Metabolic syndrome: what is it?

Metabolic syndrome: what is it?

Metabolic syndrome is a combination of four different diseases and symptoms that occur more frequently in industrialized countries and lead to an increased risk of developing cardiovascular diseases. In this article, you will find out what the “deadly quartet” is all about, how the metabolic syndrome can be recognized and treated, what role nutrition plays and what sensible prevention looks like.

Definition: What is Metabolic Syndrome?

Metabolic syndrome is not a disease in its own right. Instead, the term summarizes various risk factors or clinical pictures. These increase the probability of the occurrence of vascular diseases, including stroke and heart attack. Those affected often also develop type 2 diabetes, which can lead to severe further damage.

The cause of the metabolic syndrome is the modern lifestyle, especially in the industrialized nations of Europe and North America. Therefore, the term “diseases of affluence” is also used. Unhealthy diets and lack of exercise lead to obesity and changes in carbohydrate and fat balance that reduce the cells’ sensitivity to insulin, reducing the body’s ability to lower blood sugar levels. Blood pressure and blood lipid levels also rise accordingly.

Since the metabolism (metabolism) is affected in different ways, it is called “metabolic syndrome”. Other designations are “deadly quartet”, Reaven Syndrome or Syndrome X.


Which diseases are part of the metabolic syndrome?

The metabolic syndrome combines four risk factors, each of which can lead to vascular calcification ( arteriosclerosis ) and cardiovascular diseases. According to the International Diabetes Federation (IDF), limit values ​​are defined for individual factors. In any case, obesity must be present. At least two of the other three criteria must be met to speak of a metabolic syndrome.

  1. Overweight (trunk obesity)

The following criteria characterize severe overweight with particularly abdominal fat storage (obesity):

  • Waist circumference greater than or equal to 80 cm (women) or
  • Waist circumference greater than or equal to 94 cm (men)

Obesity is a BMI (Body Mass Index) of 25 or more.


  1. Elevated blood sugar level or sugar metabolism disorder

The following laboratory values and criteria indicate elevated blood sugar levels (insulin insensitivity or insulin resistance):

  • Fasting blood glucose greater than 100 mg/dL (5.6 mmol/L) or
  • diagnosed type 2 diabetes mellitus
  1. Hypertension

High blood pressure (hypertension) is present when the blood pressure shows the following values:

  • systolic (upper value) higher than 130 mmHg or
  • diastolic (lower value) higher than 85 mmHg
  1. Fat metabolism disorder

The following laboratory values ​​indicate changes in blood lipid levels (dyslipoproteinemia):

  • Triglycerides (neutral fats) higher than 150 mg/dl (1.7 mmol/l) or
  • HDL cholesterol (“good cholesterol”) lower than 50 mg/dl (women) or 40 mg/dl (men)


Why Is Metabolic Syndrome So Dangerous?

The simultaneous occurrence of several of these vascular-damaging influencing factors in metabolic syndrome (compared to the occurrence of one risk factor alone) increases the risk of cardiovascular diseases again significantly. These diseases are the leading cause of death in the Western world, which is why the four main factors of the metabolic syndrome are known as the “fatal quartet”.

The consequences of the mentioned risk factors can also lead to further health restrictions, such as increased blood clotting. This increases the risk of vascular occlusions and thrombi (blood clots).

In addition, disorders of vascular regulation can occur so that, for example, the vascular width can no longer be regulated correctly or the accumulation of blood platelets (thrombocytes) is uncontrolled, increasing the risk of vascular occlusion. These processes also increase the risk of vascular calcification. This is called endothelial dysfunction.

Inflammation and elevated uric acid levels (with gout as a possible result) are possible other adverse health effects.

Symptoms and course of the metabolic syndrome

The first recognizable symptom of the metabolic syndrome is usually a pronounced obesity. Elevated blood sugar levels and lousy blood lipids are usually added throughout the disease.

Arteriosclerotic changes (narrowing of the vessels due to calcification) dramatically increase the risk of the affected person developing various diseases of civilization. These include diseases caused by a modern lifestyle, especially in Western countries. These secondary diseases include, for example, an increased risk of heart attack or stroke. Degenerative skeletal and joint diseases (e.g. arthrosis or rheumatoid arthritis) and the increased occurrence of tumours, e.g. breast or colon cancer, have also been proven.

Diabetes mellitus – a severe secondary disease

Due to lack of exercise and excessive sugar intake, the insulin-producing cells in the pancreas (pancreas) release increased amounts of insulin. The body needs this hormone to absorb sugar from the blood into the cells and thus lower the blood sugar level.

The permanently increased insulin release can lead to insulin resistance; moreover, developing type 2 diabetes is very likely. The cells respond less and less to the hormone, so they absorb too little sugar. The blood sugar level is increased accordingly. Therefore, the metabolic syndrome is also known as “insulin resistance syndrome”.

