THE DYSMETABOLIC SYDROME – DEFIITIO, HISTORY, COMPOETS Dr. icoleta Milici The Institute of Anthropology „Francisc I. Rainer” Abstract Some researchers tend to think of the group of researchers from OMS (the group dysmetabolic syndrome as being the most being concerned with studying diabetes). It important medical problem of the 21st century made precise the fact that the syndrome is beginning. defined by the presence of type II diabetes The dysmetabolic syndrome is rather mellitus or the altered tolerance to glucose difficult to estimate because of the numerous combined with at least 2 other factors existing points of view regarding the elements (hypertension, increased level of blood lipids, needed for the diagnosis. obesity and microalbuminuria). It isn’t about a singular disease, but an Starting with that first definition (initial association of impairments that can appear one) of the metabolic syndrome a range of simultaneously or gradually in the same alternative definitions was suggested. The individual, caused by associating the genetic most widely accepted definition was and environmental factors (+ lifestyle) with formulated by EGIR (European Group for the the insulin - resistance, considered as the Study of Insulin Resistance) and NCEP (USA fundamental pathogenic component. National Cholesterol Education Panel). The first definition of the metabolic syndrome (MS) was formulated in 1998 by a beginning. Recent studies showed the epidemic proportions that this affection Introduction reached worldwide (global numbers show a Such a great interest taken in this theme prevalence of 20 - 25%). The diagnosis, starts from the increased prevalence of the clinical evaluation and efficient treatment of metabolic syndrome and its association with a such a big number of patients are heavily decreasing hope for a longer lifespan, trying the public health systems. On the other especially by the increasing of the side, the delaying in curing the dysmetabolic cardiovascular mortality, the increasing of syndrome leads to an increasing of the diabetes, myocardial infarction and cardiovascular diseases and type II diabetes cerebrovascular disease risk. incidence, with disastrous consequences over Some researchers tend to think of the the human society. It is estimated that, in dysmetabolic syndrome as being the most 2020, approximately 2/3 of the world important medical problem of the 21 st century morbidity will be due to the non - transmissible confirmed diseases. Passing to a food that is rich in refined products, food of (altered tolerance to glucose/ type 2 diabetes animal origin and fats plays an important part mellitus), the protein metabolism in the worldwide epidemics of obesity, (hyperuricemia), as well as the arterial diabetes mellitus and cardiovascular diseases hypertension (a hemodynamic disturbance (non – transmissible confirmed diseases). having a metabolic starting point) (2). Unfortunately, the obesity generating media, amplified by the number of cultural Terminology modifications associated with globalization, make it increasingly difficult to adopt a The term “syndrome” derives from the healthy lifestyle, especially among children Greek word sundromos (sun-syn + dromos= a and teenagers (1). fugi) and it means “to run together” . The dysmetabolic syndrome is rather The dysmetabolic syndrome was diversely difficult to estimate because of the numerous named in time: the plurimetabolic syndrome, existing points of view regarding the elements the X syndrome, the X plus syndrome, the X needed for the diagnosis. It isn’t about a metabolic syndrome, the cardiovascular singular disease, but an association of metabolic syndrome, the insulin - resistance – impairments that can appear simultaneously or dislipidemia syndrome, the atherogenic gradually in the same individual, caused by metabolic syndrome, the syndrome of associating the genetic and environmental atherogenic factors’ agglomeration, the deadly factors (+ lifestyle) with the insulin - quartet). Recently, there was used the MetS resistance, considered as the fundamental acronym as replacing the term of Metabolic pathogenic component. The modern lifestyle, Syndrome. which is stressful, always in a rush after Out of the numerous terms suggested to success and fortune, associates the define this nosologic entity, the World Health hyperglucid/hyperlipid food with the Organization (OMS) –(WHO), the sedentariness promoted by the comfort of the International Diabetes Federation (IDF) and contemporary civilization. other international bodies agreed upon the term “metabolic syndrome”. Nevertheless, Definition from a semantical point of view, this term is not correct; let’s not forget that the According to the encyclopedic dictionary metabolism per se represents a