METABOLIC SYNDROME

Introduction

The metabolic syndrome (Met-S) is a major and escalating public health and clinical
challenges worldwide in the wake of urbanization, surplus energy intake, increasing obesity,
and sedentary life habits.
Met-S confer a 5-fold increase in the risk of type 2 diabetes mellitus and 2 fold the risk of
developing cardiovascular disease over the next 5-10 years.

Definition
Met-S is defined by a constellation of an interconnected physiological, biochemical, clinical,
and metabolic factors that directly increases the risk of atherosclerotic cardiovascular disease,
T2DM and all cause mortality.
Unhealthy body measurements and abnormal laboratory test results include atherogenic
dyslipidemia, hypertension, impaired glucose intolerance, proinflammatory state, and
aprothrombotic state.
According to International Diabetes Federation, the metabolic syndrome (2006) is defined as:
A) Central Obesity (Waist circumference) and
B) Any two of the following:
1. Raised triglycerides: > 150 mg/dL
2. Reduced HDL Cholesterol: < 40 mg/dL in males, < 50 mg/dL in females.
3. Raised Blood Pressure: Systolic BP > 130 or diastolic BP > 85 mm Hg
4. Raised fasting plasma glucose: FBG> 100 mg/dL
If BMl is > 30 kg/m², central obesity can be assumed and waist circumference doesn't
need to be measured.

Metabolic syndrome (Met-S) is a cluster of cardiovascular risk factors that increase

the incidence of CVD.

Five risk factors are included in Met-S:

 Central obesity (e.g., increased waist circumference)

 Increased triglycerides
 Hypercholesterolemia
 Hypertension
 Elevated fasting glucose

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 A person is considered to have metabolic syndrome when at least three of the five risk
factors are present. Each risk factor is usually treated individually. Overall, lifestyle activities
and behaviours, such as nutrition and physical activity, are the best preventions for the
development of Met-S risk factors.

Metabolic syndrome is collections of risk factors that increase an individual’s chance

of developing cardiovascular disease and diabetes mellitus.

Metabolic syndrome, also known as syndrome X, insulin resistance syndrome, and

dysmetabolic syndrome, is a collection of risk factors that increase an individual’s chance of

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developing cardiovascular disease, stroke, and diabetes mellitus. It is estimated that around
70 million to 80 million, or about 25%, of Americans have metabolic syndrome. The
syndrome is more prevalent in those 60 years of age and older.

Epidemiology

 Worldwide prevalence of MetS ranges from <10% to as much as 84%,depending on

the region, urban or rural environment, composition (sex, age, race, and ethnicity) of
the population studied, and the definition of the syndrome used.
 In general, the IDF estimates that one-quarter of the world's adult population has the
MetS.
 Higher socioeconomic status, sedentary lifestyle, and high body mass index (BMI)
were significantly associated with MetS.
 Differences in genetic background, diet, levels of physical activity, smoking, family
history of diabetes, and education all influence the prevalence of the MetS and its
components.

CRITERIA FOR METABOLIC SYNDROME

Currently health professionals are debating the usefulness of focusing attention on the
syndrome itself. The interventions are focused on each risk factor, since there is not one
standard treatment for the syndrome itself.

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Causes

Common Causes mainly due to

 Overweight or obesity
 Sedentary lifestyle
 Insulin resistance

Risk factors include:

 Age - people are more prone with increase in age

 Diabetes
 Family history
 Stress
 Other conditions such as fatty liver, polycystic ovarian syndrome or sleep apnea

Etiology and Pathophysiology

The main underlying risk factor for metabolic syndrome is insulin resistance related to
excessive visceral fat. Insulin resistance is the body’s cells diminished ability to respond to
the action of insulin. The pancreas compensates by secreting more insulin, resulting in
hyperinsulinemia. Other characteristics of metabolic syndrome include hypertension,
increased risk for clotting, and abnormalities in cholesterol levels. The net effect of these
conditions is an increased prevalence of coronary artery disease. Genetics and environment
have important roles in the development of metabolic syndrome. African Americans,
Hispanics Native Americans, and Asians are at an increased risk for metabolic syndrome.
Environmental factors that influence the chances of having the syndrome are the same
involved in the development of obesity. Metabolic syndrome is also associated with aging.

