MEDICINE ANTROPOLOGY A SHORT HISTORY OF THE METABOLIC SYNDROME DEFINITIONS NICOLETA MILICI Institut of Anthropology “Francisc I. Rainer”, Bd. Eroii Sanitari 8, sector 5, Bucharest, E-mail: [email protected], tel/fax : 021-317 50 72 Received Mars 1th, 2010 Some researchers tend to think of the metabolic syndrome (MS) as being the most important medical problem of the 21st century beginning. The metabolic syndrome is rather difficult to estimate because of the numerous existing points of view regarding the elements needed for the diagnosis. It isn’t about a singular disease, but an association of impairments that can appear simultaneously or gradually in the same individual, caused by associating the genetic and environmental factors (+ lifestyle) with the insulin-resistance, considered as the fundamental pathogenic component. The first definition of the metabolic syndrome was formulated in 1998 by a group of researchers from OMS (the group being concerned with studying diabetes). Starting with that first definition (initial one) of the metabolic syndrome a range of alternative definitions was suggested. The most widely accepted definition was formulated by EGIR (European Group for the Study of Insulin Resistance) and NCEP (USA National Cholesterol Education Panel). Key words: Metabolic syndrome; Anthropometry; Obesity. INTRODUCTION 2 diabetes incidences, with disastrous consequences over the human society. Passing to a food that is Such a great interest taken in this theme starts rich in refined products, food of animal origin and from the increased prevalence of the metabolic fats plays an important part in the worldwide syndrome and its association with a decreasing epidemics of obesity, diabetes mellitus and hope for a longer lifespan, especially by the cardiovascular diseases (non – transmissible increasing of the cardiovascular mortality, the chronic diseases). increasing of diabetes, myocardial infarction and It was noticed that the probability to develop cerebrovascular disease risk. metabolic disorders, including MS, increase with Some researchers tend to think of the metabolic obesity level. For example, in comparison with syndrome as being the most important medical normal weight subjects, the probability to have MS problem of the 21st century beginning. Recent increases 5.2 times for overweight subjects, 25.2 studies showed the epidemic proportions that this times for moderate obese subjects and 67.7 times affection reached worldwide (global numbers show for severe obese subjects 1, 2. a prevalence of 20–25%). The diagnosis, clinical Medical definition of obesity requires, with all evaluation and efficient treatment of such a big the rigor, being able to assess the fat mass. But fat number of patients are heavily trying the public mass cannot be measured with satisfactory health systems. On the other side, the delaying in precision in any other way than by sophisticated curing the metabolic syndrome leads to an methods (the measurement of body density, the increasing of the cardiovascular diseases and type assessment by dual energy X ray absorptiometry, Proc. Rom. Acad., Series B, 2010, 1, p. 13–20 14 Nicoleta Milici tomodensitometry, magnetic resonance) too expen- The metabolic syndrome was diversely named sive to be available for routine. In clinical practice, in time: the plurimetabolic syndrome, the X the obesity is defined using a corporality index, syndrome, the X plus syndrome, the X metabolic which takes account of weight and stature (BMI) syndrome, the cardiovascular metabolic syndrome, that has become the international reference to the insulin-resistance – dislipidemia syndrome, the define obesity 3,4. atherogenic metabolic syndrome, the syndrome of To define obesity, besides BMI, we can also atherogenic factors’ agglomeration, the deadly use other anthropological parameters: quartet). Recently, there was used the MetS acronym ● Thickness of skin folds as replacing the term of Metabolic Syndrome. ● Waist circumference ∗ Out of the numerous terms suggested to define ● The waist / hip ratio this nosologic entity, the World Health The metabolic syndrome is rather difficult to Organization (WHO), the International Diabetes estimate because of the numerous existing points Federation (IDF) and other international bodies of view regarding the elements needed for the agreed upon the term “metabolic syndrome”. diagnosis. It isn’t about a singular disease, but an Nevertheless, from a semantical point of view, this association of impairments that can appear term is not correct; let’s not forget that the simultaneously or gradually in the same individual, metabolism per se represents a natural phenomenon. caused by associating the genetic and environ- Thus, if we refer to its dysfunction, it would be