A physical exam is crucial for the diagnosis of metabolic syndrome as one of the criteria involves the waist circumference. Furthermore, if suspected, the patient should be screened for physical manifestations of insulin resistance such as peripheral neuropathy, retinopathy, acanthosis nigricans.

A clinician should listen for arterial bruits that could be due to atherosclerotic disease. Patients with dyslipidemia may present with xanthomas.

Thus, a thorough physical examination is vital to the diagnosis of metabolic syndrome. After a thorough history and physical, the evaluation needs to be complemented with laboratory analysis. The blood work should include hemoglobin A1C to screen for insulin resistance and diabetes mellitus type 2.

A lipid panel should also be drawn to assess for abnormally elevated triglyceride level, low HDL level, and elevated low-density lipoprotein level. The initial evaluation should also include a basic metabolic panel to evaluate for renal dysfunction and examine glucose level. Further studies such as C-reactive protein, liver panel, thyroid study, and uric acid can be drawn to investigate the existence of further and support the diagnosis of metabolic syndrome.

Imaging studies can be ordered when appropriate. For instance, anyone suspected to have atherosclerotic coronary artery disease should have an electrocardiogram to evaluate for signs of cardiac ischemia, infarct, arrhythmias, as well as evaluate for hypertension with structural heart disease.

If warranted, patients should be evaluated further with cardiac stress testing including electrocardiogram stress test, stress echocardiography, stress single-photon emission computed tomography or myocardial perfusion imaging.

Management should be targeted at treating the conditions contributing to metabolic syndrome and possibly reverting the risk factors. Thus, modifiable factors such as diet and exercise should be emphasized in patients with metabolic syndrome.

After a comprehensive analysis, patients should first be counseled for lifestyle changes including abstinence from smoking, weight loss, and diet and exercise modification.

Patients are usually on a moderate to high-intensity statin therapy first; however, fibrates, niacin, and omega acids are also available for treating hypertriglyceridemia. Elevated LDL should also be aggressively managed in these patients especially if the atherosclerotic cardiovascular disease ASCVD risk score if more than 7.

Patients with severe obesity may benefit from bariatric surgery. Bariatric surgery is considered as the most effective single therapy of metabolic syndrome. The most common procedures carried out are laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass, and laparoscopic sleeve gastrectomy.

Patients should have a long-term follow-up after surgery to avoid surgical, nutritional, and psychiatric complications. Sleep health and hygiene should also be discussed with patients who have metabolic syndrome because sleep apnea and sleep deprivation can lead to the development of metabolic syndrome.

Studies have shown that in patients with moderate to severe sleep apnea, 3 months of continuous positive airway pressure can reduce blood pressure and potentially reverse some metabolic syndrome abnormalities. To recognize the development of metabolic syndrome is crucial to treatment, prevention, and reversal of the disease process.

Through history and physical exam, patient education, and workup of the contributing factors appropriately, physicians can not only treat the metabolic syndrome but also potentially alter the trajectory of disease development.

The management of metabolic syndrome is best done with an interprofessional team that includes a dietitian, physical therapist, pharmacist, cardiologist, internist, neurologist, bariatric surgeon, nurse practitioner, an endocrinologist, and a social worker. The key to this disorder is the prevention and education of the patient.

The patient must be told of the importance of changes in lifestyle and weight loss. The dietitian should educate the patient on a Mediterranean-style diet and the importance of exercise. The patient should be urged to stop smoking and abstaining from alcohol.

The pharmacist must ensure that the patient is compliant with the medications. Probably the most important intervention is an exercise because it can lower body weight, cholesterol, blood pressure, and blood glucose at the same time. Finally, patients with metabolic syndrome should be educated on good sleep hygiene.

Patients with metabolic complications can develop a wide range of complications including heart disease, aortic stenosis, atrial fibrillation, stroke, and even thromboembolic disease.

Today evidence seems to indicate that the risk of an ischemic stroke is much higher in patients with metabolic syndrome than previously thought. In addition, other problems associated with metabolic syndrome include a risk for malignancies of the kidney, gallbladder, colon and even the prostate gland.

Further, the metabolic syndrome may also increase the risk of eclampsia and affect cognitive performance. Finally, patients with metabolic syndrome also face higher medical bills, are more likely to be poor and may find access to good quality healthcare difficult.

Disclosure: Supreeya Swarup declares no relevant financial relationships with ineligible companies. Disclosure: Amandeep Goyal declares no relevant financial relationships with ineligible companies.

Disclosure: Yulia Grigorova declares no relevant financial relationships with ineligible companies. Disclosure: Roman Zeltser declares no relevant financial relationships with ineligible companies. This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.

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StatPearls [Internet]. Treasure Island FL : StatPearls Publishing; Jan-. Show details Treasure Island FL : StatPearls Publishing ; Jan-. Search term. Metabolic Syndrome Supreeya Swarup ; Amandeep Goyal ; Yulia Grigorova ; Roman Zeltser.