Abdominal Obesity
 The "obesity epidemic" is principally driven by an increased consumption of cheap,
calorie dense food and reduced physical activity.
 Adipose tissue responds rapidly and dynamically to alterations in nutrient excess
through adipocytes hypertrophy and hyperplasia.
 With obesity and progressive adipocytes enlargement, the blood supply to adipocytes
may be reduced withconsequent hypoxia.

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  Hypoxia has been proposed to be an inciting etiology of necrosis and macrophage
infiltration into adipose tissue that leads to an overproduction of biologically active
metabolites known as adipocytokines.
 Adipocytokines includes free fatty acids (FFA), pro-inflammatory mediators (TNFa,
IL-6, PAI-1, CRP).
 These adipocytokines results in a localized inflammation in adipose tissue that
propagates an overall systemic inflammation associated with the development of
obesity related comorbidities.

FFA

 Splanchic FFA levels may contribute to the liver fat accumulation commonly found in
abdominal obesity.
 Acute exposure of skeletal muscle to the elevated level of FFA induces insulin
resistance by inhibiting the insulin-mediated glucose uptake.
 Chronic exposure of the pancreas to elevated FFA impairs a pancreatic B-cel
 Function FFAS increase fibrinogen and PAI-1 production.

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TNFA

 TNF-a acts as a paracrine mediator in adipocy tes and appears to act locally to reduce
the insulin sensitivity.
 TNF-a induces adipocytes apoptosis and promotes insulin resistance by the inhibition
of the insulin receptor substrate 1 (|RS-1) signalling pathway.
 TNF-a is positively associated with the body weight, waist circumference and
triglycerides (TGs), while negatively associated with High density lipoprotein-
cholesterol (HDL-C).

CRP

 High-sensitivity C-reactive protein (hs-CRP) has been developed and used as a

marker to predict CVD in metabolic syndrome and it was recently used as a predictor
for non-alcoholic fatty liver disease.
 CRP level is more likely to be elevated in obese insulin-resistant, but not in obese
insulin-sensitive subjects.

Insulin Resistant States

 In an insulin-resistant person, normal levels of insulin do not have the same effect in
controlling blood glucose levels.
 During the compensated phase, insulin levels are higher and blood glucose levels are
still maintained.
 If the compensatory insulin secretion fails, then either fasting
 Eventually, type 2 diabetes occur when glucose levels become higher throughout the
day as the resistance increases and compensatory insulin secretion fails.
 The elevated insulin levels have additional effects that cause further abnormal
biological effects throughout the body.

Diet

 It is well known that insulin resistance commonly coexist with obesity.

Saturated fat appears to be the most effective at producing insulin resistance.
 High fat diet has the tendency to result in calorie intake that is far in excess from our
energy needs, resulting in rapid weight gain

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  IR is positively correlate with fat intake and negatively correlated with dietary fibre
intake.

Sedentary lifestyle
Sedentary lifestyle increases the likelihood of development of insulin resistance.

Clinical Manifestations and Diagnostic Studies

The signs of metabolic syndrome are:

 Increased blood sugar- present with other signs and symptoms of diabetes like
increased thirst and urination, fatigue and blurred vision

 Hypertension
 Abnormal cholesterol levels
 Obesity.

 Increased waist line

Medical problems develop over time if the condition remains unaddressed. Patients
with this syndrome are at a higher risk of heart disease, stroke, diabetes, renal disease, and
polycystic ovary syndrome. Patients who have metabolic syndrome and smoke are at an even
higher risk.

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Diagnosis

 Blood pressure measurement

A high blood pressure is a metabolic risk factor.
 Blood glucose test
Measurement of glucose level in blood.
 Lipid profile test
A panel of blood tests to check for abnormalities in lipids, such as cholesterol and
triglycerides.

Prevention
One can follow these measures to reduce risk:
 Maintain a healthy lifestyle
 Have an ideal and nutritious diet
 Do regular exercise
 Quit smoking

Complications
 The complications are generally long term and may include:
 Heart attack
 Hardening of the arteries (atherosclerosis)
 Diabetes leading to nerve or eye damage
 Stroke
 Cardiovascular disease
 Fatty liver
 Kidney disease

Nutrition
Foods to eat:
 Eat foods rich in Omega 3, like fish, walnuts, grass fed beef and flax seeds
 Include green leafy vegetables and fruits in your diet
Foods to avoid:

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  Avoid processed foods and artificial sweeteners
 Reduce the consumption of trans fats and alcohol
 Lower the consumption of refined carbohydrates and sugar

NURSING AND COLLABORATIVE MANAGEMENT METABOLIC SYNDROME

Lifestyle modifications are the first-line interventions to reduce the risk factors for
metabolic syndrome.

