The incidence of metabolic syndrome often parallels that of obesity and type 2 diabetes. It is very common; in the US, > 40% of people > 50 years may have metabolic syndrome. Children and adolescents can develop metabolic syndrome, but in these age groups, no definition is established.
Development of metabolic syndrome depends on distribution as well as amount of fat. Excess fat in the abdomen (called apple shape), particularly when it results in a high waist-to-hip ratio (reflecting a relatively low muscle-to-fat mass ratio), increases risk. The syndrome is less common among people who have excess subcutaneous fat around the hips (called pear shape) and a low waist-to-hip ratio (reflecting a higher muscle-to-fat mass ratio).
Excess abdominal fat leads to excess free fatty acids in the portal vein, increasing fat accumulation in the liver. Fat also accumulates in muscle cells. Insulin resistance Type 2 diabetes Diabetes mellitus is impaired insulin secretion and variable degrees of peripheral insulin resistance leading to hyperglycemia. Early symptoms are related to hyperglycemia and include polydipsia... read more develops, with hyperinsulinemia. Glucose metabolism is impaired, and dyslipidemias Dyslipidemia Dyslipidemia is elevation of plasma cholesterol, triglycerides (TGs), or both, or a low high-density lipoprotein cholesterol level that contributes to the development of atherosclerosis... read more 
and hypertension Hypertension Hypertension is sustained elevation of resting systolic blood pressure (≥ 130 mm Hg), diastolic blood pressure (≥ 80 mm Hg), or both. Hypertension with no known cause (primary; formerly, essential... read more 
develop. Serum uric acid levels are typically elevated (increasing risk of gout Gout Gout is a disorder caused by hyperuricemia (serum urate > 6.8 mg/dL [> 0.4 mmol/L]) that results in the precipitation of monosodium urate crystals in and around joints, most often causing... read more 
), and a prothrombotic state (with increased levels of fibrinogen and plasminogen activator inhibitor I) and an inflammatory state develop.
Risks of metabolic syndrome include
Low plasma testosterone Male Hypogonadism Hypogonadism is defined as testosterone deficiency with associated symptoms or signs, deficiency of spermatozoa production, or both. It may result from a disorder of the testes (primary hypogonadism)... read more , erectile dysfunction Erectile Dysfunction Erectile dysfunction is the inability to attain or sustain an erection satisfactory for sexual intercourse. Most erectile dysfunction is related to vascular, neurologic, psychologic, and hormonal... read more , or both (for men)
Diagnosis of Metabolic Syndrome
Waist circumference and blood pressure
Fasting plasma glucose and a lipid profile
Screening for metabolic syndrome is important. A family history plus measurement of waist circumference and blood pressure are part of routine care. If patients with a family history of type 2 diabetes mellitus, particularly those ≥ 40 years, have a waist circumference greater than that recommended for their race and sex, fasting plasma glucose and a lipid profile must be determined.
Metabolic syndrome has many different definitions, but it is most often diagnosed when ≥ 3 of the following are present (see table Criteria Often Used for Diagnosis of Metabolic Syndrome Criteria Often Used for Diagnosis of Metabolic Syndrome* 
):
Excess abdominal fat
A high fasting plasma glucose level
A high triglyceride level
A low high-density lipoprotein (HDL) cholesterol level
Treatment of Metabolic Syndrome
Healthy diet and exercise
Sometimes metformin
Management of cardiovascular risk factors
Optimally, the management approach results in weight loss based on a healthy diet and regular physical activity, which includes a combination of aerobic activity and resistance training, reinforced with behavioral therapy. Metformin, an insulin sensitizer, or a thiazolidinedione (eg, rosiglitazone, pioglitazone) may be useful. Weight loss of ≈ 7% may be sufficient to reverse the syndrome, but if not, each feature of the syndrome should be managed to achieve recommended targets; available drug treatment is very effective.
Other cardiovascular risk factors (eg, smoking cessation) also need to be managed. Increased physical activity has cardiovascular benefits even if weight is not lost.
Key Points
Excess abdominal fat leads to abnormal fasting plasma glucose or insulin resistance, dyslipidemias, and hypertension.
Metabolic syndrome is extremely common (eg, prevalence in the US of possibly > 40% in people > 50 years).
Determine waist circumference, blood pressure, fasting plasma glucose, and lipid profile.
Emphasize following a healthy diet and exercising and manage cardiovascular risk factors; if these measures are not completely effective, consider use of metformin.
Drugs Mentioned In This Article
| Drug Name | Select Trade |
|---|---|
testosterone |
DELATESTRYL |
metformin |
GLUCOPHAGE |
rosiglitazone |
AVANDIA |
pioglitazone |
ACTOS |
