useful for students in nursing and medical sciences

1. Metabolic syndrome
Dr Asha S Kumar
Assistant Professor
Govt. College of Nursing
Thiruvananthapuram

2. Introduction
• MetS is a new non-communicable disease has become the major health
hazard of modern world.
• first described by Gerald M. Raevan in the 1980s
• Also known as Syndrome X
• India proclaimed as the “heart disease capital” and “diabetic capital” of the
world, is a major hotspot for cardiometabolic abnormalities
• The two basic forces spreading this malady are the increase in consumption
of high calorie-low fiber fast food and the decrease in physical activity due
to mechanized transportations and sedentary form of leisure time activities

3. Facts on Metabolic syndrome
• prevalence is increasing in epidemic proportions in both developed and
developing countries globally.
• The worldwide prevalence of MetS in the adult population is estimated to be
20–25%
• In most countries nearly 1/5th of the adult population or more were
affected by Metabolic Syndrome.
• The ICMR-INDIAB study has shown that 72.3% of the Indian population has
low levels of HDL-c, 13.9% have hypercholesterolemia, 29.5% have
hypertriglyceridemia and 11.8% have high low density-cholesterol (LDL-c).
• Regional disparities were observed in the prevalence rates with highest
rates of hypercholesterolemia (18.3%) and LDL-c (15.8%) in Tamilnadu, South
India.

4. Prevalence in India
 Age-standardized prevalence rates
of metabolic syndrome were 33.5%
overall, 24.9 % in males and 42.3%
in females.
 Metabolic syndrome is a significant
public health problem even in the
poorest states of India
Data from a large community-based surveys done from Eastern India Prasad,Dash ,2011

5. Fact sheet
• A combination of conditions that together increase the risk of
cardiovascular disease (CVD) and diabetes, metabolic syndrome is the
precursor to complications that may be lifelong, chronic, or even lead to
death.
• As per AHA ,metabolic syndrome doubles the risk of CVD and quintuples
the diabetes risk. Risk is especially high in men older than age 45 and
women older than age 55.

6. Criteria for metabolic syndrome
Patients meet the criteria for metabolic
syndrome if they have at least three of the
five conditions below:
• hypertriglyceridemia
• hypercholesterolemia
• hypertension
• elevated fasting blood glucose
• central obesity

7. Causes
Metabolic syndrome is closely linked to
 overweight or obesity
 Physical inactivity.
 insulin resistance.
 Genetics
 Nutrient deficiency

8. Causes
o Lack of micronutrients
lack of phytonutrients (fruits & veggies), Folic Acid, Vitamin B6, B12, C, Chromium,
Biotin, Magnesium, Zinc, Coenzyme Q10, Alpha-Lipoic Acid, Acetyl-L-Carnitine, and
Omega-3 Fatty Acids.
o Life style
 Exercise is also a great way to improve insulin sensitivity in the body, so sitting around
too much will increase the risk of insulin resistance and metabolic syndrome, stress, not
getting enough sleep, and not engaging in human connection or positive human
relationships also increases the risk of inflammation and metabolic syndrome.
o Environment
Bisphenol-A (BPA) which entered our environment in 1957
Persistent organic pollutants coming from pesticides
Increased levels of heavy metals such as mercury and inorganic arsenic contaminating
our food supply are also causing problems.

9. Risk factors
• Age. Risk increases with age.
• Ethnicity. Hispanics— especially Hispanic women
• Obesity. especially in your abdomen
• Diabetes. Risk increases with gestational diabetes or family
history of type 2 diabetes.
Other diseases.
• nonalcoholic fatty liver disease,
• polycystic ovary syndrome
• sleep apnea.

10. Apple and pear body shapes
People who have metabolic syndrome typically
have apple-shaped bodies, meaning they have
larger waists and carry a lot of weight around
their abdomens.
A pear-shaped body — that is, carrying more
of your weight around your hips and having a
narrower waist — doesn't increase your risk of
diabetes, heart disease and other
complications of metabolic syndrome.

