What is metabolic syndrome?
The metabolic syndrome, sometimes known as deadly quartet, Reavan syndrome or syndrome X, is now, in addition to smoking as a risk factor for the ultimate disease of the arterial vessels, in particular coronary heart disease considered. It is characterized by the following four factors:
-Abdominal obesity,
-High blood pressure,
-To high blood lipid levels (hypercholesterolemia hyperlipidemia va) and
-Insulin resistance, the main cause of diabetes in adulthood.
The disease develops from a lifestyle that is characterized by constant overeating and lack of exercise, and relates to the living population in industrialized countries.
Metabolic syndrome definition was changed repeatedly in the past years. A generally accepted definition does not exist yet. The classification is based mostly on either the insulin resistance (insulin resistance syndrome, WHO classification 1999) or lifestyle (NCEP-ATP III). There is a globally valid ICD-10 code does not, in Germany the DIMDI Thesaurus allows the detection with the code E.88.9 "metabolic disorder, unspecified". But according to the German Kodierrichtlinie (DKR) D004d no specific code within the ICD-10 catalog is available, the individual manifestations must be encrypted within the G-DRG system.
The treatment focuses primarily on the treatment of obesity. Regardless of drug treatment of high blood pressure, sugar and fat metabolism disorder is usually necessary.
Pathophysiology
The metabolic syndrome is primarily a disease of developed countries and developed from a Western lifestyle, characterized by hypercaloric nutrition and lack of physical exercise. Which triggered obesity leads to insulin resistance. The pancreas is not able to produce enough insulin for the body. This hormone is mainly responsible for the blood sugar levels and ensures that both muscle and adipose tissue can absorb the existing glucose by GLUT-4 transporters. An oversupply of glucose in the blood the pancreas temporarily by increased insulin production to compensate (hyperinsulinemia) with the aim to maintain a euglycemic metabolic state. The high insulin levels lead but with time to a loss of efficacy of the hormone and developed insulin resistance, which can progress to type 2 diabetes.
Significant influence on the development of the metabolic syndrome has the visceral adipose tissue. These are adipocytes (fat cells), which are located between the organs of the abdominal cavity (intra-abdominal). These adipocytes are hormonally active and subject to an increased lipolysis, which is no longer responsive to the inhibitory effect of insulin. Substances secreted TNF-α are inter alia, and interleukin-6 (inflammatory mediators that promote, inter alia, insulin resistance). Simultaneously, the concentration of adiponectin, a hormone produced by adipocytes that acts insulin sensitive, anti-atherogenic and anti-inflammatory drops. The increased release of nonesterified fatty acids by these adipocytes inhibit the action of insulin on the liver, as well as the muscles. This glycogenolysis and gluconeogenesis in the liver will be facilitated and there is increased release of glucose from the liver.
In parallel, it comes to atherogenic dyslipidemia, a special modification of blood lipids characterized by low HDL levels and high levels of triglycerides and small, dense LDL particles. By the influence of free fatty acids increases in the liver, the VLDL production. These lipoproteins are characterized by a high concentration of triglycerides, which make their way into the periphery. VLDL particles are metabolized within the lipid metabolism with elimination of fatty acids by lipoprotein lipase to IDL and LDL. In this case, these lipoproteins interact with HDL particles and exchange over the cholesterol ester transfer protein (CETP), cholesterol esters from triglycerides against. Thus, the Cholesterolanteil decreases in HDL molecules and their concentration decreases. The LDL particle composition also changed due to a decrease in Cholesterolanteile within the lipoproteins. The resulting small dense LDL molecules are atherogenic.
Diagnostics
WHO criteria
According to the WHO criteria of 1998, metabolic syndrome is present when the following risk factors:
-Diabetes mellitus
-Impaired glucose tolerance
-Pathological fasting blood sugar or insulin resistance.
And two of the following parameters:
-Arterial hypertension, ie blood pressure ≥ 140/90 mmHg
-Dyslipidemia: Triglyceride> 1.695 mmol / l and HDL ≤ 0.9 mmol / l (men) or ≤ 1.0 mmol / l (women)
-Visceral obesity: waist-to-hip ratio of> 0.9 (men) or> 0.85 (for women) and / or a BMI> 30 kg / m²
The criteria for the metabolic syndrome have evolved since the original definition by the WHO through better clinical evidence and the analysis by various consensus conferences and professional organizations:
Waist circumference as a criterion
Plays a major role in the definition of metabolic syndrome, as already indicated above, an increased waist circumference. Because cardiovascular risk is less the amount of excess weight rather than the fat distribution pattern decisively: A particular disadvantage here affect fat deposits from the abdomen and the internal organs. This deep abdominal fat - Experts call it "intra-abdominal fat" or "visceral fat" - is very metabolically active. It affects lipid and carbohydrate metabolism (glucose metabolism), so that lipid disorders and diabetes can result.
A measurement of the waist circumference at the waist is considered to be easier and faster way to make an initial risk assessment. An increased risk is, according to ATP III ago for women over 88 cm. In men, the risk area of 102 cm begins. In Germany, about 30-40% exceed this risk threshold. The reduction in waist circumference, for example through sport, the risk of cardiovascular disease can be significantly reduced.
Importance of symptoms
Insulin resistance, obesity, hypertension and dyslipidemia occur independently of each other and each itself indicate increased risk for the later occurrence of coronary heart disease and atherosclerosis.
Therapy
After the diagnosis, a change in lifestyle should be. The aim is to reduce body weight and waist circumference, reduce blood fats and postpone the possible occurrence of diabetes mellitus as far as possible. Recommended this, especially regular physical activity (eg 30 minutes per day, at least three times a week, at least daily but noticeable increase in activity).
On the normalization of body weight on the diet, there are several recommendations: the DGE recommends slowly digested carbohydrates as largest nutritional ingredient and a reduction in the levels of fat (carbohydrates 50 to 60% of the total diet / fat: 20 to 25% / protein = rest about 15 to 20% ). However, there are also studies that look at a greater effectiveness in symptom improvement of the metabolic syndrome with the reduction of the carbohydrate moieties in the diet.
If a diabetes mellitus before, he should be treated medically with insufficient effect of diet and exercise therapy. The same applies to the setting of hypertension.
An increase in the vitamin D levels could possibly be helpful. A meta-analysis of 100,000 patients showed that the metabolic syndrome only half as often as participants occurred in subjects with high vitamin D levels with low levels of vitamin D in the blood.