mental factors (+ lifestyle) with the insulin- logical to call it “dysmetabolic” (ex: we call the resistance, considered as the fundamental pathogenic disturbance of the lipid metabolism “dyslipidemia”, component. The modern lifestyle, which is not “lipidemia”)6. stressful, always in a rush after success and fortune, associates the hyperglucid/hyperlipid food with the sedentariness promoted by the comfort of HISTORY the contemporary civilization. As early as 250 years ago, long before the MS description, the Italian physician and anatomist DEFINITION Morgagni identified the association between visceral obesity, HTA (arterial hypertension), According to the encyclopedic dictionary of the atherosclerosis, the high levels of uric acid in the Romanian language the term “syndrome” = group blood and the frequent respiratory disorders during of signs and symptoms that appear together during sleep (the obstructive apnea) 7. a pathological process, giving it the characteristic In 1920, Nicolae Paulescu, speaking about note. obesity and diabetes, said “most frequently, the The metabolic syndrome expresses a complex obese people become glycosuric, as if the two disturbance of the genetic metabolism of the organism, affections (obesity and fat diabetes) represent two including disturbances of the lipid metabolism consequent phases of the same pathological (obesity, dyslipidemia), the carbohydrate metabolism process” 8. (altered tolerance to glucose/ type 2 diabetes In 1927, Maranon, the founder of modern mellitus), the protein metabolism (hyperuricemia), endocrinology in Spain, explicitly described the as well as the arterial hypertension (a hemodynamic fact that the arterial hypertension is a pre-diabetical 5 disturbance having a metabolic starting point) . stage and this concept is similarly applied to obesity. Maranon also underlined the fact that food is essential for preventing and treating these TERMINOLOGY disturbances 7. At the middle of the 20th century (1947), Vague, The term “syndrome” derives from the Greek a French physician, was the first to identify word sundromos (sun-syn + dromos= to run) and it android obesity (adiposity of the superior part of means “to run together”. the body) as being the condition the most frequently associated with diabetes mellitus and ∗ According to EGIR > 80 cm for women and > 94 cm for cardiovascular diseases. men or according to NCEP-ATPIII ≥ 88 cm for women and ≥ The often-simultaneous presence of obesity, the 94 cm for men of European (caucasian) origin. For South Asia high level of blood lipids, diabetes mellitus and have been proposed: for men > 90 cm, for women > 80 cm; arterial hypertension was first mentioned under the China: men > 90 cm, women > 80 cm; Japan: men ≥ 85 cm, women ≥ 90 cm. name of plurimetabolical syndrome in the 60’s. A short history of the metabolic syndrome definitions 15 In the 70’s, Moga, Orha, Haragus 9,10 supported blood glucose level tends to increase with age, the idea of the existence of a close connection accelerating aging by connection to proteins 14. among the components that constitute the During mid 70’s, the biologist Anthony Cerami metabolic syndrome at present, correlating them to discovered the fact that the chronically increased the cardiovascular diseases. From the point of view glucose levels represent the main trigger in the of the school from Cluj, the atherosclerosis is chemical process of manufacturing the final represented by a complex disturbance of the glycolsylation products (AGE = Advanced metabolism, vaso-motility, coagulation and hydro- Glycosylation End). AGES are involved in the electrolytic and mineral equilibrium 11. processes of normal and accelerated aging, by The cardiologists were the first to notice the chemical reactions between glucose and molecular connection between the major disturbances of the proteins, producing serious damages at the level of metabolic syndrome. Making an inventory of the cellular membranes and collagen fibers 15. risk factors for the coronary diseases, alongside The appearance of the metabolic syndrome with HTA they recorded dyslipidemia notion was due to the fact that, more often than (hypercholesterolemia / hypertriglyceridaemia), not, the risk factors associate for the same obesity, diabetes and hyperuricaemia, as well as individual. This suggests that, on the one side, food factors, the sedentary lifestyle, environment there is possible a common etiopathogeny, and, on factors, psychosocial factors, etc. the other side, it was considered that it offers a Towards the end of the 80’s, the assembly of better capacity to predict risks and, therefore, to glucose, insulin metabolism disorders, obesity, intervene. dyslipidemia and arterial hypertension received the In 1998, the first definition