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Metabolic Syndrome

What is metabolic syndrome?

Metabolic syndrome is a condition that includes the presence of a cluster of risk factors specific for cardiovascular disease. According to the National Heart Lung and Blood Institute (NHLBI), metabolic syndrome significantly raises the risk of developing diabetes, heart disease, and/or stroke.

Most people who have metabolic syndrome have insulin resistance. The body makes insulin to move glucose (sugar) into cells for use as energy. Obesity, commonly found in people with metabolic syndrome, makes it more difficult for cells in the body to respond to insulin. If the body cannot make enough insulin to override the resistance, the blood sugar level increases, and type 2 diabetes can result. Metabolic syndrome may be a beginning of the development of type 2 diabetes.

The cluster of conditions and risk factors related to metabolic syndrome was first named in 1988. Dr. Gerald Reaven proposed that insulin resistance was central to the cause of type 2 diabetes, high blood pressure, and cardiovascular artery disease. Reaven called this cluster of abnormalities "Syndrome X." Since that time, Syndrome X has come to be known by various names, including metabolic syndrome, dysmetabolic syndrome, and insulin resistance syndrome. Syndrome X is now widely known as metabolic syndrome.

The American Heart Association (AHA) recognizes metabolic syndrome as a problem of growing concern, especially for those older than 60. Research suggests that more than 47 million Americans have it. Because the population of the United States is aging, and because metabolic syndrome prevalence increases with age, the AHA has estimated that metabolic syndrome soon will become the primary risk factor for cardiovascular disease, ahead of cigarette smoking. Increasing rates of obesity are also thought to be related to the increasing rates of metabolic syndrome.

The cluster of metabolic factors involved, according to the NHLBI, includes:

The NHLBI and AHA recommend a diagnosis of metabolic syndrome when three or more of these factors are identified.

What causes metabolic syndrome?

Because of the involvement of several interconnected factors in metabolic syndrome, the direct cause is not clearly understood. The rise in obesity, coupled with a sedentary lifestyle, contributes to risk factors for metabolic syndrome, such as high cholesterol, insulin resistance, and high blood pressure. These risk factors may lead to cardiovascular disease and type 2 diabetes.

Because metabolic syndrome and insulin resistance are closely associated, many health care professionals believe that insulin resistance may be a cause of metabolic syndrome. However, a direct link between the two conditions has not been established. Others believe that hormone changes, caused by chronic stress, lead to the development of abdominal obesity, insulin resistance, and elevated blood lipids (triglycerides and cholesterol).

Other factors that are thought to contribute to the development of metabolic syndrome include genetic variations in a person's ability to break down lipids (fats) in the blood, older age, and abnormalities in the distribution of body fat.

What are the risk factors for metabolic syndrome?

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases have different risk factors.

Knowing your risk factors for any disease can help to guide you to take the appropriate actions, including changing behaviors and being clinically monitored for the disease.

Risk factors most closely associated with metabolic syndrome include:

What are the symptoms of metabolic syndrome?

While there are few symptoms experienced in metabolic syndrome, there may be several signs. A symptom is evidence of disease or physical disturbance that a person experiences and can describe. By contrast, a sign is objective evidence of disease as observed and interpreted by a doctor or other clinician.

Factors such as high blood pressure, elevated triglycerides, and/or overweight or obesity may be signs of metabolic syndrome. People with insulin resistance may have acanthosis nigricans, which is darkened skin areas on the back of the neck, in the armpits, and under the breasts. In general, however, people do not directly experience symptoms of metabolic syndrome.

The indications of metabolic syndrome may resemble other conditions. Consult your doctor for a diagnosis.

How is metabolic syndrome diagnosed?

The National Cholesterol Education Program's Adult Treatment Panel III, the World Health Organization, and the American Association of Clinical Endocrinologists have each developed a set of criteria to be used as an aid in diagnosing metabolic syndrome.

Included among the criteria of these organizations are:

Each organization has its own guidelines for using the above criteria to establish a diagnosis of metabolic syndrome.

How is metabolic syndrome treated?

Specific treatment will be determined by your doctor based on:

Because metabolic syndrome increases the risk for the development of more serious, chronic conditions, such as cardiovascular disease and type 2 diabetes, treatment for metabolic syndrome is important. Other conditions that may develop as a result of metabolic syndrome include:

Types of treatment that may be recommended for metabolic syndrome include:

Lifestyle management

A program of weight loss and exercise provide the foundation of treatment for metabolic syndrome. Weight loss increases HDL cholesterol (the "good" cholesterol) and decreases the harmful type of LDL cholesterol and triglycerides. Weight loss can also reduce the risk of type 2 diabetes.
Even a modest weight loss of five to ten percent of total weight can positively affect blood pressure and increase sensitivity to insulin, as well as reduce central obesity. Together, diet and exercise improve risk factors more than diet alone.
Other lifestyle management factors include smoking cessation and limiting alcohol consumption.


Changes in dietary habits are important in the treatment of metabolic syndrome. According to the AHA, treatment of insulin resistance is necessary to achieve the greatest benefit for modifying metabolic risk factors. In general, the best way to treat insulin resistance is through weight loss and increased physical activity.
A variety of methods can be used to lose weight and increase physical activity. Incorporating multiple methods, such as making diet changes and maintaining a regular amount of moderate to vigorous physical activity, may be beneficial. These methods include, but are not limited to, the following:


Exercise benefits people who are overweight or obese by helping to keep and add lean body mass, or muscle tissue, while losing fat. It also helps to increase the rate at which weight is lost if a person is eating healthy food according to a meal plan because muscle tissue has a higher rate of metabolism, thus burning calories faster.
Walking is an excellent choice of exercise for people who are obese. A walking program should start slowly by walking 30 minutes daily for a few days a week and increase gradually to the goal of walking for longer periods most days of the week.
Exercise lowers blood pressure and can help prevent type 2 diabetes. Exercise also helps to improve emotional well-being, reduce appetite, improve sleeping ability, improve flexibility, and lower LDL cholesterol.
Consult your health care provider before starting any exercise program.


People who have metabolic syndrome and who are at risk may be candidates for medication therapy, especially if other measures, such as dieting and lifestyle changes, have failed to produce acceptable results with weight loss, decreased blood pressure, lowered cholesterol levels, and/or decreased insulin resistance.
Medications may be prescribed to help lower blood pressure, improve insulin metabolism, lower LDL cholesterol and raise HDL cholesterol, and/or increase weight loss.

Weight loss surgery

Weight-loss surgery (bariatric surgery) is the only option today that effectively treats morbid obesity in people for whom more conservative measures, such as diet, exercise, and medication, have failed.
Studies have shown that all aspects of metabolic syndrome, including blood pressure, cholesterol, and increased body weight, may be improved by gastric bypass surgery for morbid obesity at one year after the procedure.
There are a variety of approaches to bariatric surgery, but all procedures are either malabsorptive, restrictive, or a combination of the two. Malabsorptive procedures change the way the digestive system works. Restrictive procedures are those that severely reduce the size of the stomach to hold less food, but the digestive functions remain intact.