Summary: Metabolic syndrome (MetS), also called Syndrome X, is a group of interrelated metabolic conditions like central obesity, high blood pressure, high fasting blood sugar, high triglyceride levels, and low HDL cholesterol. Its incidence has been on the rise lately and this is a cause for concern because MetS increases the risk of developing chronic conditions like diabetes, chronic hypertension, and stroke. It is brought on by an interplay of genetic, environmental, and lifestyle factors and is closely connected to insulin resistance. Lifestyle changes, such as following a low salt and sugar diet, reducing intake of red meat and saturated fats, and engaging in physical activities, are recommended to manage MetS. Medical management may also be necessary to manage the associated hypertension, dyslipidemia, and diabetes.
Metabolic syndrome (MetS) or Syndrome X combines several interrelated conditions like elevated blood pressure, increased Waist Circumference, elevated fasting blood sugar, low HDL, and high triglycerides (TGs).
Why is MetS a concern?
Studies have shown that the prevalence of metabolic syndrome (MetS) increased by 35% from 1980 to 2012 . MetS raises a significant risk of developing Diabetes, Chronic hypertension, Cerebrovascular, and neurovascular conditions like Stroke. There has been an estimated increase in mortality related to high BMI, often seen in people with MetS, between the years 1990 to 2015 by 28.3% .
How does it start?
One of the reasons MetS is on the rise is due to the newly adopted Westernized fast food diet combined with a sedentary lifestyle. When someone has a high BMI, especially if their weight is mostly in their belly, it can make it harder for their body to use a type of sugar called glucose. This can increase their risk of getting conditions like diabetes. Diabetes, when not managed well, can damage the lining of the blood vessels, making them stiff and resistant. This in turn can cause high blood pressure, changes in the heart's shape, and even blockages in the heart's blood vessels.
Who could have Syndrome X?
Anyone with any 3 of the following:
Waist Circumference is more than 40 inches (102 cm) in men or more than 35 inches (88 cm) in women.
Blood Pressure (BP) > or equal to 130mmHg systolic and 85mmHg diastolic.
Triglycerides (TGs) > 150 mm/dl
High Density Lipoproteins (HDL) < 40 mg/dl in men, HDL <50 mg/dl in women
Fasting Blood Sugar (BS) > 100 mg/dl or more than 140mg/dl after 2 hours of Oral Glucose Tolerance Test (GTT).
How to identify if you have Syndrome X?
Your physician may want to understand your complete history, perform physical exams, and relevant lab investigations to confirm the diagnosis of MetS.
Important visible clues to look for to identify MetS are waist circumference, xanthomas (Fig. 1), and acanthosis nigricans (Fig. 2). Chronic insulin resistance could present as peripheral neuropathy, retinopathy, or healing impairment. Central obesity, which is often seen in MetS, is often related to snoring which could be due to underlying Obstructive Sleep Apnea (OSA) and should be evaluated . On examination, a healthcare provider may find high blood pressure or a specific sound in the abdomen (bruit) during a check-up, which could mean a person has atherosclerosis. Atherosclerosis, in simple terms, is when fatty deposits build up in blood vessels. Multiple organ systems like the hepatobiliary and renal systems can be involved hence, liver function and renal function need to be checked.
(FIG. 1) ( FIG. 2)
What tests should you get done?
Serum tests like lipid profile might show reduced HDL, elevated LDH and triglycerides, abnormal thyroid profile, fasting blood sugar, or HbA1C. At times co-morbidities associated with MetS could require a panel of specialists to be involved in performing tests like echocardiography to detect cardiac structural changes, Elastography/liver biopsy to assess fatty liver changes/chronic liver disease, Polygraphy/Polysomnography to check for sleep disorders like Obstructive Sleep Apnea (OSA) or measuring androgen levels or performing a female pelvic ultrasound to rule out Polycystic Ovarian Disease (PCOD).
How can Syndrome X be prevented, and how is it treated?
Lifestyle Changes: An Effective way to prevent or manage Syndrome X is through diet and exercise.
Switching to a diet low in salt (lowers BP) and sugars, low in saturated fats, especially trans-fat, and increasing daily portions of healthier options like whole-grain products, fruits, and vegetables helps lower unhealthy fats like LDL and raise HDL. Reducing the intake of red meat, dairy, and coconut oils could be helpful as they raise triglycerides and LDH, which are the fats that could potentially cause heart attacks.
Additionally, simple physical activities such as doing daily chores, taking the stairs instead of using a lift, and brisk walking have to be incorporated into the daily routine. According to the European Society of Cardiology Guidelines, 150 to 300 minutes of moderate-intensity aerobic physical activity or 75 to 150 minutes of vigorous-intensity aerobic exercise per week lowers all-cause mortality, cardiovascular mortality, and morbidity.
Smokers have more than a twofold increased risk of having MetS than non-smokers as it mainly lowers HDL and raises triglycerides . Hence it is advisable to quit smoking. Nicotine Replacement Therapy (NRT) is beneficial if there are signs of nicotine dependence.
Similarly, Alcohol, a non-nutritive calorie source, is cytotoxic to multiple organ systems. Reducing alcohol intake helps decrease triglyceride levels .
Clinical management: If already diagnosed with hypertension, it is managed medically by drugs like ACE inhibitors, angiotensin receptor blockers, beta-blockers, and diuretics. A clinically evident, deranged lipid profile is managed with Statins and niacin pills. Omega-3 fatty acids also help lower TGs. Medical management of diabetes is crucial if Hb1AC is above 6.5% or above. Lastly, medical and surgical management of obesity helps in weight loss.
Written by: Dr.Rohit Kumar Edited by: Dr.Manognya Chekragari