Management or reversal of metabolic syndrome can be achieved by reducing the major

risk factors of cardiovascular disease:

 Reducing LDL cholesterol

 Stopping smoking
 Lowering BP
 Reducing glucose levels.

For long-term risk reduction:

 Weight should be decreased

 Physical activity increased
 Healthy dietary habits established.

There is no specific management of metabolic syndrome.

Nursing Assessment

You can assist patients by providing information on healthy diets, exercise, and positive
lifestyle changes. The diet, which should be low in saturated fats, should promote weight
loss. Weight reduction and maintenance of a lower weight should be the first priority in those
with abdominal obesity and metabolic syndrome.

Because sedentary lifestyles contribute to metabolic syndrome, increasing regular

physical activity will lower a patient’s risk factors. In addition to assisting in weight
reduction, regular exercise has been found to decrease the triglyceride level and increase the
HDL cholesterol level in patients with metabolic syndrome.

Patient’s unable to lower risk factors with lifestyle therapies alone or those at high
risk for a coronary event or diabetes may be considered for drug therapy. Although there is

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 no specific medication for metabolic syndrome, cholesterol-lowering and antihypertensive
drugs can be used. Metformin (Glucophage) has also been used to prevent diabetes by
lowering glucose levels and enhancing the cells’ sensitivity to insulin.

Nursing interventions

Metabolic syndrome can be controlled largely through lifestyle changes (the preferred
treatment). To help patients make recommended lifestyle changes, teach them about risk
factors and how to alter them. Point out that dietary modifications that may help prevent or
control diabetes also can lower the CVD risk.

 Diet, weight loss, or both. For overweight patients, the goal is to decrease weight by 7%
to 10%. A low-fat diet commonly is recommended. Help patients select foods low in fat
and avoid those high in saturated fats and cholesterol, which can increase cholesterol
levels. Foods high in saturated fats include cream, cheese, butter, and fatty meats. Point out
that vegetable products, such as coconut oil, cottonseed oil, and palm kernel oil, as well as
chocolate and many prepared foods may be high in saturated fats and cholesterol as well.
Emphasize that a low-fat diet can accomplish more than just weight loss; it also can reduce
cholesterol levels and blood pressure. Encourage patients to consume plenty of fiber-rich
foods, such as whole grains, beans, fruits, and vegetables, which can help lower insulin
levels. As needed, refer patients to a dietitian for meal-planning guidance.
 Exercise. Advise patients to increase physical activity to reduce their weight and improve
blood pressure. Encourage them to get 30 minutes of moderately intense exercise, such as
walking, 5 to 7 days per week. Instruct them to consult a physician before starting an
exercise regimen.
 Smoking. Smoking can raise the CVD risk and increase insulin resistance. Nicotine is
highly addictive, making it hard for many people to stop smoking. Teach patients about the
link between smoking and CVD and refer them to smoking-cessation resources.
 Alcohol use. Excessive alcohol use can adversely affect cholesterol levels and cause
weight gain. Like nicotine, alcohol is addictive. While some people can stop drinking on
their own, others need medical help to manage physical withdrawal. Numerous resources
are available for those who want to stop drinking. In most areas, Alcoholics Anonymous
(AA) meetings are available, as are inpatient and outpatient treatment centers or hospitals
and alcohol treatment hotlines.
With the increasing prevalence and life-threatening implications of metabolic syndrome, all
nurses need to be familiar with this condition and skilled in assessing for signs, symptoms,
and laboratory markers. Your knowledge can make a life-saving difference.

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 Conclusion
Metabolic syndrome is a lifestyle disorders with different underlying disease. Our discussion
include etiology, causes, pathophysiology its clinical features and diagnosis. Also discussed
about the management available. We also discussed about nursing assessment and
management.

Bibliography
1. Seaton, T. Buckley, S. L. Lewis, S. R. Dirksen, M. M. Heitkemper, & L. Bucher
(Eds.), Lewis's medical-surgical nursing: Assessment and management of clinical
problems (4th ed., pp 921
2. https://my.clevelandclinic.org/health/diseases/10783-metabolic-syndrome
3. Supreeya Swarup; Amandeep Goyal; Yulia Grigorova; Roman Zeltser. Metabolic
Syndrome. StatPearls [Internet].
4. Metabolic syndrome: Symptoms, causes, diagnosis and treatments (msn.com)

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