Metabolic syndrome: causes, symptoms and treatment
Metabolic syndrome is a combination of hormonal and metabolic pathologies, such as abdominal-visceral obesity, disorders of carbohydrate and lipid metabolism, arterial hypertension, and breathing disorders during nighttime sleep. All these diseases are closely related to each other, and it is their combination that determines the presence of metabolic syndrome in humans. This complex of pathologies poses a threat to human life, which is why experts call it a deadly quartet.
The disease is widespread among the adult population, and so much so that metabolic syndrome can be compared to an epidemic. According to various sources, 20-30% of people in the age range from 20 to 49 years old suffer from it. In this age range, metabolic syndrome is most commonly diagnosed in men. After 50 years, the number of patients among men and women becomes the same. At the same time, there is evidence that people with obesity every 10 years are increasing by 10%.
This syndrome adversely affects the progression of cardiovascular diseases, which are associated with atherosclerosis. The syndrome also increases the risk of developing coronary complications, which leads to the death of patients. If a person, in addition to this, suffers from obesity, then the likelihood of developing arterial hypertension in him increases by 50% or more.
Although not a single Russian conference of a therapeutic profile is complete without a discussion of the metabolic syndrome, in practice patients are faced with the fact that they often do not receive adequate therapy for their condition. According to the data provided by the State Research Center for Preventive Medicine, only 20% of patients are provided with the necessary antihypertensive care, while only 10% of patients receive adequate lipid-lowering treatment.
Content:
- Causes of metabolic syndrome
- Metabolic Syndrome Symptoms
- Diagnostics of the metabolic syndrome
- Metabolic Syndrome Treatment
Causes of metabolic syndrome
The main causes of metabolic syndrome are considered to be the patient's genetic predisposition to insulin resistance, his excessive consumption of fats, as well as lack of physical activity.
The main role in the development of the syndrome belongs to insulin resistance. This hormone in the human body is responsible for many important functions, but its basic purpose is to bind to receptors sensitive to it, which are present in the membrane of every cell. After adequate communication, the process of transporting glucose into the cell begins to function. Insulin is needed to open these "entry gates" for glucose. However, when the receptors remain insensitive to insulin, glucose cannot enter the cell and accumulates in the blood. Also, there is an accumulation in the bloodstream of insulin itself.
So, the reasons for the development of metabolic syndrome are:
Genetic predisposition to insulin resistance
Some people have this predisposition from birth.
Gene mutations on chromosome 19 lead to the following problems:
- The cells will not have enough receptors that are insulin sensitive;
- There may be enough receptors, but they lack insulin sensitivity, as a result of which glucose and food are deposited in adipose tissue;
- Human immunity can produce antibodies that block insulin-sensitive receptors;
- Abnormal insulin will be produced by the pancreas against the background of depletion of the apparatus of the organ responsible for the production of beta-protein.
There are about 50 gene mutations that can lead to insulin resistance. Scientists are of the opinion that human insulin sensitivity has become lower as a result of evolution, which made it possible for his body to safely endure temporary hunger. It is known that ancient people often experienced food shortages. In the modern world, everything has changed dramatically. As a result of excessive intake of foods rich in fats and calories, visceral fat accumulates and metabolic syndrome develops. After all, a modern person, as a rule, does not experience a shortage of food, and he consumes mainly fatty foods.
The predominance of food rich in fat
When the mass of consumed saturated fatty acids exceeds the body's ability to process and oxidize them, obesity begins to develop and progress. (read also: Obesity - the degree of obesity and its causes)
Saturated fatty acids negatively affect phospholipids contained in cell membranes, causing changes in their structure. As a result, glucose is not able to enter the cell normally. Also, do not lose sight of the point that fats have a higher calorie content compared to carbohydrates and proteins. This value differs by more than 2 times. So, if 1 g of fat contains 9 kcal, then proteins and carbohydrates are only 4 kcal. It is quite logical that the human body saves extra kilocalories coming from food into fat reserves.
