Metabolic Syndrome

(Syndrome X, MetS, Insulin Resistance Syndrome)

It is being increasingly identified in the urban population. The importance lies in its association with risk of developing diabetes mellitus and cardiovascular disease. The incidence in South Asian Population during middle age groups is estimated at 30 to 40%.

The criteria for diagnosis (ATPIII) are

  1. Waist circumference >40 inches in man and > 35 inches in woman
  2. Fasting blood glucose >100 mg/dl or treatment for high sugars
  3. BP of >130/85 mm Hg or drug treatment for hypertension
  4. S Triglycerides >150 mg/dl or drug treatment for elevated triglycerides
  5. HDL cholesterol <40 mg/dl in man or <50 mg/dl in woman

Any 3 of these 5 criteria qualify for a diagnosis of metabolic syndrome. In some modifications, waist circumference has been made an essential criterion while in some waist circumference has been modified for different ethnic groups. In South Asians now the waist circumference has been reduced to 90 and 80 cms respectively for man and woman.

The factors associated with high risk for metabolic syndrome are

age, race, weight, postmenopausal status, smoking, lack of physical activity, alcohol intake, household income etc.

The syndrome gains importance as it has been found to

  • Increase risk of diabetes mellitus by 5 to 5 times
  • Risk of Cardiovascular ailments by 5 to 2 times.

It is also associated with increased risk for

  • Chronic kidney disease
  • Fatty liver,(steatosis), fibrosis and cirrhosis of liver
  • Cholangiocarcinoma and hepatocellular carcinoma
  • Obstructive sleep apnea
  • Polycystic ovary syndrome
  • Hyperuricemia and Gout.

Treatment requires multimodality approach with modifications of diet, physical activity, cessation of smoking, and drugs as needed. Aggressive treatment reduces the risk of diseases associated with syndrome X and is thus rewarding.