Metabolic syndrome in Community Medicine

Metabolic Syndrome

Prepared by Dr.Anees AlSaadi
Community Medicine Residents
1

• History and Definition.
• Criteria of Diagnosis.
• Epidemiology.
• Risk Factors.
• Complications
• Etiology.
• Group Exercise.
• Prevention.

2

Changing
Diagnostic
Criteria.

1988 Reaven
1998
WHO
1999 EGIR
2001 NCEP
ATPIII
2005
AHA/NHLBI

Agreement on One criteria

Many
Definitions.

History of the Diseases

Definition

3

Definition
• Clustering of Risk Factors:
– Impaired Glucose test.
– Hyperinsulinemia.
– High Triglycerides.
– Low HDL.
– HyperUricemia.
– High PAI-1 Coronary Heart

Dr. Reaven
“ Syndrome X” 1988

Disease.
DMII.
Hypertension.
4

Insulin Resistance.
BMI ≥ 30kg/m²
Hypertension
140/90mmHg
Microalbumineuria

• WHO
1998

Insulin Resistance Syndrome.
Excluding DMII. fasting Insulin.
Obesity By Waist Circumference.
Hypertension.
Dyslipidemia.
Coronary Heart Disease.

Metabolic
Syndrome.

• European Group
for the Study of
Insulin
Resistance 1999

• NCEP/ATPIII 2001
• IDF/AHA/NHLBI
2005

5

Definition
Diabetes
Mellitus

Hypertension

Central
Obesity

Dyslipidemia

Metabolic
Syndrome

6

Definition
Central Obesity

Abdominal Waist Circumference
≥102 cm (40 in) in men
≥ 88 cm (35 in) in women

7

Definition
Dyslipidemia

Serum Lipids
• TG ≥ 150 mg/dl (1.7 mmol/L)

• HDL ˂ 40 mg/dl (1.03 mmol/L) in men
˂ 50 mg/dl (1.30 mmol/L in women
)

8

Definition
Diabetes Mellitus

Fasting Glucose
≥ 100 mg/dl (5.6 mmol/L)

9

Definition
Hypertension

Blood pressure
≥ 130 mm Hg systolic blood pressure.
≥ 85 mm Hg diastolic blood pressure.
10

Epidemiology
International Burden

• U.S. prevalence adults (22% - 34.6%) [IDF 2006]
• Sweden prevalence (24% m &19% f)[IDF 2007]
• India prevalence of (19.52%) [ATPIII 2010]

12

Epidemiology
Regional Burden

• Turkey 33.9% (28% m & 39.6% f) [ATP III/ 2007]
• Iranian (34.7%m &37.4%f) [ ATPII, IDF/ 2007]
• Tunisia (24.3%m, 45.5%f) [ ATPIII, IDF/2007]

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Epidemiology
Regional Burden

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Epidemiology
Regional Burden

• Jordan 37.4% (31.7% m & 41.0% f)[ATPIII/ 2007]
• Oman 21.0% [ATPIII/ 2003]

15

Epidemiology
Situation in Qatar
• Overall prevalence of
among obese patients was
46.3%.

• [IDF/ 2010]

• The prevalence was higher
in females (50%) than in
males (42.4%).

20

Epidemiology
Situation in Qatar
• Overall prevalence 3.0% in
children aged 6–12 years.
• The prevalence 9.5% in
overweight and obese subjects.
• Increased TG frequent
abnormality (28.4%) .
• Low HDL-C (19.4%) .

21

Where Can You Find
The Highest Metabolic
Syndrome ….?

22

WHAT
ARE
THE
RISK FACTORS
FOR
METABOLIC SYNDROME?

24

Epidemiology
Risk Factors
• Age.

• More than 40% of
individuals 60 years.

• Gender.

• Increasing prevalence
among women.

• Race.

• African American and
Mexican American
populations.
25

Epidemiology
Risk Factors

22%
Overweight.

5%
Normal Weight.

60%
Obese.
26

Epidemiology
Risk Factors
• Low socioeconomic status.
• Lack of physical activity.
• High carbohydrate diet.

• No alcohol intake.
• Smoking.

27

What are
the Complications of
Metabolic Syndrome?

28

Complications
7 X DMII

Metabolic
Syndrome

2 X CVD

1.5 X
Mortality
29

Complications
– Cognitive decline (elderly).
– Fatty liver disease,
– Polycystic ovary syndrome.
– Obstructive sleep apnea.
– Gout.
– Chronic Kidney Disease.
30

Etiology
Genetic
Susceptibility

Metabolic
Syndrome
Environmental
Factors

31

Prevention

Fighting
The Related
Risk Factors.
32

Group Exercise

Outline
Prevention Program
For Obesity ….

33

Primary Prevention

Promotion of
Healthy Eating.
Promotion of
Physical Activity
Healthy School
Initiatives
34

Secondary Prevention

Screening for
Obesity.
Management of
Healthy life style
Medications/ Surgery

35

Medications :
BMI ˂27 + comorbidity
OR
BMI ˂30
OR/and
If no weight loss after (3-6 months) of life style
changes.
36

Bariatric Surgery
BMI ˃35 + Co
-morbidity.
BMI ˃ 40.

37

References :
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Study in Americans:
Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings
from the third National Health and Nutrition Examination Survey.J Am Med Assoc 2002;287(3):356–
9.

Maggi S, Noale M, Gallina P, et al. Metabolic syndrome, diabetes, and cardiovascular disease in an
elderly Caucasian cohort: the Italian longitudinal study on aging. J Gerontol A Biol Sci Med Sci
2006;61(5):505–10.
Patel A, Huang KC, Janus ED, et al. Is a single definition of the metabolic syndrome appropriate? A
comparative study of the USA and Asia. Atherosclerosis 2006;184(1):225–32.

Study in Sweden:
Halldina M, Rosella M, de Fairea U, et al. The metabolic syndrome: prevalence and association to
leisure-time and work-related physical activity in 60-year-old men and women. Nutr Metab
Cardiovasc Dis 2007;17(5):349–57.
Study in Saudi Arabia:
Bahijri SM, Al Raddadi RM. The importance of local criteria in the diagnosis of metabolic syndrome
in Saudi Arabia. Saudi: Ther Adv Endocrinol Metab; 2013;4(2) 51–59. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632005/pdf/10.1177_2042018813483165.pdf

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References :
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Study in India:
Sawant A, Mankeshwar R, Shah S, Raghavan R, Dhongde G, Raje H, et al. Prevalence of Metabolic
Syndrome in Urban India. India: Hindawi Publishing Corporation; 2011. Available
from:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114375/pdf/CHOL2011-920983.pdf
South Asian Countries:
P. Nestel, R. Lyu, P. L. Lip et al., “Metabolic syndrome: recent prevalence in East and Southeast
Asian populations,” Asia Pacific Journal of Clinical Nutrition, vol. 16, no. 2, pp. 362–367, 2007.

D. Eapen, G. L. Kalra, N. Merchant, A. Arora, and B. V. Khan, “Metabolic syndrome and
cardiovascular disease in South Asians,” Vascular Health and RiskManagement, vol. 5, pp. 731–743,
2009.
Jordan Study:
Yasein N, Masa'd D. Metabolic syndrome in family practice in Jordan: a study of high-risk groups.
Jordan: East Mediterr Health J; 2011 Dec;17(12):943-8.

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