METABOLIC SYNDROME- TAKE A WALK THROUGH IT

Introduction

Metabolic syndrome or syndrome X or resistance syndrome comprises of features such as central obesity, increased levels of triglycerides, low levels of high density lipoproteins, increased blood pressure, increased glucose levels.

Risk factors 

• Obesity
• Sedentary lifestyle
• Aging
• Diabetes mellitus
• Cardiovascular diseases
• Lipodystrophy

Etiology

• Insulin resistance
• Increased waist circumference
• Hypertension
• Dyslipidemia
• Glucose intolerance
• Adiponectin
• Proinflammatory cytokines

Diagnosis

• Symptoms of obstructive sleep apnea and polycystic ovarian syndrome
• Check blood pressure
• Measurement of waist circumference
• Lipoatrophy, acanthosis nigricans
• Family history of cardiovascular diseases and diabetes mellitus
• Investigations- lipid profile, FBS, PPBS sugar levels, liver function tests, Apo B, fibrinogen, hsCRP, uric acid, urine microalbumin levels, sleep study, testosterone, FSH, LH levels.

Treatment 

• Drugs to reduce lipid levels - fenofibrate, gemfibrozil, rosuvastatin, atorvastatin, Omega 3 fatty acids, nicotinic acids, ezetimibe, diet restriction of saturated and trans fats.
• Lifestyle modification - weight reduction through increased physical activity for 30 to 60 min per day , calorie restriction where diet rich in fruits, vegetables, fish, whole grains, lean poultry and behavioural changes for weight maintainence
• Obesity reducing drugs that can be tried are Phentermine (3 months only), Phentermine/ topiramate combination and locaserin. Orlistat is another drug that can be tried. Bariatric Surgery suggested when BMI > 40kg/m2
• Impaired glucose tolerance and type 2 diabetes mellitus- metformin and thiazolidinediones, lifestyle modification can control glucose levels in blood.