11. Waist/Hip Ratio
 Waist circumference is measured at the level of the umbilicus
 The subject stands erect with relaxed abdominal muscles, arms at the side,
and feet together
 The measurement should be
taken at the end of a normal
expiration.

12. Waist circumference
Waist circumference predicts mortality better than any other
anthropometric measurement.
It has been proposed that waist measurement alone can be used to
assess obesity, and two levels of risk have been identified
MALES FEMALE
LEVEL 1 > 94cm > 80cm
LEVEL2 > 102cm > 88cm

13. Waist circumference
Level 1 is the maximum acceptable waist circumference irrespective
of the adult age and there should be no further weight gain.
Level 2 denotes obesity and
requires weight management to
reduce the risk of type 2 diabetes &
CVS complications.

14. Hip Circumference
Is measured at the point of greatest circumference around hips &
buttocks
The subject should be standing and the measurer should squat
beside him.
Both measurement should taken with a flexible, non-stretchable
tape in close contact with the skin, but without indenting the soft
tissue.

15. Interpretation of WHR
High risk WHR= >0.80 for females &
>0.95 for males
i.e. waist measurement >80% of hip measurement for women and
>95% for men indicates central (upper body) obesity and is
considered high risk for diabetes & CVS disorders.
A WHR below these cut-off levels is considered low risk.

16. Waist/Hip Ratio

18. Pathophysiological changes

21. Diagnosis
The National Institutes of Health guidelines define metabolic syndrome as having
three or more of the following traits, including traits you're taking medication to
control:
• Large waist — A waistline that measures at least 35 inches (89 cm) for women
and 40 inches (102 cm) for men
• High triglyceride level — 150 milligrams per deciliter (mg/dL), or higher of this
type of fat found in blood
• Reduced "good" or HDL cholesterol — Less than 40 mg/dL in men or less than 50
mg/dL in women
• Increased blood pressure — 130/85 mm Hg or higher
• Elevated fasting blood sugar — 100 mg/dL or higher

22. Consequences of Metabolic syndrome

23. Assessing patients for risk factors
Health history, physical examination, and
check laboratory findings.
• Hypercholesterolemia and hypertriglyceridemia.
• Review the patient’s cholesterol and triglyceride levels
• Triglyceride level of 150 mg/dL or more or receiving drug treatment for
hypertriglyceridemia
• HDL cholesterol level of 50 mg/dL or less in women or 40 mg/dL or less in
men, or receiving drug therapy for reduced HDL-C

24. Hypertension.
• Check BP and history of taking antihypertensive drugs.
• Hypertension is defined as a systolic pressure of 130 mm Hg or higher or a
diastolic pressure of 90 mm Hg or higher
• A systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 is
considered prehypertension.

25. High blood glucose level
• Check the fasting blood glucose level.
> 100mg/dl
• History of medications that lower
blood glucose, such as insulin or oral
antidiabetic medications

26. Obesity
• Weigh the patient and calculate BMI.
• Be sure to observe weight distribution.
• Studies show a correlation between abdominal
fat and development of insulin resistance and
type 2 diabetes.
• For a diagnosis of metabolic syndrome, obesity
is defined by a
waist circumference of 40” (102 cm) or more for
men and 35” (89 cm) or more for women.

27. Assess for associated conditions
• Coronary heart disease.
• Atrial fibrillation.
• hypotension, SOB, syncope, and angina.
• irregular pulses of variable amplitude;
• suspect this arrhythmia if pulse pressure narrows to 30 mm Hg or less.
• Aortic stenosis.
• In early stages, it may be asymptomatic, but as it progresses, dyspnea on exertion,
angina pectoris, and exertional syncope may occur.
• Check for elevated pulse pressure and a harsh systolic murmur.

28. Obstructive sleep apnea (OSA).
 Marked by intermittent absence of airflow through the mouth and nose during
sleep,
 Combined with insulin resistance, OSA can raise CVD risk, particularly in
patients with BMIs above 40 kg/m2.
 Obtain the history and ask about daytime fatigue and sleepiness, morning
headache, depression, intellectual impairment, impotence, heartburn, and
gastroesophageal reflux disorder.
 Ask the spouse or another person who has witnessed the patient sleeping
about the following OSA signs during sleep: loud, cyclic snoring; periods of
apnea; gasping or choking; restlessness; and thrashing.

