Metabolic syndrome, which is also called Syndrome X, is becoming more and more prevalent in the western world.

It is estimated that up to 34% of American adults older than 20 years already suffer from this syndrome and it is very plausible that more or less the same figures will apply in all population groups in Australia, who eat a western diet and follow a western lifestyle.

What is the metabolic syndrome?


The metabolic syndrome is a cluster of important risk factors that include:

    • raised blood fat levels - low-density lipoprote

    • in cholesterol (LDL-C), which is also know as 'bad cholesterol', triglycerides and other fat fractions;

    • decreased high-density lipoprotein cholesterol (HDL-C), which is also referred to as 'good cholesterol';

    • hypertension or high blood pressure;

    • high glucose and insulin levels or insulin resistance;

    • obesity which is defined as a BMI of 30 or more.



A patient is defined as suffering from the metabolic syndrome if he, or she, has three or more of the above-mentioned conditions.

Metabolic syndrome is also linked to conditions such as polycystic ovary syndrome (PCOS), the menopause and advancing age.

American research


An American study conducted in the period between 2003 – 2006 among more than 3,400 adults aged 20 or older, of both sexes and different ethnic origins, used the National Cholesterol Education Program’s Adult Treatment Panel III guidelines to identify adults who met the criteria for metabolic syndrome. Ervin (2009) reported the following in relation to the metabolic syndrome:

    • nearly 34% of both the male and female subjects were classified as suffering from the metabolic syndrome;

    • males and females of 40-59 years were 3 times more likely to meet the criteria for metabolic syndrome as those aged 20-39 years of age;

    • males older than 60 years were 4 times as likely and women of the same age were 6 times more likely to meet the criteria compared to the younger age groups;

    • Hispanic and white men were more prone to the metabolic syndrome than black men;

    • Hispanic and black women were more prone to developing the metabolic syndrome than white females;

    • the incidence of metabolic syndrome increased with advancing age;

    • overweight and obese males were respectively 6 and 32 times more likely to have metabolic syndrome than normal weight men, while overweight and obese females were respectively 5 and 17 more likely than normal weight women to have metabolic syndrome;

    • additional risk factors for developing the metabolic syndrome included smoking, high refined carbohydrate intake and physical inactivity in men, as well as smoking, non-drinking, low household income and postmenopausal status in women;

    • the predominant risk factors associated with the metabolic syndrome predispose adults to developing heart disease, stroke and type 2 diabetes (NIDDM or non-insulin dependent diabetes mellitus);

    • 'central adiposity' or abdominal fat increases the risk of metabolic syndrome, i.e. individuals with a typical 'beer gut' are more likely to develop this syndrome than individuals with other fat distributions (e.g. on the hips and breasts);

    • in women, the menopause is associated with a shift in body fat from the hips and breast to the abdominal area and a concomitant increase in metabolic syndrome.



How to counteract the metabolic syndrome


Research has shown that the most potent lifestyle change anyone can make to counteract the metabolic syndrome is to do more exercise. The next best thing to increasing physical activity is to lose weight.

Researchers have found that even a modest loss of 5% or more of body weight (e.g. an obese woman weighing 70kg would only have to lose 3.5kg) will improve many of the risk factors associated with the metabolic syndrome.

Patients who have been diagnosed with the metabolic syndrome should, therefore, strive to do two things:

    • Increase their physical activity by doing 30 minutes of exercise a day. The simplest way to achieve this is to go for a brisk walk for half an hour every day of the week. Most people should be able to fit this type of exercise into their schedules and the beauty of such a solution is that one does not need complicated equipment or to pay expensive gym fees to get active. Other inexpensive options are to cycle or swim. However, if you are a person who needs encouragement to get active, then it may be an idea to join a fitness club that specialises in walking (i.e. Walk for Life) or a good gym so that the instructors can keep you motivated and monitor your progress. Always check with your medical doctor if you are allowed to do exercise and if walking is indicated. Don't start off with 10 km a day – ease into exercise slowly and listen to your body while you gradually increase the intensity and duration of your exercise.

    • Lose five percent or more of their weight. There are many ways in which you can achieve weight loss, but the most sensible way is to consult a clinical dietitian. You will need a diet that is low in total fat, saturated fat and cholesterol (to lower 'bad cholesterol') and high in foods with a low glycaemic index (GI). Such a diet is not easy to compile and you may find it difficult to apply - this is where the dietitian will come in useful. He or she will firstly work out a diet that is tailored to your unique set of circumstances (e.g. obesity, raised blood glucose and insulin levels, high blood pressure and raised blood fats). Then the dietitian will assist you with correct food choices and steer you through the problems you may encounter with purchasing the right foods and working out portion sizes and distribution of certain foods over the day (e.g. intake of carbohydrates with a low GI at each meal in combination with other foods that lower your blood glucose and insulin levels). Such a diet will also decrease your blood fat levels and help you to lose weight.



Your doctor may also prescribe certain medications (blood pressure pills, or statins to lower cholesterol, or one or more diabetic medicines), which you would use in combination with exercise and diet.

If you have been diagnosed with metabolic syndrome there is no need to panic, follow your doctor's instructions, get active and consult a dietitian. Once you have got into the habit of exercising on a daily basis, eating correctly and taking the correct medications, your symptoms will improve dramatically.

Reference

Ervin B (2009). Prevalence of metabolic syndrome among adults 20 years of age and over, by sex, age, race and ethnicity, and body mass index: United States, 2003-2006. National Health Statistics Reports. No. 13, May 5, 2009. US Department of Health & Human Services. Centres for Disease Control & Prevention, National Centre for Health Statistics.