Severe diabetes can lead to acidosis, which is understood to be an “acidification” of the blood. Left untreated, diabetic ketoacidosis can lead to diabetic coma (coma diabetic), a life-threatening condition.

Before diabetes develops, it usually takes a few years for the metabolic syndrome to cause damage to the body. The increased risk of cardiovascular disease is often accompanied by potentially fatal complications such as strokes or heart attacks. Accordingly, life expectancy is significantly reduced.

Early preventive measures can prevent type 2 diabetes and other secondary diseases, especially those affecting the cardiovascular system.


Diagnosis of Metabolic Syndrome

In addition to the traditional classification according to the International Diabetes Federation (IDF), the ATP-III criteria of the NCEP (National Cholesterol Education Program) are used in Germany to diagnose metabolic syndrome. According to this classification, three out of five risk factors must be present, which are determined by medical measurements and blood tests:

  • Obesity with increased waist circumference (increased abdominal fat): over 102 cm in men and over 88 cm in women
  • Elevated fasting blood glucose of at least 110 mg/dl
  • increased arterial blood pressure (hypertension) of at least 130/85 mmHg
  • Blood lipid levels:
    • Fasting triglycerides greater than 150 mg/dl or
    • reduced HDL values ​​(good cholesterol) of below 50 mg/dl (women) or below 40 mg/dl (men)

What Helps Metabolic Syndrome?

Starting treatment early can reduce all risk factors that promote the development of cardiovascular complications. The primary goal of treatment is to avoid complications. Therapy focuses on exercise, healthy eating and weight reduction.

Regarding “empowerment”, different training courses are available for adults and children, who should thus be given a healthy lifestyle and a balanced diet. If those affected find it difficult to change their eating habits, drawing up a nutrition plan as part of a nutritional consultation makes sense.

Important: Short-term diets are not advisable for a lasting effect; instead, there must be a long-term change in diet in connection with regular exercise or sporting activity. A healthy eating style should include the following characteristics:

  • Eating at fixed times, two to three times a day, with no snacks or sweets in between
  • Sufficient fluid intake (at least two litres daily, especially water and tea )
  • Preference for high-fibre carbohydrates ( e.g. wholemeal bread, wholemeal pasta) as these keep you full longer – fewer potatoesrice or ordinary pasta.
  • healthy fats (e.g. olive oil, linseed oil, nut oil)
  • Avoiding saturated fat (excessive meat consumption, processed foods)
  • adequate protein intake (one gram per kilogram of body weight per day)
  • Vegetables as the basis of the diet, prepared with healthy fats and oils
  • low-cholesterol diet (e.g. replacing butter with margarine, reducing meat consumption)
  • Sufficient consumption of mainly low-sugar types of fruit (e.g. berries, oranges, grapefruit, apricots, kiwis, passion fruit, plums, watermelons)
  • Abstinence from nicotine and alcohol

What other treatment options are there?

Other options are available if the lifestyle and eating habits change does not improve the symptoms. In severe cases, a stomach reduction can be considered, which reduces the capacity for food intake and can have a lasting positive effect on obesity.

More common, however, is drug therapy, which is often used even with the individual risk factors of the metabolic syndrome, provided that no improvement is achieved through alternative measures:

  • For example, high blood pressure is treated with drugs using so-called ACE inhibitors, AT1 receptor blockers, diuretics (water tablets), beta-blockers or calcium channel blockers. These drugs are used in different ways to lower blood pressure and thus relieve the vessels.
  • Drug therapy can also be used if blood fat levels are too high. For example, statins, fibrates or cholesterol absorption inhibitors are used here.
  • If the blood sugar level is elevated, various means of influencing the insulin and sugar metabolism are also used. These include, for example, metformin, sulfonylureas, glitazones and alpha-glucosidase inhibitors.

With the therapeutic measures mentioned, the metabolic syndrome can be “cured” because the risk factors can be significantly reduced. However, most of those affected are dependent on medication for life. A lasting lifestyle change requires discipline and perseverance, but it works well for many affected and helps maintain health for a long time.


How to prevent metabolic syndrome?

According to the current state of research, the foundation for the metabolic syndrome can already be laid during pregnancy. Both a significant oversupply of nutrients, for example, due to gestational diabetes, and an undersupply due to smoking during pregnancy, can lead to unfavourable developments in the unborn child, which promotes the development of a metabolic syndrome.

In this way, a predisposition for fat accumulation in the abdominal area can be developed early, and the craving for foods rich in sugar and fat can be increased. Nevertheless, it is possible – and especially important for those affected in such cases – to prevent the development of a metabolic syndrome.

Metabolic syndrome is mainly caused by an unhealthy lifestyle with a lack of exercise and an unhealthy diet. Therefore, regular physical activity in combination with a healthy and balanced diet and weight loss are the essential measures to prevent metabolic syndrome.

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