Tanta University

Faculty of Medicine

Student Research Project

Year: One Two Three

Group Number : 67
Course / Module Title : Nutrition module
Course/Module Code : NM2202
Research Topic : Metabolic syndrome
Date of Submission : 2 / 6 /2020

Student Names :

1
‫‪Student name‬‬ ‫‪Student ID‬‬ ‫‪National ID‬‬
‫‪ 4181351‬زياد صابر عبد المعطي حسين‬ ‫‪30005271601359‬‬
‫‪ 4181352‬زياد فوزي محيسن شعيب‬ ‫‪30004091601834‬‬
‫‪ 4181353‬زياد دمحم مبروك عبد القادر عالم‬ ‫‪30011061601631‬‬
‫‪ 4181354‬زياد وليد السيد زكي‬ ‫‪30001151602895‬‬
‫‪ 4181355‬زينب ابراهيم مسعد الخواجه‬ ‫‪29912011608769‬‬

‫‪Student name‬‬ ‫‪Role in the research‬‬

‫زياد صابر عبد المعطي حسين‬ ‫‪Total review of the research‬‬

‫زياد فوزي محيسن شعيب‬ ‫‪Collecting pictures and writing resources‬‬

‫زياد دمحم مبروك عبد القادر عالم‬ ‫‪Writing summary and conclusion‬‬

‫زياد وليد السيد زكي‬ ‫‪Writing introduction and objectives‬‬

‫زينب ابراهيم مسعد الخواجه‬ ‫‪Writing the research review‬‬

‫‪2‬‬
 Introduction and Objectives

Introduction:
Metabolic syndrome itself is not considered a disease. Instead, it is a group of risk factors
including diabetes and raised fasting plasma glucose, central obesity, high level of
cholesterol, and elevated blood pressure. It raises the risk of heart disease and other health
problems, such as cardiovascular diseases, diabetes mellitus, stroke, and diseases related to
fatty accumulation in artery walls.
Metabolic syndrome has many causes that act together, such as obesity and fat distribution, a
sedentary lifestyle, genetic cause, and endocrine cause.
Metabolic syndrome has many components among them abdominal obesity, atherogenic
dyslipidemi , elevated blood pressure, insulin resistance, proinflammatory state,
prothrombotic state and other components.
Although metabolic syndrome is a serious condition, the risks can be reduced significantly
by reducing body weight, increasing physical exercise, eating a heart-healthy diet that is low
in sugar, fat and sodium and management of blood glucose, blood cholesterol, and blood
pressure.
Metabolic syndrome can be diagnosed by physical exam and blood tests. The person must
have at least three of the five metabolic risk factors to be diagnosed with metabolic
syndrome.

Objectives:
1. To know the medical definition of metabolic syndrome.
2. To understand the causes of metabolic syndrome.
3. To analyze the components of metabolic syndrome.

4. To understand the risk factors of the metabolic syndrome.

5. To discuss the pathophysiology of atherosclerotic cardiovascular disease and insulin

resistance in metabolic syndrome.

6. To know the diagnosis of metabolic syndrome.

7. To know how to manage and the treatment of metabolic syndrome.

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 Research review
 Definition:
(Grundy et al., 2004) It is a group of biochemical and physiological abnormalities associated
with the development of a cardiovascular disease, atherosclerosis, stroke, and type 2 diabetes
mellitus.

 Prevalence:
(Beigh & Jain, 2012) Gender differences were seen as considerable statistically concerning
HDL cholesterol, waist circumference, and fasting blood glucose levels while they were
similar related triglyceride. Using the standard severance values of the individual components
for metabolic syndrome the distribution was as follows: the low HDL cholesterol was seen in
25% of females as compared to 34% males. 42% of males had waist circumference>/=90 cm,
while 63% of females had a waist circumference >/= 80 cm. Similarly, hyperglycemia also
significantly varied in males as contrasted to females i.e. 25%vs 42% respectively. Metabolic
syndrome according to ATP III criteria i.e. the people who had three or further risk factors,
was found in 128 (25.6%) of study participants. Table1 shows that in both women and men a
cluster corresponding to the metabolic syndrome represented 29% and 23% of the women's
and men's samples, respectively the statistical results were analyzed to be sign ificant which
was also statistically considerable.

