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An Overview of Metabolic Syndrome

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An Overview of Metabolic Syndrome 2 Objectives Discuss metabolic syndrome and its impact on overall health An Overview Assess laboratory findings of Metabolic associated with metabolic Syndrome syndrome Stephanie Blackburn, MHS, MLS(ASCP)CM Relate metabolic syndrome with chronic disease 1 3 4 Metabolic Syndrome “Metabolic” “Syndrome” Collection of cardiovascular risk Pattern of factors that accelerate the onset Refers to symptoms biochemical of heart disease, stroke, and Type 2 that together processes diabetes mellitus are involved in characteristic the body’s of a specific normal disorder or functioning disease 5 6 Leading causes of death (CDC) According to National Heart, Lung, 1. Heart disease and Blood Institute, “ a person with 2. Cancer metabolic syndrome is twice as 3. Chronic lower respiratory disease likely to develop heart disease and five times as likely to develop 4. Accident diabetes as someone without 5. Stroke metabolic syndrome” 6. Alzheimer’s disease 7. Diabetes http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm 1 7 8 History of Metabolic Syndrome 1947 Atherosclerosis Risk factors for diabetes observed in 1920s Upper Gout body Diabetes “Metabolic syndrome” coined in obesity 1950s Better understood in 1970s Kidney stones 9 10 Early 1950s 1977 – Metabolic Syndrome Term described association Low- between obesity, diabetes calorie diet Improvements: mellitus, high triglycerides, high Diabetes uric acid, and fatty liver disease Cholesterol Combination à increased risk for Low- Triglycerides atherosclerosis carb diet Later, described association between hyperlipidemia, obesity, gout, diabetes, and hypertension 11 12 1978 Metabolic Syndrome Combination of risk factors for myocardial infarction & obesity Dysmetabolic syndrome Described risk factors as Hypertriglyceridemic waist “constellation abnormalities” Glucose intolerance Insulin resistance syndrome Hyperinsulinemia High triglycerides Obesity syndrome High glucose High cholesterol Syndrome X 2 13 14 “Syndrome” Who is at risk? Cluster of conditions that occur Posses at least 3 of the following: together Central obesity Men waist: >40 in. Metabolic syndrome Women waist: >35 in. Various conditions that occur Triglycerides: ≥ 150 mg/dl together that increase risk of heart HDL-C: <40 mg/dl (male), <50 disease, stroke, and diabetes mg/dl (female) Hypertension: 130/85 mmHg FPG: ≥ 100 mg/dl 15 16 Other risk factors: Prevalence Age ~40% of those over age 60 Characteristic Male Female Race 20-39 years 20.3 % 15.6% Mexican American at highest risk 40-59 years 40.8 % 37.2 % Obesity Over 60 years 51.5% 54.4 % Diabetes Family history or gestational diabetes Other diseases http://www.cdc.gov/nchs/data/nhsr/nhsr013.pdf 17 18 Prevalence Prevalence Characteristic Male Female Characteristic Male Female Non-Hispanic 37.2% 31.5 % Underweight and 6.8 % 9.3 % white normal weight Non-Hispanic 25.3 % 38.8 % Overweight 29.8 % 33.1 % black Obese and 65 % 56.1 % Mexican 33.2 % 40.6 % extremely obese American http://www.cdc.gov/nchs/data/nhsr/nhsr013.pdf http://www.cdc.gov/nchs/data/nhsr/nhsr013.pdf 3 19 20 Role of obesity Body Mass Index (BMI) “apple” vs. “pear” Measure of body fat based on height and weight Sedentary lifestyle Weight (kg) / Height (m2) > 50% U.S. population is overweight or obese OR [Weight (lbs) / Height (in)2] x 704 Children being affected 21 22 BMI Example BMI Height = 5 ft 7 in (67 in) Underweight = <18.5 Weight = 170 lbs Normal weight = 18.5-24.9 Overweight = 25-29.9 2 [Weight (lbs) / Height (in) ] x 704 Obesity = BMI of 30 or greater (170 / 672) x 704 BMI = 26.6 http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm 23 24 Calculation of BMI BMI Target value = ≤ 24.9 http://www.nhlbi.nih.gov/health/ lose 12 lbs (158) = 24.7 educational/lose_wt/BMI/ bmicalc.htm Overweight = 25 – 29.9 Our 5’7” 170 lbs = 26.6 Obese = 30 – 39.9 BMI Table at http://www.nhlbi.nih.gov/health/ gain 22 lbs (192) = 30.1 educational/lose_wt/BMI/ Morbidly obese = ≥ 40 bmi_tbl.htm 4 25 26 Other risk factors associated Limitations of BMI with obesity May overestimate body fat in athletes and others with muscular Hypertension High LDL Low HDL build High blood Family history High TG of heart May underestimate body fat in glucose disease older persons and others who have lost muscle Inactivity Smoking 27 Obesity prevalence, 1992 Weight Diabetes 30 Obesity prevalence, 2007 Obesity prevalence, 2015 http://www.cdc.gov/obesity/data/prevalence-maps.html 5 31 32 Why increased incidence of obesity in U.S.? Insulin Resistance Insulin Hormone that aids in regulation of blood glucose Lifestyle Environment Insulin resistance Inability of cells to respond to insulin- stimulated glucose uptake Blood glucose levels rise, promoting storage as fat and glycogen = weight gain. Genes 33 Insulin Resistance “Inadequate” Compensatory Insulin Response Hyperinsulinemia Type 2 Diabetes Metabolic Syndrome Heart Disease Retinopathy Hypertension Nephropathy Stroke Neuropathy 35 36 Diabetes Statistics in U.S. (2014) Fasting 2 hrs. post Glycated >29 million diabetics