors for years and have called it many names, including syndrome X and insulin resistance syndrome. Whatever it's called, and however it's precisely defined, this collection of risk factors is apparently becoming more prevalent.

If you have metabolic syndrome or any of its components, you have the opportunity to make aggressive lifestyle changes that can delay or derail the development of serious diseases.

Having metabolic disorder syndrome means you have several disorders related to your metabolism at the same time, including:

• Obesity, particularly around your waist (having an "apple shape")
• Elevated blood pressure
• An elevated level of the blood fat called triglycerides and a low level of high-density lipoprotein (HDL) cholesterol - the "good" cholesterol
• Resistance to insulin, a hormone that helps to regulate the amount of sugar in your body

Having one component of metabolic syndrome means you're more likely to have others. And the more components you have, the greater are the risks to your health.

One study showed that men with three factors of metabolic syndrome are nearly twice as likely to have a heart attack or stroke and more than three times as likely to develop heart disease as are those with no factors.

Most doctors believe that the underlying cause of metabolic syndrome is resistance to insulin - a hormone made by the pancreas that helps control the amount of sugar in your bloodstream.

Normally, your digestive system breaks down some of the food you eat into sugar (glucose). Your blood carries the glucose to your body's tissues, where the cells use it as fuel. Glucose enters the cells with the help of insulin. In people with insulin resistance, cells don't respond to insulin and glucose can't enter the cells.

Your body reacts by churning out more and more insulin to help glucose get into your cells. This results in higher than normal levels of insulin and glucose in the blood. Although perhaps not high enough to qualify as diabetes, an elevated glucose level still interferes with your body processes. Increased insulin raises your triglyceride level and those of other blood fats. It also interferes with how your kidneys work, leading to increased blood pressure.

These combined effects of insulin resistance put you at risk of heart disease, stroke, diabetes and other conditions.

Researchers are still learning what causes insulin resistance. It probably involves a variety of genetic and environmental factors. They think some people are genetically prone to insulin resistance, inheriting the tendency from their parents. But being overweight and inactive are major contributors.

The following factors increase your chances of having metabolic syndrome:

• Age. The prevalence of metabolic syndrome increases with age, affecting less than 10 percent of people in their 20s and 40 percent of people in their 60s. However, one study shows that about one in eight schoolchildren have three or more components of metabolic syndrome.
• Race. Hispanics and Asians seem to be at greater risk for metabolic syndrome than other races are.
• Obesity. A body mass index (BMI) - a measure of your percentage of body fat based on height and weight - greater than 25 increases your risk of metabolic syndrome. So does abdominal obesity - having an apple shape rather than a pear shape.
• History of diabetes. You're more likely to have metabolic syndrome if you have a family history of type 2 diabetes or a history of diabetes during pregnancy (gestational diabetes).
• Other diseases. A diagnosis of high blood pressure, cardiovascular disease or polycystic ovary syndrome - a similar type of metabolic problem that affects a woman's hormones and reproductive system - also increases the risk of metabolic syndrome.

Although your doctor is not typically looking for "metabolic syndrome," the label may apply if you have three or more of the traits associated with this condition. Several organizations have criteria for diagnosing metabolic syndrome. These guidelines were created by the National Cholesterol Education Program (NCEP) with modifications by the American Heart Association. According to these guidelines, you have metabolic syndrome if you have three or more of these traits:

• Elevated waist circumference, greater than 35 inches for women and 40 inches for men. For people genetically at greater risk of diabetes, the circumference limit is slightly lower; 31 to 35 inches for women and 37 to 39 inches for men.
• Elevated level of triglycerides of 150 milligrams per deciliter (mg/dL) or higher, or you're receiving treatment for high triglycerides.
• Reduced HDL (less than 40 mg/dL in men or less than 50 mg/dL in women) or you're receiving treatment for low HDL.
• Elevated blood pressure of 130 millimeters of mercury (mm Hg) systolic (the top number) or higher or 85 (mm Hg) diastolic (the bottom number) or higher, or you're receiving treatment for high blood pressure.
• Elevated fasting blood sugar (blood glucose) of 100 mg/dL or higher, or you're receiving treatment for high blood sugar.

Tackling one of the risk factors of metabolic syndrome is tough - taking on all of them might seem overwhelming. But aggressive lifestyle changes and, in some cases, medication can improve all of the metabolic syndrome components. Getting more physical activity, losing weight and quitting smoking help reduce blood pressure and improve cholesterol and blood sugar levels. These changes are key to reducing your risk.

• Exercise. Doctors recommend getting 30 to 60 minutes of moderate intensity exercise, such as brisk walking, every day.
• Lose weight. Losing as little as 5 percent to 10 percent of your body weight can reduce insulin levels and blood pressure and decrease your risk of diabetes.
• Stop smoking. Smoking cigarettes increases insulin resistance and worsens the health consequences of metabolic syndrome. Talk to your doctor if you need help kicking the cigarette habit.

Work with your doctor to monitor your weight and your blood glucose, cholesterol and blood pressure levels to ensure that lifestyle modifications are working. If you're not able to achieve your goals with lifestyle changes, your doctor may also prescribe medications to lower blood pressure, control cholesterol or help you lose weight. Insulin sensitizers may be prescribed to help your body use insulin more effectively. Aspirin therapy may help reduce your risk of heart attack and stroke.

Whether you have one, two or none of the components of metabolic syndrome, the following lifestyle changes will reduce your risk of heart disease, diabetes and stroke:

Healthy Weight Pyramid is a tool to help you lose weight or maintain your weight. It focuses on nutritious foods that contain a small number of calories in a large amount of food - such as fruits, vegetables, legumes, poultry, fish or whole grains. Fruits and vegetables, allowed in unlimited amounts, form the foundation of the pyramid. This pyramid also recommends healthy food choices within each food group. Candy and other processed sweets are acceptable, but in moderation - up to 75 calories daily.


• Commit to a healthy diet. Eat plenty of fruits and vegetables. Choose lean cuts of white meat or fish over red meat. Avoid processed or deep-fried foods. Eliminate table salt and experiment with other herbs and spices.
• Get moving. Get 30 to 60 minutes of moderately strenuous activity most days of the week.
• Schedule regular checkups. Check your blood pressure, cholesterol and blood sugar levels on a regular basis. Make additional lifestyle modifications if the numbers are going the wrong way.