The Metabolic Syndrome
What is the metabolic syndrome?
The Metabolic Syndrome was first described by in 1988 by Gerald Reavson. It was
originally described as the clustering of four conditions that, when present together in
one individual, increased the risk of cardiovascular disease.
The four conditions were:
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Glucose intolerance
Hypertension
Dyslipidemia
Central Obesity
Glucose intolerance
Glucose intolerance means that glucose metabolism, in that individual, is damaged or
impaired.
The best way to test for this condition is by performing a blood test to measure the
level of fasting blood glucose. This is done by fasting the patient overnight and taking
blood for the test in the morning before breakfast is eaten.
The blood sugar level is considered to be abnormal if the fasting blood glucose is
higher than 5.6 mmol/L. (fasting blood glucose >5.6 mmol/L)
Hypertension
Hypertension is an elevated blood pressure. The levels at which one is considered to
be hypertensive have changed over the years. Blood pressure levels that were once
considered acceptable are now often considered to be too high and unacceptable.
Blood pressure (BP) is now considered to be raised if the systolic blood pressure is
higher than 130, or if the diastolic blood pressure is greater than 85.
(Systolic BP > 130, diastolic BP >85).
Until recently a blood pressure of 140/90 was considered to be the cut off mark for the
presence of hypertension. This was lowered because large trials showed that risk
increased at lower blood pressures than was previously thought.
© Dr Leon Massage, Body Metabolism Institute, 2006
The Metabolic Syndrome
Dyslipdemia
Dyslipidemia means an abnormality of the blood fats – not just cholesterol. The
abnormalities associated with the Metabolic Syndrome can consist of either a low
level of HDL cholesterol or it can be a raised level of triglycerides.
HDL cholesterol is the ‘good’, or protective, cholesterol. The higher the level, the
greater is the protection from heart disease.
Triglycerides are simply the blood fats. Many people confuse cholesterol with fat
when, in fact, cholesterol is in a separate category of its own. However, it is important
to realise that cholesterol and triglycerides are independent risk factors for heart
disease and cardiovascular disease in general.
A raised triglyceride level is one that is higher than (>) 1.7 (measured in mmol/)
A reduced HDL-cholesterol level is less than (<) 1.03 in males (measured in mmol/)
and a level that is less than (<) 1.29 in female (measured in mmol/)
Central Obesity
Central obesity describes the accumulation of excess fat around the waist or
abdominal region. But, more importantly, it is a reflection of the metabolically active
fat that is present in the abdominal cavity and between the vital organs. This fat is
called visceral fat, and it produces a number of harmful substances which promote
plaque formation and thrombosis in the blood vessels. It also releases free fatty acids
which travel to the liver and cause fatty liver.
Central obesity is considered to be present if:
Waist circumference is greater than 94 cm. (in men)
Waist circumference is greater than 80 cm. (in women)
However, this measure is only correct for Caucasians.
For people of South Asian and Chinese descent, the acceptable measurements are
lower and central obesity is considered to be present if:
Waist circumference is >90 cm. (in men)
Waist circumference is >80 cm. (in women)
© Dr Leon Massage, Body Metabolism Institute, 2006
The Metabolic Syndrome
Metabolic Syndrome has been described by many other names. One very popular
alternative name is Syndrome X.
The four conditions that constitute the syndrome were initially referred to, in medical
circles as the Deadly Quartet, because they significantly increase the risk of
developing cardiovascular disease.
Further research into this syndrome, in the past decade, has found that there are other
abnormalities to be found in the blood of patients who have the Metabolic Syndrome.
These conditions include:
 Elevated Uric Acid levels – high levels of Uric Acid are a cause of gout.
 Hyperfibrinogenemia – this increases the tendency of the blood to clot.
 Increase in the small, dense LDL particles in the blood – these are often referred to
as ‘bad’ cholesterol.
 Disorders of endothelial function. The endothelium is the lining of blood vessels,
and abnormalities here have a major influence on heart and blood vessel disease.
According to the World Health Organisation (WHO), in order to make a diagnosis of
Metabolic Syndrome it is necessary to have at least 3 of the four possible original
conditions, or 2 of the major and 2 of the secondary abnormalities, mentioned above.
The Latest Classification of Metabolic Syndrome
The latest and currently most accepted classification of the metabolic syndrome is the
one described by the International Diabetes Federation. Its main focus is on central
obesity and it states that in order to make a diagnosis of Metabolic Syndrome one
needs to have the following:
 Central obesity
As well as any two of the following:
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Raised blood pressure
Raised serum triglyceride levels
Reduced serum HDL-cholesterol levels
Impaired fasting blood sugar levels
© Dr Leon Massage, Body Metabolism Institute, 2006
The Metabolic Syndrome
Why is this diagnosis important?
Knowing that you have metabolic syndrome is vitally important because it has
potentially lethal consequences. For example, a Finnish study, reported in the Journal
of the American Medical Association, showed that it you suffer from this condition
you triple your risk of death from coronary heart disease. Furthermore, your risk of
developing Type 2 Diabetes increases five-fold.
The important thing to remember is that if it is identified early it is possible to treat
and reverse many of the risk factors associated with the Metabolic Syndrome.
Important Facts
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Metabolic Syndrome affects at least 25% of adults
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Metabolic Syndrome affects 40% of the over 40’s
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Metabolic Syndrome is fuelled by central obesity
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Central obesity can cause fatty liver
One very interesting discovery to emerge from the research into the Metabolic
Syndrome is that there is a common underlying abnormality in all of these cases, and
that is Insulin Resistance.
For more information on Insulin resistance and Metabolic Syndrome visit:
www.bmiweight.com.au
© Dr Leon Massage, Body Metabolism Institute, 2006