Hypodynamia
Low physical activity is another reason for the development of metabolic syndrome. If a person does not move much, then he slows down the process of splitting fats into lipases, in addition, more triglycerides are stored in adipose and muscle tissue, and glucose enters the muscles in a smaller volume. As a result, metabolic syndrome develops.
Taking medications
Some drugs contribute to the fact that a person's body weight increases.
Among these drugs:
- Antipsychotics (Clozapine, Olanzapine, Risperidone);
- Tricyclic antidepressants;
- Drugs that lower blood sugar (sulfonylurea derivatives, glitazones);
- Glucocorticoids;
- Anticonvulsants (carbamazepine, valproic acid);
- Adrenergic blockers (Beta and Alpha);
- Antihistamines;
- Hormonal contraceptives (Gestagens).
It is these four reasons (genetic predisposition, unhealthy diet, physical inactivity and drug intake) that are leading in the formation of metabolic syndrome.
Nevertheless, it is possible to separately highlight the risk factors that influence its development:
- Obesity;
- Belonging to the male sex;
- Postmenopausal period;
- Abuse of bad habits;
- Senile age;
- Long-term psychological stress on the body;
- Arterial hypertension;
- Certain diseases (Werner's syndrome, familial insulin resistance syndrome, Rabson-Mendenhall syndrome).
Metabolic Syndrome Symptoms
The symptoms of metabolic syndrome are difficult to identify on your own, especially initially. This pathology develops imperceptibly and, unlike many other syndromes, does not cause any painful sensations. However, this does not reduce the risk of illness. So, one of the distinctive features of the metabolic syndrome is that cerebrovascular disease and ischemia of the heart against its background, even in young patients, will be difficult.
The clinical picture of the development of the disease is as follows:
- The patient is more likely to have bouts of bad mood, especially when he is hungry. The appearance of unmotivated aggression and irritability is possible. This is due to insufficient supply of glucose to the brain.
- Decreased performance. Despite the fact that blood sugar levels remain high, the cells themselves are deficient in glucose, which means they are left without a source of energy.
- Sleep apnea syndrome. So, during sleep, a person may snore, but not suspect about it. But during the day, he becomes sleepy, because the night's rest was significantly disturbed. Snoring at night is unsafe, as it increases the risk of coronary heart disease and stroke. In addition, the likelihood of getting professional injuries and provoking car accidents increases.
- An increase in blood pressure with the development of arterial hypertension even in patients at a young age. In this case, the pressure can rise to high levels, without causing sensations characteristic of this state. The pressure does not decrease at night, and sometimes even increases. In parallel, ophthalmologists observe rapidly progressive changes in the fundus. Controlling high blood pressure in metabolic syndrome is especially difficult.
- The development of nephritis (tubulointerstitial) is possible, which may be indicated by an increase in blood pressure and a qualitative change in urine. This is determined by laboratory tests (hypoisostenuria). Patients have attacks of gouty arthritis, which is associated with an increase in the level of uric acid in the blood.
- Abdominal obesity, which is characterized by the deposition of fat in the abdomen and in the shoulder girdle. The danger lies in the fact that fat envelops the internal organs of a person. This leads to their clamping, failures in normal functioning. Abdominal obesity can be talked about when the waist in men becomes more than 94 cm, and in women more than 80 cm.
- External manifestations of metabolic syndrome can be red spots that appear on the skin of the patient's chest and neck. This indicates an increase in blood pressure and vasospasm.
- The appearance of headaches, pain in the heart is possible.
- Symptoms of diabetes mellitus are: constant thirst, a feeling of dry mouth, drowsiness after eating, excessive cravings for sweets, etc.
Diagnostics of the metabolic syndrome
Diagnosis of metabolic syndrome comes down to examining the patient, interviewing him and measuring the waist circumference. The criteria for making a diagnosis are:
- Increase in blood pressure by more than 130 to 80 mm Hg. Art.
- Decrease in HDL cholesterol less than 1.2 mmol.
- Increase in triglycerides by more than 1.7 mmol per liter.
