Haramaya university college of health and medical

science

SCHOOL OF MLS

Advanced Analytical Clinical Chemistry assignment

Title :Metabolic syndrome

By Gada Diba
1 metabolic syndrome 12/15/2022
 Objectives
At the end of this presentation, the students should be able to:

Define metabolic syndrome.

List diagnostic criteria for metabolic syndrome.

Explain pathophysiology of metabolic syndrome.

Describe sign and symptoms of metabolic syndrome.

Explain pharmacological and non pharmacological managements of metabolic

syndrome.

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 Introduction
 Metabolic syndrome (MetS) is an increasing public health concern globally.

 The worldwide prevalence of MetS has steadily risen over the years, hand-

in-hand with the development of industrialization and globalization.

 MetS have been currently estimated to affect approximately 30 % of the

global population and is associated with an increased risk of morbidity and

mortality that is two to three times higher compared to healthy subjects.

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 Cont…
 In Asian countries, the highest rate of MetS prevalence is found in India ,

followed by Taiwan , Korea, China , and lastly Indonesia.

 In Africa, MetS prevalence is higher in North Africa and is closely

followed by Central Africa.

 In Ethiopia, according to cross sectional study done in Addis Abeba in

2019, which involves 325 participants the overall prevalence of MetS is

20.3% (Solomon S, Mulugeta W.,2019) .

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 Cont…
 Systematic review and meta-analysis was conducted in 2020 to estimate the

pooled prevalence of MetS based on IDF and NCEP/ATP III criteria among
different study subjects in Ethiopia (Ambachew et al., 2020)
 This systematic review provides evidence of an estimated pooled prevalence

of MetS among various study subjects of the Ethiopian population.

 According to this review, the combined pooled prevalence of MetS was

34.89% and 27.92% by using NCEP/ATP III and IDF criteria, respectively

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 Another name of metabolic syndrome:

 Syndrome X

 Insulin resistance syndrome

 Deadly quartet

 Reaven’s syndrome

 Cardiometabolic syndrome

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 Definition
 metabolic syndrome is a cluster of risk factors, comprising:
obesity,
elevated blood pressure and
 distorted lipid- and glucose metabolism.

 MetS is not a disease, but rather a clustering of metabolic risk factors that have
been proven to make the incidence of cardiovascular disease (CVD) at least
twice as likely, and increase the possibility of suffering from type 2 diabetes
(T2D) fivefold (Haverinen et al.,2021).

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 Cont…

 The risk of coronary heart disease, stroke, nonalcoholic fatty liver disease,

diabetes mellitus type 2 (T2DM), other forms of cardiovascular diseases, and

all-cause mortality is directly linked to MetS.
 Currently, several well-known and accepted MetS definitions are used in clinical

and research fields including the same components (obesity, glucose and lipid
metabolism and blood pressure), however the definitions emphasize different
components and use different cutoff points.

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 Cont…

E.g. the definition by the World Health Organization (WHO) emphasizes insulin

resistance, where the International Diabetes Federation (IDF) has a prerequisite of

central obesity.

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 Metabolic Syndrome Diagnostic Criteria
 During the past 10 years, several groups have developed criteria for the
identification and clinical diagnosis of metabolic syndrome.
 Numerous criteria are available;
AHA/NHLBI
 IDF
World Health Organization (WHO) criteria

 AHA/NHLBI and IDF criteria are the most commonly used because of their
simplicity and practicality in the clinical setting.

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 Cont…
 There are four major components of metabolic syndrome which is used as
diagnostic criteria, those are:
Abdominal Obesity

Atherogenic Dyslipidemia  

Hypertension

Elevated Fasting Glucose

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 Abdominal Obesity
 Computed tomography and magnetic resonance imaging are the most
accurate tools to assess intra-abdominal adiposity.
 However, these measurements are expensive and impractical to routinely use in
the clinical setting.
 Measurement of an individual’s waist circumference with a cloth tape measure
is a simple yet practical way to assess intra-abdominal fat.

