Metabolic Syndrome


Malcolm in the Middle, Fox Broadcasting Company.
Meet Jester. He is in his 30s. He is a go-getter, busy juggling work, family and social responsibilities. He has no time for healthy eating habits and definitely no time for a regular workout schedule. Jester has pretty much maintained a similar lifestyle since his 20s and will continue with this sedentary lifestyle going forward into his 40s and 50s. After all, who has time for their health anyways? Sound familiar? Well Jester is a fictional character, but in this context, he could be you, me, or every third person we know.
That’s because it is estimated that 34% of US adults have Metabolic Syndrome, which is approximately 78 million Americans. The prevalence of obesity worldwide is reaching epidemic levels with other countries such as India, China and Japan joining the bandwagon. The World Health Organization (WHO) estimates that by 2015, 1.5 billion people around the world will be overweight1!
The term Metabolic Syndrome (MetS), was first coined by Haller and Hanefeld in 19752. Also known as Syndrome X or insulin resistance, it is the name of a group of risk factors which include at least 3 of the following 5 conditions:
  • Abdominal obesity (waist circumference: men >40 inches; women >35 inches)
  • Hypertriglyceridemia (>150 mg/dL)
  • Low levels of HDL cholesterol (c-HDL) (<40 mg/dL)
  • Arterial hypertension (>130/85 mm Hg)
  • Hyperglycemia (>100 mg/dL)

The prevalence of MetS correlates with a person’s age, sex, ethnic origin, lifestyle, income and stress levels. It is equally common in men and women, and increases with age.
MetS is a systemic disease involving, and in turn, affecting, several tissues. High fat diet, or increased lipid synthesis/breakdown in the adipose tissue, muscle and liver can cause an increase in free fatty acid levels in the blood that finally accumulate in peripheral tissues. Subsequently, increased carbohydrate breakdown and glucose synthesis in the liver leads to hyperglycemia, which causes hyperinsulinemia and ultimately insulin resistance. Insulin resistance is also sustained by the disruption of the delicate balance between insulin and glucagon secretion by the pancreas. Hormones released by the adipose tissue such as leptin, adiponectin, resistin, etc., also regulate metabolic aspects of carbohydrates and lipids. Dysregulation of genes that control glucose and lipid metabolism in the liver, muscle and adipose tissue, contribute further to the pathogenesis of MetS.

Crosstalk between several tissues can promote Metabolic Syndrome.
The causes of MetS are multifactorial, and the inter-correlation among the mechanisms underlying the different metabolic conditions are not very well understood. However, there is some evidence of a genetic component to MetS, in addition to environmental factors. The heritability of this disease is approximately 25% and genome-wide studies have revealed regions that harbor susceptibility genes for this disease such as the glucose transporter, GLUT23. Further, a single nucleotide polymorphism in the first intron of the fat mass and obesity-associated protein (FTO) gene on chromosome 16q predisposes individuals to MetS4.
There are several consequential risks associated with MetS. It has been established that those with MetS have five times higher risk of developing Type 2 Diabetes and three times higher risk of developing cardiovascular disease. Further, obesity is associated with a high risk for cancer and is a poor prognostic factor for many malignancies including breast, ovarian and pancreatic cancers.
The Simpsons, Fox Broadcasting Company.
Ironically, like Jester, we sometimes feel that these disorders can’t happen to us, right? Even though we’re relatively young, diseases like MetS can sneak up on us. Most of the time, people don’t realize they have it for many years, until a more serious symptom reveals it. So how do we treat MetS? The good news is that it can be managed and, in some cases, even reversed up to a certain stage. The first line of treatment is diet and exercise. Even brisk walking for 40 minutes, 5 days a week, can make a significant difference. The USDA now recommends an eating chart that emphasizes the right proportions of the different food groups to help consumers make healthier food choices5. However, if a change in lifestyle is not effective, then treatment with drugs is required and generally the individual disorders that constitute the MetS are treated separately.

Image from The Harvard Medical School of Public Health.
You may have seen a television show in 2006, about the 1,320-lb guy who was forced to shed some pounds so he could leave his bed, or the 650-lb woman who did something about her weight so she could get married (yes, in America we have our own television shows about how morbidly obese individuals are on a journey of drastic weight loss!). The 1,320-lb guy was last reported to be relatively healthier, weighing 440-lbs in February 2012. So there is hope. If others can do it, we can too! Let’s make sure we stick to our resolution of living and eating healthy and paying regular visits to the doctor. Now if only there was some way of miraculously tying all of these to our monthly paychecks, it would have been so much easier to achieve our goal!

Nutty Professor, Imagine Entertainment.
References:
  1. Metabolic syndrome: a closer look at the growing epidemic and its associated pathologies
  2. Metabolic Syndrome
  3. Genetics of metabolic syndrome
  4. A common variant in the FTO gene is associated with body mass index and predisposes to childhood and adult obesity
  5. Choose My Plate

Family Guy, Fox Broadcasting Network.
Contributed by Mohar Chattopadhyay, PhD.
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