Metabolic Syndrome
Signs and Symptoms of Metabolic syndrome: 5
1. central obesity (increased abdominal adipose tissue (apple shape) 2. Hyperglycemia (imparied glucose tolerance ) > diabetes mellitus 3. Dyslipidemia (increased triglycerides) -> arterial plaque buildup 4. Dyslipidemia (decreased HDL- cholesterol) -> arterial plaque buildup 5. Hypertensinon (increased blood pressure) 3 of any 5
Catabolism dominates in the fasted state: (4 major adaptations)
1. proteolysis: mobilizes amino acids in skeletal muscle 2. gluconeogenesis: in liver and kidney cells 3. Triacylglycerol lipolysis: in adipose tissue 4. Beta oxidation and ketogenesis: in liver cells
Lifetime Probability of developing metabolic syndrome: Men and Women
1:3
Risk Factors for Metabolic Syndrome: Vascular diseases
3 - fold higher risk for atherosclerosis and cardiovascular disease
Risk Factors for Metabolic Syndrome: Kidney Disease
3 - fold higher risk for chronic kidney disease
Risk Factors for Metabolic Syndrome: Diabetes Mellitus
5- fold higher risk for type 2 diabetes mellitus
Effects of physical activity
Increases insulin sensitivity and glucose transport improves cardiovascular risk - decreases blood pressure - decreases triglycerides - increases good HDL cholesterol - decreases bad LDL cholesterol improves weight management
Treatment for metabolic Syndrome: Primary intervention
Lifestyle changes Quit smoking weight reduction (<25 BMI) - healthy diet (low in sugar and fat) to lower caloric intake - increase physical activity Beneficial effects on weight, lipid profile, insulin sensitivity, and blood pressure
Cytokine: Adipocnectin - adipocytes
anti- atherogenic: decrease foam cell formation decrease vascular remodeling Anti- diabetic: increased insulin sensitivity decreased hepatic glucose output decreased in central obesity
What is the best predictor of adverse lipid proflies
central obesity
Fibrates
decrease Fatty acids and triglycerides in circulation increase HDL Cholesterol
antihypertensives
decrease blood pressure
Statins
decreases LDL cholesterol inhibit HMG- CoA reductase
Cytokine: Interleukin 6 (IL-6) - macrophate
pro-atherogenic: increases vascular inflammation Pro - diabetic: decreases insulin signalling increases in central obesity
Population attributable risk (PAR)
the proportion of heart attacks in the total population attributable to a specific risk factor
Thiazolidinediones (TZDs)
activate PPAR gamma decrease hyperglycemia
Risk Factors for Metabolic Syndrome - 6
1. Central obesity (BMI> 30) 2. Insulin resistance 3. Aging 4. Genetic predisposition 5. Hormonal Changes 6. Lack of exercise
Prevalence of Metabolic Syndrome in the US (ethnicity) : Women
Hispanic > African American > White> Other
Prevalence of Metabolic Syndrome in the US (ethnicity) : Men
Hispanic > White > Other > African American
Risk Factors for Metabolic Syndrome: Other Disorders
Increased risk for non alcoholic fatty liver disease increased risk for reproductive disorders (PCOS)
Cytokine: Tumor Necrosis Factor a (TNF-a) - Macrophage
Pro-atherogenic - increases vascular remodeling Pro - diabetic - decreases insulin sensitivity in adipocytes increased in central obesity
Cytokine: Plasminogen activator inhibitor 1 (Pal-1) - adipcytes
Pro-atherogenic: increased thrombotic (blood clot) risk at sites of atherosclerosis increased in central obesity
Risk Factors for Metabolic Syndrome: Metabolic Syndrome itself is a Risk Factor: 4
Vascular disease Diabetes Mellitus Kidney disease Other disorders
glipizide
insulin sensitizer decreases hyperglycemia
Treatment for metabolic Syndrome: Secondary intervention
management of dyslipidemia, hyperglycemia, and hypertension (blood pressure) Aspirin for cardiovascular disease prevention by reducing thrombotic events (blood clots)
What are the best predictors of cardiovascular disease and heart attack
metabolic syndrome risk factors - Dyslipiedemia, decreased HDL (49) Central Obesity (20) Hypertension (18) Diabetes (10)
Metformin
suppresses hepatic glucose production and fatty acid synthesis Decreaes hyperglycemia
