Metabolic Syndrome Is Related Cardio-Cerebro Vascular Disease
Metabolic Syndrome Is Related Cardio-Cerebro Vascular Disease
FK UWKS
Metabolic syndrome
Insulin resistance syndrome
Dysmetabolic syndrome
Cardiometabolic syndrome
Dyslipidemic hypertension
Hypertriglycerdemic waist
The deadly quartet.
Krans HM., Insulin Resistence and The Metabolic Syndrome, SUMETSU 3, Surabaya, Februari 2007
Tabel. Definitions of the Metabolic Syndrome
ATP III (American Heart World Health International Diabetes Federation
Association) (2005) Organisation 1999 (2005)
Minimal Any 3 or mor of the Diabetes, IFG, IGT, or Central obesity (see under) + any
requirements following criteria insulin resistance + any 2 or more of the following criteria
2 or more of the
following criteria
Waist In men < 102 cm In men 94 cm
circumference In women < 88 cm In womwn 80 cm
Waist to hip < 0,90 in men
ratio < 0,85 in womwn
Reduced HDL < 1.00 mmol/l in men < 0.90 mmol/l in men < 1.03 mmol/l (40 mg/dl) in men
cholesterol < 1.30 mmol/l in women < 1.00 mmol/l in women < 1.29 mmol/l (50 mg/dl) in women
Elevated > 1.70 mmol/l > 1.70 mmol/l 1.70 mmol/l (150 mg/dl)
Triglycerides
Elevated Blood > 130 / >85 140 / 90 130 / 85
Pressure
Urinary Albumin > 20 mg/min
Excretion
Serum glucose 6.1 (5.6) mmol/l 5.6 mmol/l (100 mg/dl)
ACR = Albumin Creatinine Ratio, IDF = International Diabetes Federation, IMA = Infark Miokard Akut, PJK = Penyakit Jantung Koroner
International Diabetes Federation Definition:
Abdominal obesity plus two other components:
elevated BP, low HDL, elevated TG, or impaired
fasting glucose
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Lifestyle Related Diseases (LRD): from Stage- 0 to Stage- 4
(Clinical Experiences : Tjokroprawiro 1995-2007)
INTENSIVE
INTENSIVE "Well Programmed"
1 HEALTH EDUCATION 1 HEALTH EDUCATION 1 HEALTH EDUCATION
2 TLC : GULOH-CISAR 2 TLC : GULOH-CISAR 2 TLC : GULOH-CISAR
Stage - 3 Stage - 4
Preclinical Diseases Clinical Diseases
the MetS, Pre-DM, Adolescent Obesity CAD, T2DM, Adolescent-T2DM, Stroke
Intensive - Well Programmed Intensive - Well Programmed
TLC : GULOH-CISAR TLC : GULOH-CISAR
GULOH-CISAR = SYNDROME-10
(Tjokroprawiro 1995,1996,1997,1998,1999,2000,2001,2003,2006)
JAS-BUKET : Jerohan, Alkohol, Sarden - Burung Dara, Unggas, Kaldu, Emping, Tape
(Bowels, Alcohol, Sardines - Pigeon, Fowls, Meat-Broth, Beaten Nut, Fermented Cassava)
"MABUK" (Rich in Chromium) : Mrica, Apel, Brokoli, Udang, Kacang-kacangan; good for DM
1. Lingkar perut
wanita 80 cm
pria 90 cm
2. Trigliserida 150mg/dL
3. HDLkolesterol
wanita < 50mg/dL
pria < 40mg/dL
4. Tekanan Darah 130/85mmHg
5. Gula Darah Puasa 110mg/dL. (sekarang > 100)
METABOLIC SYNDROME
THE PREVALENCE
Insulin resistance
Insulin secretion
Post-Meal glucose
Microvascular complications
Fasting glucose
Cardiovascular Complications
Pre-diabetes Type 2 diabetes
Type 2
30% diabetes 50%
Weight (kilogram)
kg
Height (meter2) m2
CLASSIFICATION (NIH, 1998)
Disease Risk *) Relative to Normal
Risk of Commorbidities
Waist Circumference
Classification BMI (kg/m2) < 90 cm (Men) > 90 cm (Men)
