Metabolic Syndrome – Symptoms, Risk Factors, Diagnosis, Treatment

Posted by Medical Board on May 16, 2019 in Men Women Last updated on May 21, 2019

Age, family history, lifestyle; each of these put you at risk for heart disease, but only one is within your control.

Currently nearly half of all Americans have one or more key risk factors for heart disease that they can do something about.

High blood pressure, high cholesterol, and smoking each lower your life expectancy and increase your chances for heart attack or stroke significantly.[2] 

Metabolic Syndrome-Major Threat to Your Heart & Lungs

Where once cigarette smoking was considered the most important risk factor for cardiovascular disease, the American Heart Association now believes that metabolic syndrome will likely become the leading cause of cardiovascular disease among adults in the future.[4]

Metabolic Syndrome Defined

Metabolic syndrome involves the body’s many biological processes that contribute to overall function.  It is further categorized by the risk factors that put individuals at increased risk for developing certain diseases or health conditions including heart disease, diabetes, and stroke.[5]

Prevalence of Metabolic Syndrome 

Research indicates that the rate of metabolic syndrome among Americans has increased at an alarming rate over the past two decades.

In one U.S study, metabolic syndrome was shown to have increased by 35% from 1988-2012 across every socioeconomic group in the nation.  By 2012 over one-third of the U.S. population was defined as having metabolic syndrome.

Since the 1990’s there has been a surge in weight gain and obesity with more than two-thirds of the nation overweight or obese.

According to U.S. government sources, the two major reasons for an escalation in metabolic syndrome, especially in the West involve food quality and exercise.  Inexpensive readily available high calorie fast food combined with greater sedentary leisure activities has fundamentally changed the health of many Americans.  Automated processes, at home delivery programs and instant access to non-physical recreation have become the new norm over the past two decades.  

Where once communicable diseases spread rapidly through populations, the threat of non-communicable disease is killing us.  

Cost of Metabolic Syndrome

Globally, the cost of metabolic syndrome is high.  Mounting healthcare costs coupled with the loss of productivity in the workplace is now somewhere in the trillions.[12]

Risk Factors for Metabolic Syndrome

There are many factors that put individuals at risk for heart disease, diabetes or stroke.  

This group of risk factors is known as metabolic syndrome.[6]

Current criteria for metabolic syndrome includes 3 out of 5 risk factors from the following:

  • High waist circumference
  • High triglyceride levels, or on medication to treat high triglycerides
  • High blood pressure, or on medication for high blood pressure
  • Low HDL cholesterol
  • High fasting glucose, or on medication for high fasting glucose[4]

Causes of Metabolic Syndrome

While further research is necessary to completely understand all of the causes for metabolic syndrome, the following factors likely play at least some role in the diagnosis.  

Insulin resistance—This occurs when cells in the body no longer respond to insulin efficiently.  Insulin is necessary to transport glucose to cells for energy.  While a direct link between metabolic syndrome and insulin resistance is yet to be found, research shows that the majority of people diagnosed with metabolic syndrome also have insulin resistance.  Metabolic syndrome may also lead to type 2 diabetes in some individuals.[4]

Hormonal changes—Some medical professionals believe that an overabundance of cortisol, caused by prolonged stress may also contribute to obesity, waist circumference, insulin resistance and elevated levels of triglycerides and bad cholesterol.

PCOS—Studies that specifically focus on individuals with PCOS have determined that these women (all other risk factors the same) will develop metabolic syndrome a full three years before other women of the same age and size.  This puts PCOS sufferers at greater risk for heart disease, stroke, or diabetes earlier than other women who do not share a diagnosis of polycystic ovarian syndrome.  Polycystic ovarian syndrome (PCOS) is a medical condition characterized by multiple fluid filled cysts on the ovaries, which impacts ovulation, menstrual cycle and fertility.[9]

Genetics—Genetics may affect how well the body breaks down fats in the bloodstream.

Age and fat distribution in the body may also contribute to metabolic syndrome.

