(Syndrome X; Insulin Resistance Syndrome; Dysmetabolic Syndrome)
Metabolic syndrome is a group of risk factors for
cardiovascular disease. The factors are related to the
breakdown and use of food and the action of the hormone
insulin. These conditions are risk factors for health
issues, such as:
Type 2 diabetes
Coronary artery disease
Peripheral vascular disease
In general, metabolic syndrome is characterized by:
Abdominal obesity—high amount of fat
around the waist
Low levels of "good cholesterol", also
called high density lipoprotein (HDL)
High triglyceride level—type of fat
measured in the blood
High blood pressure
Insulin resistance (glucose intolerance
or prediabetes )—insulin helps move
glucose out of the blood into cells,
resistance increases blood glucose
Coronary Heart Disease
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The exact cause of metabolic syndrome is not known. It
believed to be due to a combination of factors, such as:
Obesity (especially central obesity)
Lack of physical activity
Fatty tissue abnormalities linked to
insulin resistance and obesity
Chronic low-grade inflammation
Risk factors for metabolic syndrome may include the
Overweight (especially excessive fat in
the abdominal region)
Poor diet leading to weight gain
Eating a diet high in
saturated fats, and
starchy foods (eg,
bread, cereal, rice,
pasta, potatoes), and
low in dietary fiber
Drinking a lot of soda,
including diet soda
No difference in
females more than males
females more than males
Genetics: family history of diabetes,
lipid disorders, high blood pressure, or
Socioeconomic factors: low income
Age: over 60 years old
Ethnicity: Latino/Hispanic American,
African American, Native American, Asian
American, Pacific Islander
History of glucose intolerance or
A diagnosis of any of the following
High blood pressure
Chronic kidney disease
Except for obesity, there are no obvious symptoms. The
following symptoms are associated with obesity:
Back or knee pain
Shortness of breath
Reduced exercise tolerance
Elevated blood pressure
The doctor will ask about your medical history. A
physical exam will be done. Your doctor may order lab
tests. such as:
Blood tests to measure:
C reactive protein
Urine test for protein
Calculation of body mass index (BMI)
Measurement of waist circumference
Calculation of 10-year risk of
According to the National Heart Lung and Blood
Institute, you may be diagnosed with metabolic syndrome
if you have at least three of the following:
Waist measurement—greater than 40 inches
in Caucasian men (35 inches in Asian
men) or 35 inches in Caucasian women (30
inches in Asian women)
Fasting glucose level—greater than or
equal to 100 mg/dL* (5.55 mmol/L)
Triglyceride level—greater than or equal
to 150 mg/dL (1.7 mmol/L)
HDL cholesterol—less than 40 mg/dL (1.0
mmol/L) in men and less than 50 mg/dL
(1.3 mmol/L) in women
Blood pressure—greater than or equal to
130/85 millimeters of mercury (mm Hg)
*mg/dL = milligrams per deciliter blood, mmol/L =
millimoles per liter blood
The treatment of metabolic syndrome involves:
Treatment of underlying causes
Treatment of specific metabolic
Gastric bypass or other weight loss surgery may be
helpful to treat metabolic syndrome. Talk to your doctor
to learn if this is an option for you.
Treatment of Underlying Causes
Reducing excess weight by at least 10%
in the next 6-12 months
Increasing physical activity to 30-60
minutes of moderate aerobic exercise
four or more days per week (if approved
by your doctor)
Lowering blood pressure to below 130/85
mmHg with diet, exercise, and possibly
Improving triglyceride and HDL
cholesterol levels through diet,
exercise, and possibly medicine
Treatment of Specific Metabolic Abnormality
High blood pressure—treated with
Insulin resistance—treated with diabetes
medicines (eg, metformin ) and lifestyle
changes (eg, exercise)
High cholesterol—treated with
cholesterol-lowering medicines called
Clotting tendency—treated with low-dose
aspirin (especially in those with
moderate to high cardiovascular risk)
To help prevent metabolic syndrome:
Achieve and maintain a healthy weight.
Do 30 minutes of moderate aerobic
exercise at least four days per week.
See your doctor regularly.
In addition, other unhealthy lifestyle factors also
contribute to heart disease, stroke, and peripheral
vascular disease. To lower your risk of these diseases:
Eat a healthy diet. It should be low in
saturated and trans fats. Also keep it
low in cholesterol. Aim for a diet that
is rich in whole grains, fruits, and
vegetables. Avoid soda. Ask your doctor
if the Mediterranean diet is right for
If you smoke, quit. Smoking greatly
increases cardiovascular risk
Drink alcohol in moderation. This means
no more than two drinks daily for men,
one drink daily for women.
American Heart Association http://www.americanheart.org/
National Institute of Diabetes & Digestive & Kidney Diseases http://www.niddk.nih.gov/
Canadian Cardiovascular Society http://www.ccs.ca/index.php/en/
Canadian Diabetes Association http://www.diabetes.ca/
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Reviewer: Konda Mohan Reddy, MD, FAAP
Review Date: 04/2012
Update Date: 00/40/2012