- Increase in LDL cholesterol by more than 3 mmol.
- The patient's glucose tolerance will be impaired.
- Fasting blood glucose values exceed 6 mmol.
All 6 indicators are not required to make a diagnosis. It is sufficient that the patient is diagnosed with central obesity and two additional criteria. Also, doctors use diagnostic methods such as: ECG, daily monitoring of blood pressure, EchoEG, ultrasound of the abdominal organs, CT (allows you to assess the amount of visceral adipose tissue around the organs).
Metabolic Syndrome Treatment
Treatment of metabolic syndrome is reduced to drug and non-drug therapy with the mandatory correction of the patient's lifestyle.
The goals for the doctor and the patient:
- Weight loss;
- Decrease in blood pressure;
- Prevention of complications from the heart and blood vessels;
- Achieve metabolic control.
It has been proven that a decrease in body weight by only 10 kg can reduce the risk of overall mortality by more than 20%. At the same time, the probability of death of a patient from diabetes mellitus decreases by 30% or more, and from oncology caused by obesity - by 40%. In addition, with weight loss, blood pressure will decrease, blood glucose will fall (when measured on an empty stomach) by 50%, and significant indicators such as total cholesterol, LDL, triglycerides will decrease, with an increase in HDL by 8%.
Non-drug therapy is reduced to the following activities:
- Adherence to a low calorie diet
- Changing eating habits;
- Maintaining a healthy lifestyle, refusal of harmful addictions;
- Keeping a diary with a display of the daily diet;
- Exercise.
Loads should be regular. The patient should go in for walking, jogging, swimming, etc. Four moderately intense sessions per week are enough. Their duration should be at least 30 minutes. According to available statistics, about 5% of patients with metabolic syndrome are able to achieve positive dynamics without the use of drugs.
Sometimes, non-drug therapy is not possible without taking certain medications. So, for weight loss, the following drug groups are used:
- Drugs that reduce the amount of food consumed: Mazindol, Sibutramine, Fluoxetine, Phentermine, etc.
- Drugs that increase energy expenditure: Sibutramine, Ephedrine, Caffeine.
- Orlistat helps to reduce the absorption of nutrients.
For the treatment of obesity, only two drugs are mainly used - these are Orlistat and Sibutramine.
Other medications are reduced to the following:
- Hyperglycemia is eliminated by taking drugs that stimulate the production of insulin - Glibenclamide, Glimepiride. Insulin sensitizers, for example, Troglitazone, Rosiglitazone, Pioglitazone, can increase the sensitivity of tissues to insulin.
- To correct blood pressure, ACE inhibitors (Eprosartan, Valsartan, etc.), imidazoline receptor agonists (Moxonidine, Rilmenidine) are used. If there is no heart failure, then it is possible to use drugs of the diltiazem and verapamil group.
- Against the background of coronary heart disease and with tachycardia, it is advisable to prescribe Metoprolol, Bisoprolol.
- Statins are indicated for patients with metabolic syndrome, since all patients with this diagnosis are at increased risk of developing complications from the heart and blood vessels. Against the background of dyslipidemia, it is necessary to prescribe Simvastatin, Lovastatin, Pravastatin. It is recommended to stop taking NSAIDs, grapefruit juice and alcohol.
As for surgery, it can be performed to eliminate nighttime snoring. The indication for surgery is the presence of more than 20 episodes of apnea per night. The most commonly used surgical technique is uvulopalatopharyngoplasty.
As for the prognosis, if untreated, it is unfavorable, the risk of death from the development of cardiovascular disease is high. It is also possible severe kidney damage, which occurs against the background of hypertension and diabetes mellitus. (read also: Causes, Signs and Symptoms of Diabetes Mellitus)
The author of the article: Kuzmina Vera Valerievna | Endocrinologist, nutritionist
Education: Diploma of the Russian State Medical University named after NI Pirogov with a degree in General Medicine (2004). Residency at Moscow State University of Medicine and Dentistry, diploma in Endocrinology (2006).
