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Description: Diagnosis of metabolic syndrome

A diagnosis of metabolic syndrome means it’s time to change your lifestyle

At 57, Michel Fortier of Vancouver considered himself reasonably active, trim, and healthy, and would have said he felt fine. So it came as something for a surprise when his doctor informed him he’d developed metabolic syndrome, a cluster or risk factors that doubled his chances of having a heart attack over the next decade, and at least tripled his odds of ending up with Type II diabetes. (Depending o the severity, metabolic syndrome can increase diabetes risk 15- to 20- fold, according to Dr. Jean-Pierre Després, scientific director of the International Chair on Cardiometabolic Risk at University in Quebec city.)

The history of metabolic syndrome stretches back to the late 1960s, when Dr. Gerald Reaven of Stanford University discovered that people with higher than normal, but not yet diabetic blood sugar levels made abundant amounts of insulin ( the hormone responsible for regulating blood sugar), but their bodies were resistant to its effects. Until then, scientist had believed a shortage of insulin was responsible for Type II diabetes. Over the next 25 years, Reaven also observed that these patients who often went to develop elevated blood pressure and abnormalities in the levels of certain blood fats ran a much higher than expected risk of heart attack. Originally dubbed “syndrome X,” this set of risk factors has since been acknowledged by the international medical community as a harbinger of heart disease and diabetes, and renamed metabolic syndrome. It’ also very common: estimates based on data from the Canadian Health Measures Survey place the prevalence in the Canadian population overall at one in five, and two in five among those aged 70 to 79.

It’s not yet clear whether all of the abnormalities that occur in metabolic syndrome stem from the same underlying mechanism, or, for that matter, whether the risk they confer together is exponential rather than simply additive. “There‘s a big debate in the literature as to whether the metabolic syndrome is greater than the sum of its parts,” explains Dr. Sofia Anand, a researcher and professor of medicine and epidemiology at McMaster University in Hamilton, ON.

Nonetheless, most experts agree the concept is useful in the doctor’s office because it raises the suspicion that if a patient has one risk factor, he or she may well have others too, says Dr. Arya Sharma, chair of obesity research and management at the University of Alberta in Edmonton. “From a diagnostic perspective, you need to look for the other problems, and, if they are present, you have to treat them to really reduce the patient’s risk,” he says.

Experts also agree that metabolic syndrome is the result of too little physical activity calories. In an environment that discourages exercise and presents us with high-calorie, high-fat, high-salt snacks at every turn, “you’re not exception if you’re overweight,” Després observes. “What’s really exceptional these days is having a healthy body weight. It’s over lifestyle; we wouldn’t be talking about metabolic syndrome if we were still living like hunter/ gatherers.”

The Big Six

Description: Vegetable

According to the definition developed by the American Heart Association, someone who meets any three of the six following criteria has metabolic syndrome.

  1. Large waist circumference. (40 inches/102 cm or greater for men; 35 inches/88 cm or greater for women). It was Després who pioneered the idea that a simple tape measure could help predict heart disease and diabetes risks. “It turns out that a measurement around the belly (roughly at belly-button-level) is a good indicator of the amount of fat that’s deep in the abdomen, surrounding the organs,” says Dr. Robert Hegele, an endocrinologist and director of the Blackburn Cardiovascular Genetics Lab at the Roberts Research Institute in London, ON, and the London Regional Genomics Centre. This so-called visceral fat acts almost like a gland, pumping out substances that decrease insulin sensitivity, drive up blood pressure, and promote inflammation and blood clotting, thereby increasing heart attack risk. This is why “apple-shaped” people rin a greater risk of heart attack than “pears,” who accumulate their excess weight in the thighs and buttocks. (It’s also worth noting that waist size is not only one of six criteria for metabolic syndrome, it’s also a risk factor for developing the condition.) Scientists aren’t certain whether insulin resistance leads to abdominal obesity or vice versa, but there’s no question both imperil artery and heart health.
  2. Elevated fasting blood sugar. As noted above, blood sugar levels that are higher than normal but not yet in the diabetic range (meaning between 5.7 and 7.0 mmol/L) are linked with an increased risk of heart disease. Among other things, the high levels of insulin that go hand-in-hand with high blood sugars damage blood vessel linings (which can in turn lead to atherosclerosis and heart attack, as well as kidney disease) and nerves.
  3. Elevated systolic blood pressure. A systolic blood pressure (the top number in a blood pressure reading) above 130 in one market of metabolic syndrome; ditto for having to take medications to keep it below 130. Persistent elevations in blood pressure signal that blood vessel and arties are starting to stiffen.
  4. Elevated diastolic blood pressure. Similarly, a diastolic blood pressure ( the bottom number) greater than 85, or needing to take medications to keep it below that level, is another potential indicator of metabolic syndrome.
  5. Elevated triglycerides. (1.7 mmol/L or greater). Creamlike fat (in contrast to waxy cholesterol) in the blood, triglycerides are burned up by muscle cells for energy. However, if too abundant, they can build up on blood vessel walls, which can lead to problems like peripheral artery disease (leg pain triggered by a shortage of blood and, therefore, oxygen) and heart attack. Two dietary demons that raise triglycerides: excess sugar and trans fats, a type of fat found mostly in processed foods.
  6. Low HDL cholesterol. (Less than 1.0 mmol/L for men;less than 1.1 mmol/L for women). HDL cholesterol acts as a sort of natural drain cleaner in arteries and blood vessels, clearing away potentially damaging LDL cholesterol. The goods news (yes, there is some!) is that regardless of whether or not the above-listed abnormalities stem from a common cause, all can be prevented or failing that, managed with the same simple tweaks in life style.
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