Metabolic syndrome update,☆☆

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Abstract

The metabolic syndrome is a multiplex risk factor for atherosclerotic cardiovascular disease and type 2 diabetes. It is composed of atherogenic dyslipidemia, elevated blood pressure, insulin resistance and elevated glucose, a pro-thrombotic state, and a pro-inflammatory state. Excess energy intake and concomitant obesity are the major drivers of the syndrome. Lifestyle intervention can reverse metabolic risk factors, but at times, drug therapies or bariatric surgery may be required to control more overt risk factors.

Section snippets

Definition of metabolic syndrome

The metabolic syndrome consists of five factors for ASCVD: atherogenic dyslipidemia, elevated blood pressure, dysglycemia, a pro-thrombotic state, and a pro-inflammatory state [5] (Fig. 1). They occur most commonly in obese persons. Atherogenic dyslipidemia comprises elevations in plasma triglycerides and apolipoprotein B (apo B), and reductions in high-density lipoproteins (HDL). Elevated blood pressure includes both overt and borderline hypertension. Dysglycemia consists of either prediabetes

Pathogenesis

An early hypothesis was that insulin resistance is the cause of metabolic syndrome [6], [7]. Without question, insulin resistance contributes to hyperglycemia. Its role in causing other metabolic risk factors is uncertain.

Another view sees obesity (or energy imbalance) as the main cause. Since obesity strongly associates with all metabolic risk factors, its role is plausible. A related view contends that positive caloric balance underlies the metabolic syndrome (Fig. 1). Obesity is a useful

Upper-body obesity

Most persons with the metabolic syndrome are categorically obese (BMI ≥ 30 kg/m2) [10]. Among them, individuals with predominant upper-body obesity are most prone to metabolic syndrome. Fat in the upper body can be either intraperitoneal (visceral) or subcutaneous. Excess visceral fat associates strongly with the metabolic syndrome [11], [12]. But in addition, excessive amounts of upper-body subcutaneous fat are accompanied by greater risk for metabolic syndrome [13], [14], [15], [16]. In

Lifestyle intervention

Most persons with metabolic syndrome are obese and sedentary. Urbanization and access to inexpensive foods are creating a metabolic syndrome pandemic [3]. Thus, primary intervention should be lifestyle change, i.e., caloric restriction, improved health quality of foods, and increased physical activity.

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    This work was financially supported by the Center for Human Nutrition, UT Southwestern Medical Center, United States.

    ☆☆

    The author has indicated that there are no conflicts of interest.

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