Metabolic Syndrome

Introduction
Metabolic syndrome has been associated with increased cardiovascular morbidity and mortality all over the world. Metabolic syndrome refers to several cardiovascular risk factors such as obesity, hypertension, insulin resistance, and dyslipidemia. It is important to carry out a diagnosis of metabolic syndrome as it assists in identifying the individual at a high risk of cardiovascular diseases and type 2 diabetes (Damiri, Abualsoud, & Salameh, 2018). This paper will explore more about the metabolic syndrome, its epidemiology, clinical presentation, complications, and its diagnosis.
Definition
Metabolic syndrome refers to a condition comprised of a group of reversible major risk factors for cardiovascular disease and type 2 diabetes (Han & Lean, 2016). This multiple risk factor is due to insulin resistance that follows abnormal adipose deposition and function.
Epidemiology
The prevalence of metabolic syndrome in 1988-1994 stood at 25.3% and reduced to 25.0% between 1999 and 2006 (Moore, Chaudhary, & Akinyemiju, 2017). It then increased to 34.2 between 2007 and 2012. In males, the prevalence for metabolic syndrome was 25.6% for 1988-1994 and 33.4% in 2007-2012. Among the female, the prevalence was 25.0% in 1988-1994 and 34.9% 2007-2012 (Moore et al., 2017). A study indicated that metabolic syndrome was most prevalent among non-Hispanic black men at 55%. This was followed by 44% among the non-Hispanic white women, 41% among non-Hispanic black women, 31% among non-Hispanic white men, and 12.5% among the Hispanic men. It was least common among the Mexican American women at 2% (Moore et al., 2017).

Clinical Presentation
The clinical manifestation of metabolic syndrome is wide and varied and may include hypertension, hyperglycemia, reduced high-density lipoprotein cholesterol (HDL-C), abdominal obesity, chest pain or shortness of breath, xanthomas, and acanthosis nigricans (Rochlani, Pothineni, Kovelamudi, Mehta, 2016). These factors increase the risk of diabetes and cardiovascular disease.
Complications
Insulin resistance and hyperinsulinemia are indicated to be at the core of the development of metabolic syndrome. Insulin resistance affects different organ systems and leads to other conditions such as polycystic ovary syndrome, NAFLD, and obstructive sleep apnea (Lee & Sanders, 2016). The impairment of insulin leads to a reduction in insulin action, which may cause the development of arteriosclerosis. Another complication of metabolic syndrome is dyslipidemia that causes impairment of lipid metabolism. This causes the levels of triglycerides to increase while the HDL reduce (Brede, Serfling, Klement, Schmid, & Lehnert, 2016).
Diagnosis
The diagnostic factors include a reduction in HDL-cholesterol, raised triglycerides, blood pressure and fasting plasma glucose. These factors are largely influenced by weight gain, especially the intraabdominal/ectopic fat deposit and a large waist circumference. The guidelines provided by National Heart, Lung, and Blood Institute (NHLBI) and the American Heart Association (AHA) provides 5 conditions for the diagnosis of metabolic syndrome. For a patient to be diagnosed with metabolic syndrome, he or she needs to exhibit at least 3 out of the 5 conditions. Fasting glucose should be ≥100 mg/dL, blood pressure ≥130/85 mm Hg, triglycerides ≥150 mg/dL, HDL-C <40 mg/dL in men or <50 mg/dL in women, and waist circumference ≥102 cm (40 in) in men or ≥88 cm (35 in) in women (Han & Lean, 2016).
Conclusion
Metabolic syndrome refers to a condition made up of a group of reversible major risk factors for cardiovascular disease and type 2 diabetes. The different cardiovascular factors highlighted in the discussion include obesity, hypertension, insulin resistance, and dyslipidemia. Metabolic syndrome manifests itself in many forms such as hypertension, hyperglycemia, and reduced HDL-C. This has been noted to lead to complications such as polycystic ovary syndrome, NAFLD, and obstructive sleep apnea. This leads to the development of the following PICOT question. “Among obese adults diagnosed with metabolic syndrome, would those who underwent a weight loss program and cognitive behavioral training be more likely to show a reduction in blood pressure after 6 months, compared to obese adults with metabolic syndrome that underwent a weight loss program and no cognitive behavioral training at the 6-month point?”

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References
Brede, S., Serfling, G., Klement, J., Schmid, S. M., & Lehnert, H. (2016). Clinical scenario of the metabolic syndrome. Visceral medicine, 32(5), 336-341.
Damiri, B., Abualsoud, M. S., Samara, A. M., & Salameh, S. K. (2018). Metabolic syndrome among overweight and obese adults in Palestinian refugee camps. Diabetology & Metabolic Syndrome, 10, 34.
Han, T. S., & Lean, M. E. (2016). A clinical perspective of obesity, metabolic syndrome, and cardiovascular disease. JRSM Cardiovascular Disease, 5, 2048004016633371.
Lee, L., & Sanders, R. A. (2012). Metabolic syndrome. Pediatrics in review, 33(10), 459.
Moore, J. X., Chaudhary, N., & Akinyemiju, T. (2017). Peer Reviewed: Metabolic Syndrome Prevalence by Race/Ethnicity and Sex in the United States, National Health, and Nutrition Examination Survey, 1988–2012. Preventing chronic disease, 14.
Rochlani, Y., Pothineni, N. V., Kovelamudi, S., & Mehta, J. L. (2017). Metabolic syndrome: pathophysiology, management, and modulation by natural compounds. Therapeutic advances in cardiovascular disease, 11(8), 215-225.

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