Table1 shows the prevalence of gender in metabolic syndrome (Xu et al., 2013)

 Causes : (Roberts, Hevener and Barnard, 2013)

Metabolic syndrome is a collection of risk factors , so there is no single cause.
 Obesity and fat distribution:

Prevalence of obesity is an important factor in influencing the prevalence of metabolic

syndrome as having central obesity or overweight (Figure1) is a major factor, but abnormal

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blood lipid and cholesterol levels, elevated blood pressure, and insulin resistance also share in
cardiometabolic risk. The waistline of 40 inches or more for men and 35 inches or more for
women (measured across the belly), triglyceride level above 150 mg/dl, and high-density
lipoprotein level (HDL) below 40 mg/dl (men) or under 50 mg/dl (women).

Figure 1 : shows central obesity (Jul 26 and 2019, n.d.)

 Genetic cause:
Each feature of metabolic syndrome is defined by a combination of gene-environment
interactions. Family history and ethnic background can increase the chance of
developing metabolic syndrome.

 Sedentary lifestyle :
Physical inactivity is a predictor of CVD events and related mortality and eating food
contains high calories and rich in fat. Many components of metabolic syndrome are related to
a sedentary lifestyle, involving increased adipose tissue (frequently central); reduced high-
density lipoprotein (HDL) cholesterol and elevated triglycerides, blood pressure, and blood
glucose in the genetically susceptible.

 Endocrine cause :

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Hormonal disturbances can affect the prevalence of the metabolic syndrome as the
low total testosterone and sex hormone-binding globulin levels both independently
foretell the development of the metabolic syndrome.

 Components of Metabolic Syndrome:(Grundy et al., 2004)

 Abdominal obesity
 Atherogenic dyslipidimia
 Raised blood pressure
 Insulin resistance ± glucose intolerance
 Proinflammatory state
 Prothrombotic state

 Abdominal obesity:

Abdominal obesity is strongly associated with metabolic syndrome. It presents clinically as

the presence of excess fat in the abdominal area and increases waist circumference more than
or equal to 94 cm in males or 80 cm in females.

 Atherogenic dyslipidimia:

Atherogenic dyslipidemia manifests in routine lipoprotein analysis by elevated levels of

triglycerides above 150 mg/dl and low concentrations of HDL cholesterol less than 40
mg/dl (men) or under 50 mg/dl (women), also increased remnant lipoproteins, elevated
apolipoprotein B and small LDL particles.

 Raised blood pressure:

Elevated blood pressure strongly associates with obesity and commonly occurs in insulin-
resistant persons above 130/85 mm Hg or higher or are taking blood pressure medications.
Hypertension is commonly listed among metabolic risk factors. Definitely, hypertension is
originally multi-factor. For example, increasing arteriosclerosis contributes significantly to
systolic hypertension in the elderly. Even so, most conference participants preferred the
inclusion of high blood pressure as one component of the metabolic syndrome .

 Insulin resistance ± glucose intolerance:

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Insulin resistance is found in the majority of people with metabolic syndrome. It hardly
associates with other metabolic risk factors and correlates individually with CVD risk. These
associations, combined with the belief in its importance, explain the term insulin resistance
syndrome. Fasting blood glucose more than or equal 100 mg/dl or previously diagnosed type
2 diabetes mellitus.

 Proinflammatory state: ([Link], n.d.)

It is recognized clinically by an increased level of C-reactive protein (CRP), which is

commonly present in persons with metabolic syndrome. Multiple mechanisms seemingly
underlie elevations of CRP. One cause is obesity because excess adipose tissue releases
inflammatory cytokines that may evolve higher CRP levels as c-reactive protein is the best
characterized biomarker of inflammation and also, an independent predictor of
cardiovascular events.

