What is metabolic syndrome and how is it treated

Metabolic syndrome is diagnosed based on the presence of at least 3 of the following diagnostic criteria provided by the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III in 2021:

• waist circumference ≥ 102 cm in men and ≥ 88 cm in women;
• fasting blood glucose ≥ 100;
• blood pressure ≥ 130/85; hypertension;
• fasting triglycerides ≥ 150 mg/dL, hypertriglyceridemia;
• HDL cholesterol (the so-called “good” cholesterol) < 40 mg/dL for men and < 50 mg/dL for women.

The incidence of metabolic syndrome

The diagnosed cases of metabolic syndrome, which become more prevalent with age, are steadily on the rise.

It affects nearly half of the adult population over the age of 50, but its incidence in recent years is also increasing among adolescents and young adults due to the spread of obesity.

The causes of this syndrome lie mainly in unhealthy lifestyle, such as sedentariness and unbalanced diet, but the patient may have some familiarity with a possible role of genetic factors (e.g., diabetes), which may predispose to its development. 

The higher the number of conditions one suffers from, the greater the likelihood of developing metabolic syndrome. 

Major alarm bells include: 

• increase in body mass index (BMI ≥ 30);
• presence of excessive abdominal circumference. 

Metabolic syndrome, however, is characterized by the absence of specific symptoms; therefore, it is of paramount importance to pay attention to the risk factors mentioned above that may predispose to the onset of this condition, such as: 

• abdominal obesity;
• hypertension;
• family history of diabetes;
• insulin resistance (which involves some cells in our body, especially muscle and fat cells, being less sensitive to the action of insulin, the hormone released by the pancreas to lower blood sugar);
• hypertriglyceridemia;
• low HDL cholesterol values. 

In general, a person with metabolic syndrome is associated with an increased risk of:

• cardiovascular diseases, such as atherosclerosis, myocardial infarction, and stroke;
• metabolic diseases, such as type 2 diabetes, dyslipidemia, hepatic steatosis and steatohepatitis-metabolic cirrhosis;
• oncological diseases, such as breast cancer, colon cancer, esophageal cancer, and others.

First of all, it is good to remember that at-risk patients should contact their physicians or specialized centers in order to be properly referred and taken care of. Preventing metabolic syndrome is partly possible through:

• maintaining an appropriate weight;
• avoiding overweight and obesity;
• adopting a balanced diet;
• quitting smoking;
• engaging in regular physical activity.

The treatment of metabolic syndrome, therefore, is based on reducing/controlling body weight through: 

• calories restriction resulting from a balanced diet;
• an increase in energy expenditure through aerobic physical activity. 

Physical activity, in fact, allows for greater control of blood pressure, blood sugar, triglycerides and increasing “good” cholesterol, HDL. 

Therefore, it is recommended to perform at least 30 minutes of aerobic physical activity, such as brisk walking, on a daily basis. 

The patient's diet must also be modified to be: 

• rich in vegetables, fruits, whole grains, vegetable protein, lean meats, fish;
• low in saturated fat, red meat, sausages, salt, added sugars.

If changes in dietary-behavioral norms are not sufficient to treat the syndrome, the physician may prescribe specific medications to treat blood pressure, hyperglycemia, and dyslipidemia.