natural of the Romanian language the term phenomenon. Thus, if we refer to its “syndrome” = group of signs and symptoms dysfunction, it would be logical to call it that appear together during a pathological “dysmetabolic” (ex.: we call the disturbance process, giving it the characteristic note. of the lipid metabolism “dyslipidemia”, not The dysmetabolic syndrome expresses a “lipidemia”). complex disturbance of the genetic metabolism of the organism, including disturbances of the lipid metabolism (obesity, dyslipidemia), the carbohydrate metabolism Jurnalul Român de Diabet. utriţie şi Boli Metabolice / Vol. 14 / nr. 2 /2007 2 History diseases. From the point of view of the school from Cluj, the atherosclerosis is represented As early as 250 years ago, long before the by a complex disturbance of the metabolism, MS description, the Italian physician and vaso – motility, coagulation, hydro - anatomist Morgagni identified the association electrolytic and mineral equilibrium (8). between visceral obesity, HTA (arterial The cardiologists were the first to notice hypertension), atherosclerosis, the high levels the connection between the major disturbances of uric acid in the blood and the frequent of the dysmetabolic syndrome. Making an respiratory disorders during sleep (the inventory of the risk factors for the coronary obstructive apnea) (4). diseases, alongside with HTA they recorded In 1920, Nicolae Paulescu, speaking about dyslipidemia (hypercholesterolemia/hypertri- obesity and diabetes, said that “most glyceridaemi) obesity, diabetes and hyperuri- frequently, the obese people become caemia, as well as food factors, the sedentary glycosuric, as if the two affections (obesity lifestyle, environment factors, psychosocial and fat diabetes) represent two consequent factors, etc. phases of the same pathological process” (5). Towards the end of the 80’s, the assembly In 1927, Maranon, the founder of modern of glucose, insulin metabolism disorders, endocrinology in Spain, explicitly described obesity, dyslipidemia and HTA received the the fact that the arterial hypertension is a pre - mysterious name of “X syndrome”. In 1988, diabetical stage and this concept is similarly Reaven G., an endocrinologist physician from applied to obesity. Maranon also underlined Stanford University, was the one who took a the fact that food is essential for preventing big stride forwards, interpreting the and treating these disturbances (4). association of diabetes, obesity, dyslipidemia th At the middle of the 20 century (1947), and arterial hypertension by their pathogenic Vague, a French physician, was the first to relationship with the peripheral insulin - identify android obesity (adiposity of the resistance. He named this association “X superior part of the body) as being the syndrome”, the name underlining the condition the most frequently associated with doubtfulness that accompanied the emitting of diabetes mellitus (Dz) and cardiovascular the apparently new concept (9). The insulin diseases. resistance and the compensatory The often simultaneous presence of hyperinsulinism were associated with each obesity, the high level of blood lipids, diabetes component of the dysmetabolic syndrome, mellitus and HTA (arterial hypertension) was offering thus a physio -pathological first mentioned under the name of connection between them. Continuing this plurimetabolical syndrome in the 60’s. logical chain, one can naturally reach the In the 70’s, Moga, Orha, Haragus (6,7) conclusion that the dysmetabolical syndrome from Cluj supported the idea of the existence represents a complex disturbance of the of a close connection among the components energetic metabolism, in close connection that constitute the dysmetabolic syndrome at with the insulin secretion altering, influenced present, correlating them to the cardiovascular Jurnalul Român de Diabet. utriţie şi Boli Metabolice / Vol. 14 / nr. 2 /2007 3 in its turn by the sensitivity/resistance to In 1998, the first definition of the insulin (2). metabolic syndrome (MS) was formulated by Ferranini and collab. resumed this idea, a group of researchers from OMS (the group confirming that this assembly of disturbances being concerned with studying diabetes) One is provoked by the insulin – resistance and, year later, the OMS definition was after several years, they called it the “insulin – accompanied by a criteria list meant to the resistance syndrome” (4). clinical diagnosis. It made precise the fact that Afterwards, it was found out that the the syndrome is defined by the presence of spectrum of metabolic disturbances is larger. type II diabetes mellitus or the altered Zimmet and Serjentson (10) speak about the tolerance to glucose combined with at least 2 “plus X syndrome” signaling the association