 Prothrombotic state:

It is characterized by elevated plasma plasminogen activator inhibitor (PAI) and fibrinogen,

also connect to the metabolic syndrome. Fibrinogen, an acute-phase reactant like CRP,
increases in response to a high-cytokine state. Thus, prothrombotic and proinflammatory
states may be metabolically interrelated.

 Risk factors: (Hammarsten et al., 1998)

The following factors influence the risk of promoting metabolic syndrome:

 Large waistline.

 Family history of metabolic syndrome.

 Lack of exercise combined with a high-calorie diet.

 Insulin resistance.

 The use of some medications.

Some drugs that are used to handle inflammation, HIV, allergies, and depression can raise the
risk of weight gain or experiencing changes in blood pressure, cholesterol, and blood sugar
levels.

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  Pathophysiology of atherosclerotic cardiovascular disease in
metabolic syndrome: (Reilly and Rader, 2003)

Figure 2 : Pathophysiology of atheroscleroric cardiovascular diseases (Eriksson, 2017)

Central obesity and innate immunity (Figure 2) play main roles in the development of
insulin resistance, chronic inflammation, and metabolic syndrome features through the effects
of adipokines ( leptin, adiponectin, resistin) and cytokines (tumor necrosis factor-α,
interleukin-6) on the liver, skeletal muscle, and immune cells. Moreover,
monocyte/macrophage and adipocyte-derived factors may have direct atherothrombotic
effects that enhance the development of atherosclerotic cardiovascular diseases. Common
genetic variation and environmental components may affect the development of
atherosclerosis at multiple levels through impacts on central adiposity, innate immunity,
glucose and lipoprotein metabolism, and vascular function. Metabolic syndrome is identified
by a collection of interrelated atherogenic risk factors including oxidative stress,
dyslipidemia, elevated blood pressure, high blood glucose, obesity, insulin resistance, and
lifestyle factors such as dietary patterns and physical inactivity. Together, these risk factors

8
increase the risk of stroke, heart disease, and type 2 diabetes. Having three or more of these
components would qualify a person as having metabolic syndrome.

 Pathophysiology of Insulin resistance and its relation to

metabolic syndrome : (Tenenbaum, Fisman and Motro, 2003)

Insulin resistance is defined as a defect in insulin action in target tissues, hence higher than
normal concentration of insulin is required to maintain a normal blood glucose level. On a
cellular level, it indicates an insufficient strength of insulin signaling from the insulin
receptor to the final substrates of insulin action involved in cellular function. The metabolic
response of Insulin resistance and subsequent hyperinsulinemia is referred to the
development of serious health conditions such as overweight, hypertension, hyperlipidemia,
cardiovascular disease, and type-2 diabetes mellitus. The growth of insulin resistance leads to
many of the metabolic abnormalities associated with this syndrome. Patients with insulin
resistance tend to have impaired fasting plasma glucose levels, which increases the
prevalence of more atherogenic cardiovascular diseases, small dense low-density lipoprotein
(LDL) particles. The increasing incidence of insulin resistance and metabolic syndrome is
seriously threatening human health globally. there are 2 major pathways of metabolic
syndrome development:

 With protected pancreatic beta cells function and insulin hypersecretion which can
compensate for insulin resistance. This pathway leads mainly to the vascular
complications of metabolic syndrome.
 With massive damage to pancreatic beta cells functions, it leads to a progressive
decrease of insulin secretion and to hyperglycemia. This pathway leads to vascular
complications, such as atherosclerosis.

 Complication of metabolic syndrome: (Arora, 2012)

The complications that may result from metabolic syndrome are considerably serious and
long-term complications. They include:

 Hardening of the arteries (atherosclerosis).

9
  Diabetes.

 Heart attack.

 Kidney disease.

 Stroke.

 Nonalcoholic fatty liver disease.

 Peripheral artery disease.

 Cardiovascular disease.