29. Treatment of Metabolic syndrome
The initial management of metabolic syndrome involves
lifestyle modifications, including changes in diet and exercise habits
Controlling obesity
Treatment of hypertension BP < 140/90 mm Hg
 If with diabetes mellitus, < 130/80 mm Hg.
Managing insulin resistance
 lowering lipid levels
Maintaining blood glucose and hemoglobin (Hb) A1C levels

30. Eat better.
• Adopt a diet rich in whole grains, fruits,
vegetables, lean meats, skinless poultry and
non-fried fish, and low-fat or fat-free dairy
products.
• Avoid processed foods, which are often high
in saturated and trans fats, sodium and
added sugar.
Treatment of Metabolic syndrome, contd…

31. Lose weight.
• Reduce your risk for heart disease
• Learn your recommended calorie intake,
the amount of food calories you're
consuming, and the energy calories you're
burning off with different levels of physical
activity.
• Balance healthy eating with a healthy level
of exercise to reach your goals.

32. Get active.
• At least 150 minutes of moderately vigorous
physical activity into your weekly routine.
• Walking is the easiest place to start,
• If needed, break your exercise up into
several short, sessions throughout the day
to reach your goal.

33. Managing hypertriglyceridemia
• Medications that lower triglycerides : Niacin and fibric agents -fenofibrate
and gemfibrozil.
• Management includes exercise, smoking cessation, and dietary
modifications.
Advise patients to:
• restrict intake of dietary fats, refined sugars, white flour, and white rice
• eat fish high in omega-3 fatty acids, such as sardines, and salmon
• eat more fruits and vegetables
• replace saturated fats with moderate amounts of monosaturated fats
(such as cashews, cereal, olive oil, oatmeal, popcorn, and whole grains)
• stop smoking
• limit alcohol intake

34. • high triglyceride levels are linked to
insulin resistance
• In this condition, cells don’t respond
normally to insulin and don’t promote
glucose entry into cells.
• Insulin resistance can stem from several
factors—obesity, polycystic ovary
syndrome, and a sedentary lifestyle.
• Managing insulin resistance involves
dietary modifications (such as increased
intake of whole grain foods and fiber) to
improve tissue responsiveness to insulin.
Managing insulin resistance

35. Managing hypercholesterolemia
• Cholesterol levels relate directly to CVD
development.
• Patients with levels of (HDL, the “good”
cholesterol) below 35 mg/dL are more likely to
develop CVD than those with levels above 65
mg/dL.
• LDL, the “bad” cholesterol causes plaque buildup;
levels above 190 mg/dL indicate very high
cholesterol.
• HDL, on the other hand, removes LDL cholesterol;
• HDL levels below 40 mg/dL for men or below 50
mg/dL for women increase CVD risk.
• .

36. Recommended hyper cholesterolemia treatment
• an exercise plan
• reduction of dietary saturated fats, trans fats, and cholesterol
• smoking cessation
• and alcohol restriction.
• Medications
• HMG-CoA reductase inhibitors (statins)
• bile acid sequestrants, and fibric acid agents.
• Statins are superior for lowering LDL cholesterol
and reducing myocardial infarction (MI) and stroke risk

37. Managing hypertension
• Management of hypertension typically includes
• increased physical activity,
• a weight-loss regimen,
• dietary modifications,
• antihypertensive drugs.
• AHA recommends restricting dietary saturated fats, trans fats, cholesterol,
sodium, added sugars, and alcohol.
• Antihypertensives include diuretics, angiotensin-converting enzyme
inhibitors, angiotensin II receptor blockers, calcium channel blockers, beta
blockers, alpha blockers, and alpha-adrenergic antagonists.