plasma prandial hemoglobin glucose (mg/dl) (%) 1 in 4 do not know (mg/dl) 86 million pre-diabetics Normal ≤100 <140 <5.7 15-30% will develop Pre- 101-125 140-199 ≥6.5 T2DM within 5 yrs. diabetic Diabetic ≥126 ≥200 5.7-6.4 http://www.cdc.gov/Features/DiabetesFactSheet/ 6 37 38 Increased numbers of diabetes diagnoses (1980-2014) Diabetes Statistics Cardiovascular disease death rates about 1.7x higher in diabetics About 20% people over 40 with metabolic syndrome have T2DM http://www.cdc.gov/diabetes/statistics/prev/national/figpersons.htm 39 40 Triglycerides Cholesterol Triglycerides are fat! LDL-C HDL-C “Bad” cholesterol “Good” cholesterol Ideally, <150 mg/dl Primarily Scavenger composed of Primarily cholesterol composed of Ideally <100 mg/dl protein Ideally <50 mg/dl (women) & <40 mg/dl (men) 41 42 Other conditions associated Signs & Symptoms with metabolic syndrome: Large waistline is only obvious sign Excessive blood clotting If diabetic à may be symptomatic Excessive thirst Constant, low-grade inflammation throughout body Increased urination Fatigue Hypertension Researchers unsure if these Headache conditions cause metabolic Dizzy spells syndrome or worsen it Nose bleeds 7 43 44 When to seek medical advice Laboratory Assessment Lipid profile If you have at least one risk factor – Prefer 9-12 hr. fasting period you may have others but not know it Observe: TG >150 mg/dl HDL <40 or 50 mg/dl LDL >100 mg/dl 45 46 Laboratory Assessment Laboratory Assessment Fasting glucose >100 mg/dl Proinflammatory state Elevated CRP, cytokines, & fibrinogen Insulin Decreased adiponectin concentration Ordered with glucose or GTT Levels high in patients with insulin resistance Procoagulant state May measure C-peptide, as Increased PAI-1 alternative Increased platelet aggregation 47 48 Study by American Heart Study by American Heart Association Association Participants categorized by diet Analyzed diet of 9514 participants Western-pattern diet Ages 45 – 64 Refined grains Red meat Processed meat Eggs 66 item food frequency Fried foods Soda questionnaire Prudent pattern diet Vegetables Poultry Fruit Whole grains Fish & seafood Low fat dairy 8 49 50 Study by American Heart Study by American Heart Association Association RESULTS: Assessed associations with 40% participants had 3 or more risk individual foods: fried foods, factors for metabolic syndrome sweetened drinks, diet soda, nuts, and coffee Western diet adversely associated with metabolic syndrome (18% greater risk) Follow up after nine years HOWEVER No evidence that prudent diet was beneficial 51 52 Study by American Heart Association Literature Review (2013): RESULTS: Hamburgers, hot dogs, & processed Association between low-grade meat → 26% greater risk chronic inflammation, diet, and Fried foods → 25% greater risk metabolic syndrome Diet soda → 34% greater risk Dairy products → beneficial → 13% lower risk Sweetened beverages, coffee, & nuts → no association Ahluwalia, N., Andreeva, V.A., Kesse-Guyot, E., & Hercberg, S. (2013). Dietary patterns, inflammation, and the metabolic syndrome. Diabetes & Metabolism, 39, 99-110. 53 54 Results of Literature Review: Sugar, Obesity, & Diabetes Healthy diet à reduces inflammation Sugar-sweetened beverages & incidence of metabolic syndrome (SSBs) Due to weight control Soft drinks, fruit drinks, energy drinks, vitamin water Unhealthy diet à high levels of Sucrose, high fructose corn syrup, & cytokines & CRP fruit juice concentrate Prolonged inflammation may induce insulin Largest contributor to added sugar resistance, dyslipidemia à leads to intake in U.S. diet metabolic syndrome & associated complications Ahluwalia, N., Andreeva, V.A., Kesse-Guyot, E., & Hercberg, S. (2013). Dietary patterns, inflammation, and the Malik, V.S. & Hu, F. B. (2012). Sweeteners and risk of obesity and type 2 diabetes: The role of sugar-sweetened metabolic syndrome. Diabetes & Metabolism, 39, 99-110. beverages. Current Diabetes Reports, 12, 195-203. 9 55 56 Sugar, Obesity, & Diabetes SSB & Obesity Study of 50,000 women Weight Increased SSB consumption à gain Gained ~17 lbs over 8 yrs. Decreased SSB consumption à SSB gained ~ 6 lbs over 8 yrs. Further studies confirmed findings SBB most strongly associated with T2DM 4 yr. weight change, after potato chips & potatoes Malik, V.S. & Hu, F. B. (2012). Sweeteners and risk of obesity and type 2 diabetes: The role of sugar-sweetened Malik, V.S. & Hu, F. B. (2012). Sweeteners and risk of obesity and type 2 diabetes: The role of sugar-sweetened beverages. Current Diabetes Reports, 12, 195-203. beverages. Current Diabetes Reports, 12, 195-203. 57 58 SSB & Type 2 Diabetes SBB & Metabolic Syndrome 310,819 participants High SBB consumption (≥1/day) Risk for development of T2DM associated with inc risk of: Highest SBB intake à 26% greater risk Hypertension 1 serving SBB/day à 15% increased Hypertriglyceridemia risk Low levels of HDL-C 50,000 women (same as previous High levels of LDL-C study) Higher waist circumference 1 SBB/day à 83% inc risk for T2DM Malik, V.S. & Hu, F. B. (2012). Sweeteners and risk of obesity and type 2 diabetes: The role of sugar-sweetened Malik, V.S.
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