DESCRIPTION

• Metabolic syndrome (MetS) represents a cluster of progressive metabolic abnormalities demonstrating insulin resistance, a proinflammatory and prothrombotic state that together correlate with an increased risk of premature morbidity including complications associated with COVID-19, type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD), stroke, nonalcoholic fatty liver disease (NAFLD), certain cancers, mental and cognitive disorders, and all-cause mortality.
• Multiple definitions for MetS exist. The most commonly accepted from WHO 1999, National Cholesterol Education Program (NCEP) and ATP III 2005, and International Diabetes Federation (IDF) 2006.

EPIDEMIOLOGY

ETIOLOGY AND PATHOPHYSIOLOGY

• Increase in intra-abdominal and visceral adipose tissue with abnormal fatty acid metabolism leading to hormone dysregulation including:
  • Decreased levels of adiponectin and ghrelin
  • Development of resistance to chronically elevated levels of insulin and leptin
• Systemic inflammation (increased IL-6, tumor necrosis factor-α [TNF-α], resistin, CRP), vascular endothelial dysfunction, and a prothrombotic state (increased tissue plasminogen activator inhibitor-1), elevated renin-angiotensin system activation, oxidative stress leading to HTN, atherosclerosis, and mitochondrial dysfunction
• Genetic factors and obesogen exposures appear to contribute to the predisposition promoting obesity and MetS. Parental obesity at the time of conception and epigenetic changes may play a significant role in promoting MetS in offspring.

RISK FACTORS

• Birth status: small for gestational age (SGA) and large for gestational age (LGA), gestational diabetes mellitus (DM)
• Demographics: older age; ethnicity; family history of MetS, T2DM, stroke, and cardiovascular disease
• Lifestyle factors: physical inactivity; high consumption of sugar/fructose/sugar-sweetened beverages, ultra-processed foods, alcohol, smoking, poor sleep
• Alteration of gut microbiome; disordered sleep
• Weight-promoting medications (corticosteroids, antipsychotics, β-blockers)

GENERAL PREVENTION

Maintenance of healthy weight, regular physical activity, limiting intake of processed carbohydrates and sugars, limiting alcohol consumption, smoking cessation, adequate restful sleep, stress management

COMMONLY ASSOCIATED CONDITIONS

PCOS, obesity, HTN, dyslipidemia, hypertriglyceridemia, hyperinsulinemia, acanthosis nigricans, NAFLD, obstructive sleep apnea (OSA), depression and anxiety, cognitive impairment, dementia, GERD, gallstones, osteoarthritis, chronic renal disease, hypogonadism, erectile dysfunction, hyperuricemia, and gout