38. Elevated glucose levels
• Diabetes correlates directly to CVD; diabetic patients have a
higher rate of atherosclerosis, which leads to CVD.
Diabetes treatment includes
• dietary modification (reducing intake of carbohydrates, fats, and
sugar while increasing whole grains, fiber, and lean meats),
• exercise, and weight control.
• Studies show that exercising 150 minutes a week and losing 7% of
body weight (about 15 lb for someone weighing 200 lb) can
prevent or delay type 2 diabetes).
• Diabetes medications include insulin and OHA

39. Maintaining blood glucose and hemoglobin (Hb) A1C levels
• The HbA1C level reflects the average blood glucose level over the previous 2 or 3
months, indicating the level of diabetes control.
• Ideally, HbA1C should be less than 7% in patients with diabetes. The higher the glucose
level over the past few months, the higher the HbA1C level.
HbA1C level Blood glucose level
6% 135
7% 170
8% 205;
9% 240
10% 275
11% 310
12% 345

40. Obesity
• Overweight is defined as a body mass
index (BMI) of 25 to 29.9
• obesity, a BMI above of 30 kg/m2 or
higher; and
• morbid obesity, a BMI above 40 kg/m2.
• The primary treatment for obesity is
weight reduction, usually by decreasing
caloric and fat intake and getting
adequate exercise.
• Foods appropriate for diabetic patients
include fruits, whole grains, lean meat,
nonfat dairy products, and fish.

41. Controlling obesity
• Drugs used to promote weight loss include megestrol, sibutramine,
phentermine, orlistat, and diethylpropion.
• These drugs can have serious side effects, so patients must be monitored
closely. Typically, they’re prescribed only for patients with BMIs above 27.
• Caution patients that OTC ingredients may cause serious side effects and
that some can lead to or worsen heart disease.
• Inform patients that successful weight loss takes time, patience, and
motivation.
• Stay supportive while monitoring patients for signs and symptoms of
depression.

42. Fighting inflammation and thrombosis
• Blood levels of C-reactive proteins are elevated above 3 mg/L in
patients with inflammatory processes, and are frequently elevated in
patients with metabolic syndrome.
• Elevated C-reactive proteins double the patient's risk for coronary
artery disease and are thought to be associated with an increase in
peripheral vascular disease and sudden death.
• To combat the prothrombotic state some patients with metabolic
syndrome should take daily aspirin.
• The AHA recommends aspirin prophylaxis in most patients whose
10-year risk for heart disease is 10% or more, as determined by
Framingham risk scoring.

43. Bariatric surgery
• a weight-loss option for selected obese patients.
• Most bariatric-surgery patients opt for a laparoscopic adjustable
gastric band.
• Others undergo a laparoscopic sleeve gastrostomy.
• Before surgery, patients must agree to embark on a strict diet and
exercise regimen.
• In some cases, diabetes and hypertension disappear after bariatric
surgery.

44. • Recent research recommends immediate bariatric
surgery for those with a body mass index (BMI) of 35 to
40.
• Patients with a BMI of 30 to 35 with significant
comorbidities, like diabetes, are highly advised to
receive bariatric surgery.
• Any patient with a BMI over 30 is a candidate for a
bariatric operation and should immediately seek
medical attention.
Bariatric surgery

45. Prevention
A lifelong commitment to a healthy lifestyle may prevent the
conditions that cause metabolic syndrome.
Nutritional modulation remains central to the management of
metabolic syndrome
A healthy lifestyle includes:
• Getting at least 30 minutes of physical activity most days
• Eating plenty of vegetables, fruits, lean protein and whole grains
• Limiting saturated fat and salt in your diet
• Maintaining a healthy weight
• Not smoking
• Handling stress

46. • There are certainly some elements in the causation of the metabolic syndrome
that cannot be changed but many are amenable for corrections and
curtailments.
• better urban planning to encourage active lifestyle, subsidizing consumption of
whole grains and possible taxing high calorie snacks, restricting media
advertisement of unhealthy food, etc.
• Revitalizing old fashion healthier lifestyle, promoting old-fashioned foods using
healthy herbs rather than oil and sugar, and
• educating people about choosing healthy/wholesome food over junks are
among the steps that can be considered.
Bottom Line…

47. Be motivated and continue motivating ….
The journey of Adnan Sami from 200 kilos to 70 kilos is definitely appreciable. He lost about 10 kgs
per month through low carb diet and fat burning work outs..