If diabetes develops, the person may be at risk for additional health complications, including:

 Eye damage (retinopathy).

 Nerve damage (neuropathy).

 Kidney disease.

 Amputation of limbs.

 Diagnosis : (Lee and Sanders, 2012)

Metabolic syndrome is an expression used to determine a patient who presents with 3 or more
of 5 risk factors as shown in figure 3:

 Abdominal obesity and waist circumference for men greater than 102 cm or 40
inches, and for women greater than 88 cm or 35 inches.
 Elevated triglycerides, defined as equal to or greater than 150 mg/dl
 Reduced HDL cholesterol concentration under 40mg/dl for men and less than 50
mg/dl for women.
 Elevated blood pressure: systolic over 130 mmHg or diastolic over 85 mmHg.
 Fasting blood glucose level equal to or greater than 110 mg/dl.

If the patient has three of the five previous symptoms , he definitely has
metabolic syndrome.

11
 Figure 3 : shows symptoms and signs of metabolic syndrome (Mayo Clinic, 2018)

 Management : (Fappa et al., 2008)

Metabolic syndrome results from increased calorie consumption disproportionate to metabolic
requirements. Lifestyle modification is essential in the management of risk factors as
follow:

 Eating a “heart-healthy diet” that is low in sugar, fat, and sodium, and has small
amount of calories.
 Practicing exercise as it is a great way to lose weight.
 Avoiding smoking and reducing alcohol intake.
 Limiting the intake of red meat, sodium, saturated fats, sweetened food, and
drinks.
 Eating plenty of fruits, vegetables, fish, and nuts.

 The AHA suggests doing at least 150 minutes of moderate exercise each week. These can
be broken up into 10-minute s choosing foods from healthful sources

11
 The DASH diet focuses on what people eat rather than how to reduce calories, but those
who want to lose weight should follow the diet which has low calories.

 Treatment : (Rochlani et al., 2017)

Pharmacotherapy is another option for the prohibition of CVD. Major pharmacological
involvements include:

 Management of dyslipidimia: cholesterol medicines which include statins,

niacin, zitia and other drugs.

 Decreasing prothrombotic risk: with antiplatelet drugs.

 Diabetes medicines : which may be necessary if the patient has glucose

intolerance. Drugs include: Metformin – Thiozolidinedione.

 Pressure medicines: which include ACE inhibitors, Diuretics, Beta blockers, and
other drugs.

 A Low dose of Aspirin: which can reduce the risks of heart attack and stroke.

 Fibrates : improve all components of atherogenic dyslipidemia and appear to

decrease the risk for CVD in people with metabolic syndrome.

 Statins : reduce all ApoB-containing lipoproteins and to achieve goals for LDL-c as
well as for non-HDL-c.

 NB: There is no single drug therapy for metabolic syndrome but the use of prolonged
multiple medications.

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 Summary and conclusion
Metabolic syndrome is a global epidemic that can't be underestimated and an established risk
factor for insulin resistance, atherosclerotic, and cardiovascular diseases. There are many
causes of it but the commonest cause is central obesity. Metabolic syndrome is not a disease
itself but has many components including abdominal obesity, atherogenic dyslipidemia,
elevated blood pressure, insulin resistance, proinflammatory state, and prothrombotic state.
It has many risk factors that can cause human death, such as genetic factor, fat deposition,
and lack of exercise. People with the syndrome are twice as likely to die from vascular
disease and three times as likely to have ischemic heart disease and stroke compared with
people without the syndrome. The syndrome is affecting the general population in epidemic
proportions and is frequently associated with increased risk of cardiovascular morbidity and
mortality. It can be managed by practicing exercise to lose weight, eating healthy diet, and
regulating blood pressure and blood glucose level. There is no specific pharmacotherapy for
metabolic syndrome, It can be treated by reception of cholesterol medicine, and taking
pressure and diabetes medicines. In this context, the development of nutraceuticals that are
easily available and with minimal side effects may represent an area of promise in the
development of novel therapies.

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 References

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