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  To measure waist circumference, the patient should stand in the upright
position.
 The top of the iliac crest (hip bone) and the bottom of the lower rib should be
palpated, and the midway point between these two landmarks should be marked.
 Waist circumference should be measured at the midway point at the end of a
gentle exhalation. The measuring tape should be flat to the body and snug but
not tight.

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 Atherogenic Dyslipidemia
Dyslipidemia in metabolic syndrome is characterized by the presence of:

 Elevated triglycerides.

Low HDL-C, and

Normal to elevated low-density lipoprotein cholesterol (LDL-C).

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 Hypertension
 An elevated systolic or diastolic blood pressure is another criterion for
metabolic syndrome.
 For patients without comorbid medical conditions, blood pressure levels
above 140/90 mm Hg are considered elevated.
 Patients at high risk of cardiovascular disease are considered hypertensive if
their blood pressure is above 130/80 mm Hg.
 Patients in this category include those with DM, chronic kidney disease,
known coronary artery disease.

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 Elevated Fasting Glucose
Elevated fasting glucose is defined as fasting plasma glucose of 100 mg/dL or

greater.
This definition includes patients with IFG; fasting plasma glucose between 100 mg/

dL and 126 mg/dL) and type 2 DM (fasting plasma glucose of 126 mg/dL or
greater).
Thus, elevated fasting glucose represents a progressive continuum of abnormal

glucose homeostasis.
IGT is also recognized as a state of altered glucose homeostasis.

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 Cont…
 Impaired glucose tolerance is defined as a 2-hour plasma glucose
concentration between 140 mg/dL and 200 mg/dL on a 75-g oral glucose
tolerance test, in the presence of fasting plasma glucose less than 126 mg/dL.
 The states of IFG and IGT are commonly referred to as prediabetes.

 A plasma glucose concentration after an overnight fast is the test of choice to

identify IFG or type 2 DM.

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 Table 1-1. AHA/NHLBI, IDF, and WHO Metabolic Syndrome Diagnostic Criteria
 
AHA/NHLBI IDF WHO
Number of required criteria Any 3 of 5 below Abdominal obesity plus 2 others Type 2 diabetes mellitus, IFG,
below IGT, or lowered insulin sensitivity
plus 2 others below
Abdominal obesity Waist circumference ≥ 102 cm in men Increased waist circumference Waist-to-hip ratio of > 0.90 in
or ≥ 88 cm in women (population-specifice [e.g., Europid ≥ men or > 0.85 in women and/or
94 cm in men or ≥ 80 cm in women]) BMI > 30 kg/m2
Elevated triglycerides ≥ 150 mg/dL, or drug treatment for ≥ 150 mg/dL, or drug treatment for ≥ 150 mg/dL
high triglycerides (i.e., fibrates or high triglycerides (i.e., fibrates or
nicotinic acid) nicotinic acid)
Low HDL-C < 40 mg/dL in men or < 50 mg/dL in < 40 mg/dL in men or < 50 mg/dL in < 35 mg/dL in men or < 39 mg/dL
women; or drug treatment for low women; or drug treatment for low in women
HDL-C (i.e., fibrates or nicotinic HDL-C (i.e., fibrates or nicotinic acid)
acid)
Elevated blood pressure Systolic ≥ 130 mm Hg and/or Systolic ≥ 130 mm Hg and/or diastolic ≥ 140/90 mm/Hg
diastolic ≥ 85 mm Hg; or drug ≥ 85 mm Hg; or drug treatment for
treatment for hypertension hypertension
Elevated fasting plasma glucose ≥ 100 mg/dL; or drug treatment for ≥ 100 mg/dL; or drug treatment for Required, see first row in this
elevated glucose elevated glucose column
Other _ Microalbuminuria ≥ 20 mcg/
_ minute or albumin-to-creatinine
ratio ≥ 20 mg/g
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 Pathophysiology (risk factor)
 Abdominal obesity and insulin resistance are viewed as the core defects

underlying the pathophysiology of metabolic syndrome.

 These two risk factors are highly interrelated; therefore, it is difficult to ascertain

which one plays the predominant role in metabolic syndrome pathogenesis and
progression.