< 80 cm (Women) > 80 cm (Women)
Underweight < 18.5 Low Average
(but increased risk
of other clinical
problems)
Normal range 18.5 - 22.9 Average Increase
Overweight : > 23
At risk 23-24.9 Increase Moderate
Obese I 25-29.9 Moderate Severe
Obese II > 30 Severe Very severe
Osteoarthritis
monal abnormalities Cancer
Hyperuricemia
and gout
Obesity and Metabolic Risk
Abdominal vs. Peripheral Obesity
Large Insulin-Resistant
Adipocytes
Small Insulin-Sensitive
Adipocytes
Adrenergic Receptors
Insulin-Mediated
Antilipolysis
Plasma Non-Esterified
Fatty Acids
Catecholamine-Mediated
Lipolysis
Sharma 2002
Atherogenic
dyslipidemia
Insulin
resistance
Thrombotic
state
Inflammatory
"The Widened Metabolic Syndrome : The Widened MetS 6
A Cluster of 10 Metabolic-Cardiovascular Risk Components
(Abdominal Obesity is the Key Player)
(Summarized : Tjokroprawiro 2002-2007)
Adiponectin PAI-1
Insulin Resistance
Atherosclerosis
SUMETSU 2007
YAMATO INSTITUTE OF LIFESTYLE-RELATED DISEASES 070217
EFEK RESISTENSI INSULIN
Glucose uptake
Glucose oxidation
Insulin Hyperinsulinemia
Lipolysis
Hyperglycemia
resistance Free fatty acid
Dyslipidemia
Glucose uptake
Glucose production
VLDL synthesis
Insulin Resistance
Hyperinsulinemia
Coronary heart
disease
1. Weight Loss 5 - 10 % from baseline
2. Prevents the Yoyo Syndrome ( Weight Regain )
3. Improves Comorbid Conditions
4. Improves Quality of life
1. Behavior Modification
2. Medical Nutrition Therapy (MNT), e.g., LCDs or VLCDs
3. Healthy Life Style (Physical Exercise, etc)
4. Medications
5. Surgery
Should it?
Food Patterns and Metabolic Syndrome
High carbohydrate,
high glycemic index food
exhaust pancreatic cells
hyperinsulinemia
increase in inflammatory markers
risk for MS
Blood pressure
impairment Lipid profile improved
Insulin sensitivity, Improve
impaired
Glycemia
Susceptibillity to thrombosis
Inflammation markers
Abdomin Reduced
al obesity Risk
of coronary heart disease
obesity
(waist (waist
circumference Desprs JP, BMJ 2001;322:716-20 circumference
JNC 7 Algorithm for Treatment of Hypertension
Without
Without Compelling
Compelling Indications
Indications With
With Compelling
Compelling Indications
Indications
Not at Goal BP
Systolic Diastolic
Goal (mm Hg) < 130 < 80
Behavioral therapy alone 130-139 80- 89
(Max 3 mos) then add
pharmacologic treatment
[Source: 1Wood et al. Eur Heart J 1998;19:1434-1503. 2NCEP Expert Panel. JAMA
2001;285:2486-2497.
3
Med J Aust 2001;175(suppl):S57-S85.]
Exogenous factors Increased cellular Impaired rapid
Lack of exercise insulin resistance insulin secretion Genetic
Adiposis dispositio
n
Postprandial
hyperglycemia
Hyperinsulinemia
Raised blood sugar
through Pre-
becomes toxic
compensatory
other production
(glucose toxicity) diabetes
Increased insulin
resistance and
The point of action decreased insulin
secretion
of oral antidiabetic in
the pathophysiology Chronic
Hyperlgycemia and Manifest
of type 2 diabetes hyperinsulinemia diabetes
Further increase in
insulin resistance
Advanced
diabetes
Gradual decrease
in insulin secretion