Other Factors that Affect Metabolic Syndrome

The following factors put individuals at higher risk for developing metabolic syndrome:

  • Advanced age
  • BMI (body mass index) higher than 25
  • Family history of diabetes
  • Women who had gestational diabetes while pregnant
  • Smoking
  • Heavy alcohol consumption
  • Stress
  • Diet high in fat
  • Sedentary lifestyle
  • Post-menopause

Populations At Risk for Metabolic Syndrome

Certain groups of people may be at increased risk of metabolic syndrome including:

  • Post-menopausal women
  • Sedentary individuals
  • Lower income individuals
  • Middle-aged individuals of both sexes
  • Women with PCOS

University Students and Metabolic Syndrome  

Surprising to some, one particular study involving university students finds that this population is fast becoming prone to some of the risk factors associated with metabolic syndrome.  Where once the syndrome was associated with older populations, studies point out that younger populations are developing risk factors at alarming rates, at much earlier ages. In fact, recent research determined that nearly 25% of the university population had the number one risk factor, elevated triglyceride levels.  This was thought to be caused by sedentary lifestyle and poor dietary habits.  While college is a busy time for most students, it’s also fraught with late night study sessions, prolonged periods of no exercise, and junk food runs at all hours.    Not surprising, nearly 4% of university respondents were obese while close to 20% of the students were overweight.  This increases risk of metabolic syndrome for those in the 18-25 year-old demographic significantly.[3] 

Poor Diet and Metabolic Syndrome

Preliminary government research implicates a number of foods in the causation of metabolic syndrome.  These include meat, fried food, and diet soda.  The study that examined Western diet patterns found that refined grains, processed meats, red meat and fried foods were the culprits responsible for many of the research findings, with particular focus on meats.  In the study, findings indicated that individuals who ate high numbers of hamburgers, hot dogs, and processed meats often suffered with metabolic syndrome.  Whole grains, nuts, fruit, vegetables and coffee did not appear to either reduce or increase the prevalence of metabolic syndrome in individuals.  Those who consumed dairy products on a regular basis actually showed a reduction in risk for metabolic syndrome, however.

The Diet Soda Connection

One surprising finding that came from the study associated diet soda consumption with metabolic syndrome as well.  One theory behind the zero calorie risk factor posits that individuals may gain weight from the artificial sweetener placed in diet soda to mimic real sugar.   In fact, a series of rodent studies support this possibility, as imitation sweeteners appear to hamper the body and brain’s ability to accurately gauge high calorie food values.  This leads to overeating and consumption of the wrong foods for healthy weight maintenance.[13]

Diagnosing Metabolic Syndrome

Doctors determine whether patients have metabolic syndrome based on a physical examination and blood tests.

Metabolic syndrome is suspected if: 

  • Fasting blood sugar levels are above 100mg/dl
  • High blood pressure is above 130/85
  • Triglyceride levels are above 150 mg/dl
  • HDL cholesterol level is below 50 (women)
  • HDL cholesterol level is below 40 (men)
  • Waistline measurement is above 35 inches (women)
  • Waistline measurement is above 40 inches (men)

Individuals with metabolic syndrome:

Are twice as likely to have a heart attack or stroke.

Are five times more likely to develop diabetes in their lifetime.[7]

Other Medical Issues Associated with Metabolic Syndrome

These conditions may either contribute to, or be the result of metabolic syndrome.

  • Polycystic ovarian syndrome (PCOS)
  • Fatty liver
  • Gallstones related to cholesterol levels
  • Asthma
  • Sleep difficulties
  • Some cancers[3]

Treatment for Metabolic Syndrome

Treating metabolic syndrome may take a multi-faceted approach that incorporates several different types of interventions and changes.

These include:

Heart healthy lifestyle changes—Eating a diet rich in fruits, vegetables, whole grains and healthy fats and dairy can help.  Eliminating added sugar and salt as well as avoiding fried foods and unhealthy fats significantly change the course of metabolic syndrome and the build-up of cholesterol and fats in the blood.  By maintaining a healthy weight, reducing stress, engaging in regular moderate exercise, limiting alcohol consumption and quitting smoking, individuals greatly reduce the risk of metabolic syndrome and its harmful effects.

Prevention of type 2 diabetes—Diabetes can contribute to the risk of metabolic syndrome and invite serious complications including heart and kidney disease, loss of vision and possible loss of limb in the future.

Medications if necessary—Diet and lifestyle changes alone may not be enough to reverse the course of metabolic syndrome completely.  If this is the case, your doctor may prescribe certain medications to help control individual risk factors.  Drugs called statins may be prescribed to help lower high LDL cholesterol levels that contribute to the possibility of stroke or heart attack.