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 In addition, metabolic syndrome pathophysiology is complicated by contributing
factors such as:

 dysregulation of adipose tissue–  physical inactivity

derived cytokines  diet
 inflammation  hormone imbalances
 genetics  Drugs and
 race/ethnicity,  Age .

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 Cont…

 According to cross sectional study done in Addis Abeba in 2019, which involves

325 participants, older age, Amhara ethnicity, overweight status ,higher income
and higher education levels were risk factors for MetS (Solomon S, Mulugeta
W.,2019) .
 Based on cross sectional study done in Ayder Comprehensive Specialized

Hospital, Tigray, Ethiopia in 2018. Sex, age, Regular physical exercise,

overweight and obesity were statistically associated with metabolic syndrome
(gebremeskel et al ,2019).

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22 metabolic syndrome 12/15/2022
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 Sign and Symptoms
 Most of the disorders associated with metabolic syndrome don't have obvious

signs or symptoms.
 One sign that is visible is a large waist circumference.

 And if blood sugar is high, the signs and symptoms of diabetes — such as :

increased thirst and urination, fatigue,

 and blurred vision can occur.

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 THE STANDARD IN METABOLIC SYNDROME MANAGEMENT
 The foundations of MetS management are essentially lifestyle modifications,
like changes in dietary and exercise habits.
 Moreover, current evidence supports that diet and exercise, along with
pharmacologic and surgical interventions, may inhibit the progression of MetS
to T2D or CVD.

 Therapeutical strategies will be subdivided into:

1. pharmacological
2. non-pharmacological.

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 1. Non-pharmacological management

A healthy lifestyle is the pillar of MetS treatment.

 Diet, physical activity, sleep, emotion control, and avoidance of tobacco

and other drugs that affect satiety or body weight are crucial targets, each
of which requires a systematic evaluation and a patient-centered
intervention (Aguilar-Salinas et al., 2019).

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 A. Diet
 Lifestyle modifications and weight loss are considered the most important

initial steps of MetS treatment.

 Westernized diets are strongly associated with a higher risk of developing

metabolic syndrome.
 Conversely, different diets like Mediterranean-style diets, characterized by high

dairy, fish, wine, and cereal grain intakes seem to be associated with lower risk .

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 Cont…
 Regarding wine consumption, epidemiologic studies suggest that moderate wine

intake may protect against MetS onset (Liu et al., 2008).

 Besides, diets that promote fruits, vegetables, and low-fat dairy products

consumption such as the DASH (Dietary Approaches to Stop Hypertension)–style

diet, show positive effects lowering BP and may lower the risk of stroke and
CVD(Park et al., 2017) .
 what is more, even modest adherence to the DASH diet is associated with a lower

risk of all-cause mortality.

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 B. Physical Activity
 Exercise is considered to be one of the main interventions to treat MetS.

 Currently, physical activity recommendation is at least 150-175 min/week, in

conjunction with dietary energy restriction, targeting weight loss of 5 %-7 %.

 A recent systematic review of 53 studies that evaluated 66 lifestyle intervention

programs reported that, compared with usual care, diet and physical activity
promotion programs reduced T2D incidence, body weight, and fasting blood
glucose while improving other cardio metabolic risk factors (Balk et al, 2015).

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 LIFESTYLE MODIFICATIONS

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 C. Surgical treatment
 Bariatric surgery (BS) and transcatheter bariatric embolotherapy, are the two

surgical options that have demonstrated positive effects on obesity or MetS

management.

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 2. Pharmacological management
In people for whom lifestyle change is not enough and who are
considered to be at high risk for CVD, drug therapy may be required to
treat the metabolic syndrome.
It is currently necessary to treat the individual components of the
syndrome in order that a lower individual risk associated with each
component will reduce the overall impact on CVD and diabetes risk.