Medication may also be prescribed to:

  • Lower high blood pressure levels
  • Prevent the possibility of blood clots that can lead to stroke or heart attack
  • Reduce the stress on heart function with already established coronary heart disease

It is still important however to follow a heart healthy diet regardless of whether you take medications to reduce metabolic syndrome risk factors.[5]

Managing Metabolic Syndrome with Drugs

Managing the many symptoms and facets of metabolic syndrome is challenging.  Issues involving dyslipidemia, arterial hypertension, glucose metabolism and obesity may be addressed with pharmaceuticals that include statins for the treatment of dyslipidemia, renin-angiotensin-aldosterone system inhibitors to help treat arterial hypertension, metformin or sodium/glucose cotransporter 2 inhibitors or glucagon-like peptide 1 receptor agonists (GLP-1RAs) for glucose intolerance, and the GLP-1RA liraglutide to help reduce weight in general and decrease waistline.[11]   

New Defense Against Metabolic Syndrome

One recent study where mice were fed a natural type of sugar known as, trehalose that activates the Aloxe3 gene may hold future promise for an eventual cure.  The gene, which triggers a number of important responses that help fight diabetes and metabolic syndrome, may help:

  • Increase insulin sensitivity
  • Reduce fatty liver deposits
  • Increase calorie burning
  • Overall reduction in fat and weight gain
  • Reduce fats and cholesterol in the blood

Trehalose is a sugar found in mushrooms, many crustaceans such as lobster, some seaweeds, and foods where yeast is a common ingredient. This type of glucose is the fuel that flying insects use for sudden bursts of energy.  The popular food additive is used in a number of products including chewing gum and energy bars, and while there are health concerns about dangerous bacteria feeding on trehalose, the natural sugar may just hold promise for fighting metabolic syndrome.[8]

Lifestyle Changes for Metabolic Syndrome, Successful Outcomes

One Canadian study ultimately determined that lifestyle changes were more effective for a 7% reduction in weight overall as well as a decrease in type 2 diabetes, than the popular drug Metformin.  Participants achieved success by sticking to a low fat, low calorie diet and engaging in moderate physical activity 150 minutes per week.[1]

Public Policy—Working Toward a Solution

Research indicates a definite correlation between certain risk factors and the presence of metabolic syndrome.  Because of this, some policymakers want to provide more affordable fresh fruits and vegetables for lower income, high-risk communities where cheap calorie dense foods are more widely consumed.  In order to help combat sedentary lifestyles, solutions to provide safer walking areas in urban environments are also at play.  Access to good, affordable healthcare and health education may further abate the growing epidemic of metabolic syndrome as well.[10]

References

1Emili, Anna, et al. “Treating Metabolic Syndrome: Lifestyle Change or Medication?” Canadian Family Physician Medecin De Famille Canadien, College of Family Physicians of Canada, July 2007, www.ncbi.nlm.nih.gov/pmc/articles/PMC1949307/. 

2 “Heart Disease Risk Factors.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, www.cdc.gov/heartdisease/risk_factors.htm.

3Mbugua, Samuel Mungai, et al. “Metabolic Syndrome and Its Components among University Students in Kenya.” BMC Public Health, BioMed Central, 28 Nov. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5704380/. 

4“Metabolic Syndrome.” Metabolic Syndrome – Health Encyclopedia – University of Rochester Medical Center, www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=85&ContentID=P08342. 

5Huang, Paul L. “A Comprehensive Definition for Metabolic Syndrome.” Disease Models & Mechanisms, The Company of Biologists Limited, 2009, www.ncbi.nlm.nih.gov/pmc/articles/PMC2675814/.

6“Metabolic Syndrome.” MedlinePlus, U.S. National Library of Medicine, 7 Feb. 2019, medlineplus.gov/metabolicsyndrome.html. 

7“Metabolic Syndrome | Medical Conditions.” Rush University Medical Center, www.rush.edu/services/conditions/metabolic-syndrome. 

8“Natural Sugar Defends against Metabolic Syndrome, in Mice.” Washington University School of Medicine in St. Louis, 21 Dec. 2018, medicine.wustl.edu/news/natural-sugar-defends-against-metabolic-syndrome-in-mice/. 

9Nrhoads. “Polycystic Ovary Syndrome Might Spell Trouble for Middle-Aged Women.” University of Michigan News, 18 Dec. 2018, news.umich.edu/polycystic-ovary-syndrome-might-spell-trouble-for-middle-aged-women/. 

10“Preventing Chronic Disease.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 20 Sept. 2017, www.cdc.gov/pcd/issues/2017/16_0287.htm. 

11Rask Larsen, Julie, et al. “The Pharmacological Management of Metabolic Syndrome.” Expert Review of Clinical Pharmacology, U.S. National Library of Medicine, Apr. 2018, www.ncbi.nlm.nih.gov/pubmed/29345505. 

12Saklayen, Mohammad G. “The Global Epidemic of the Metabolic Syndrome.” Current Hypertension Reports, Springer US, 26 Feb. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC5866840/. 

13“The Role of Diet in Metabolic Syndrome.” National Institutes of Health, U.S. Department of Health and Human Services, 18 Mar. 2016, www.nih.gov/news-events/nih-research-matters/role-diet-metabolic-syndrome.

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