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 IDF recommended treatment of the individual components of the metabolic
syndrome:
1. Atherogenic dyslipidaemia
 Primary aims for therapy:
Lower TG
Raise HDL-c levels
 Reduce LDL-c levels
 Options:
Fibrates
The Veterans Affairs High-Density Lipoprotein Intervention Trial (VA-HIT)
Statins

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 2. Elevated blood pressure
 antihypertensive therapy

Options:
 Angiotensin converting enzyme inhibitors and angiotensin receptor
blockers are useful antihypertensive drugs.

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 3. Insulin resistance and hyperglycaemia

 The Diabetes Prevention Program (DPP) showed that metformin therapy in

people with prediabetes will prevent or delay the development of diabetes and
 Recent thiazolidinedione studies have also demonstrated efficacy in delaying or

preventing type 2 diabetes in people with impaired glucose tolerance (IGT) and
insulin resistance (Durbin RJ ,2004).
 Other studies have shown that both acarbose and orlistat can be used to delay

the development of type 2 diabetes in people with IGT (Chiasson et al.,2003)

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 Conclusions
 Obesity is increasing worldwide at an alarming rate

 Adiposopathy leads to atherogenic dyslipidemia as well as several other risk factors for

CAD
 7%-10% weight loss significantly affects CHD risk

 Calorie restriction is the most important criteria for the diet

 Increased physical activity is also critical

 Many drugs can contribute to weight gain

 Surgical and pharmacologic therapies can be helpful in selected patients

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 References
 Solomon S, Mulugeta W. Disease burden and associated risk factors for metabolic syndrome
among adults in Ethiopia. BMC Cardiovascular Disorders. 2019 Dec; 19(1):1-8.
 Ambachew S, Endalamaw A, Worede A, Tegegne Y, Melku M, Biadgo B. The prevalence of
metabolic syndrome in Ethiopian population: a systematic review and meta-analysis. Journal of
Obesity. 2020 Dec 16; 2020.
 Haverinen E, Paalanen L, Palmieri L, Padron-Monedero A, Noguer-Zambrano I, Sarmiento Suárez
R, Tolonen H. Comparison of metabolic syndrome prevalence using four different definitions–a
population-based study in Finland. Archives of Public Health. 2021 Dec; 79(1):1-9.
 Gebremeskel GG, Berhe KK, Belay DS, Kidanu BH, Negash AI, Gebreslasse KT, Tadesse DB,
Birhanu MM. Magnitude of metabolic syndrome and its associated factors among patients with
type 2 diabetes mellitus in Ayder Comprehensive Specialized Hospital, Tigray, Ethiopia: a cross
sectional study. BMC research notes. 2019 Dec;12(1):1-7.
 Aguilar-Salinas CA, Viveros-Ruiz T. Recent advances in managing/understanding the metabolic
syndrome. F1000Research. 2019; 8:F1000 Faculty Rev-370

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 Liu L, Wang Y, Lam KSL, Xu A. Moderate wine consumption in the prevention of metabolic
syndrome and its related medical complications. Endocr Metab Immune Disord Drug Targets.
2008;8(2):89-98
Park Y-MM, Steck SE, Fung TT, Zhang J, Hazlett LJ, Han K, et al. Mediterranean diet,
Dietary Approaches to Stop Hypertension (DASH) style diet, and metabolic health in U.S.
adults. Clin Nutr Edinb Scotl. 2017; 36(5):1301-1309
Balk EM, Earley A, Raman G, Avendano EA, Pittas AG, Remington PL. Combined Diet and
Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at
Increased Risk: A Systematic Review for the Community Preventive Services Task Force.
Ann Intern Med. 2015; 163(6):437-451
Durbin RJ. Thiazolidinedione therapy in the prevention/delay of type 2 diabetes in patients
with impaired glucose tolerance and insulin resistance. Diabetes, Obesity and Metabolism
2004; 6:280-5
Chiasson JL, Josse RG, Gomis R et al. STOP-NIDDM Trial Research Group. Acarbose
treatment and the risk of cardiovascular disease and hypertension in patients with impaired
glucose tolerance: the STOP-NIDDM trial. JAMA 2003 Jul 23; 290(4):486-94.

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 THANK YOU

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