Author Information and Affiliations Authors Supreeya Swarup 1 ; Amandeep Goyal 2 ; Yulia Grigorova 3 ; Roman Zeltser 4. Affiliations 1 Nassau University Medical Center. Continuing Education Activity Metabolic syndrome is an accumulation of several disorders, which together raise the risk of an individual developing atherosclerotic cardiovascular disease, insulin resistance, and diabetes mellitus, and vascular and neurological complications such as a cerebrovascular accident.

Introduction Metabolic syndrome is an accumulation of several disorders, which together raise the risk of an individual developing atherosclerotic cardiovascular disease, insulin resistance, and diabetes mellitus, and vascular and neurological complications such as a cerebrovascular accident.

Metabolic disarrangement becomes a syndrome if the patient has any three of the following: Waist circumference more than 40 inches in men and 35 inches in women. Etiology The underlying etiology of metabolic syndrome is extra weight, obesity, lack of physical activity, and genetic predisposition.

Epidemiology In the United States, the prevalence of metabolic syndrome in adults 18 years and older is continuing to be significant. Pathophysiology Metabolic syndrome adversely influences several body systems. Histopathology The proinflammatory cytokines released from the adipose tissue are responsible for the development of atherosclerosis and coronary artery disease.

History and Physical History and physical exam are vital for disease recognition, treatment, and prevention. Evaluation After a thorough history and physical, the evaluation needs to be complemented with laboratory analysis. Differential Diagnosis Glucagonoma.

Pearls and Other Issues Sleep health and hygiene should also be discussed with patients who have metabolic syndrome because sleep apnea and sleep deprivation can lead to the development of metabolic syndrome.

Enhancing Healthcare Team Outcomes The management of metabolic syndrome is best done with an interprofessional team that includes a dietitian, physical therapist, pharmacist, cardiologist, internist, neurologist, bariatric surgeon, nurse practitioner, an endocrinologist, and a social worker.

Review Questions Access free multiple choice questions on this topic. Comment on this article. References 1. van der Pal KC, Koopman ADM, Lakerveld J, van der Heijden AA, Elders PJ, Beulens JW, Rutters F. The association between multiple sleep-related characteristics and the metabolic syndrome in the general population: the New Hoorn study.

Sleep Med. Burrage E, Marshall KL, Santanam N, Chantler PD. Cerebrovascular dysfunction with stress and depression. Brain Circ. Kim JY, Yi ES. Analysis of the relationship between physical activity and metabolic syndrome risk factors in adults with intellectual disabilities.

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Determining Factors of Arterial Stiffness in Subjects with Metabolic Syndrome. Metab Syndr Relat Disord. Fietze I, Laharnar N, Obst A, Ewert R, Felix SB, Garcia C, Gläser S, Glos M, Schmidt CO, Stubbe B, Völzke H, Zimmermann S, Penzel T.

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Metabolic syndrome and pre-eclampsia. Ultrasound Obstet Gynecol. He Y, Wu W, Wu S, Zheng HM, Li P, Sheng HF, Chen MX, Chen ZH, Ji GY, Zheng ZD, Mujagond P, Chen XJ, Rong ZH, Chen P, Lyu LY, Wang X, Xu JB, Wu CB, Yu N, Xu YJ, Yin J, Raes J, Ma WJ, Zhou HW. Linking gut microbiota, metabolic syndrome and economic status based on a population-level analysis.

Cӑtoi AF, Pârvu AE, Andreicuț AD, Mironiuc A, Crӑciun A, Cӑtoi C, Pop ID. Metabolically Healthy versus Unhealthy Morbidly Obese: Chronic Inflammation, Nitro-Oxidative Stress, and Insulin Resistance. Klimova B, Kuca K, Maresova P. Global View on Alzheimer's Disease and Diabetes Mellitus: Threats, Risks and Treatment Alzheimer's Disease and Diabetes Mellitus.

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Home Medical Services Diabetes and Endocrinology Conditions. A metabolic [met-uh-BOL-ik] disorder is when something is wrong with the body's metabolism — the ability to turn food into energy and get rid of waste.

The body has many different chemicals and processes that make metabolism work. There are many types of metabolic disorders because something can go wrong with any of these parts of the process. For others, a process that turns food into energy may not be working properly, or the body may not be getting enough of a nutrient needed for metabolism.

Or, one of the organs involved in metabolism could be diseased or damaged. There are many causes to metabolic disorders.

Some metabolic disorders are genetic. A gene that tells the body how to do a certain metabolic process or make a chemical or enzyme gets changed mutates. This genetic change can be passed down from parents to children, or the change can happen on its own. Some metabolic disorders happen because an organ involved in metabolism gets diseased or damaged, like the pancreas or thyroid.

The doctor may have you or your child do a blood test called a metabolic panel. This is a set of tests to check if you have the right type of chemicals in your blood for metabolism.

Depending on your situation, the doctor may order a basic metabolic panel or a comprehensive metabolic panel, which includes more tests.

Treatment for metabolic disorders depends on the specific disorder. Common treatments include: Changes to diet and lifestyle. Medicines can also be used to control certain symptoms, help you feel better, and avoid life-threatening emergencies.

But there are things you can do to lower your risk for developing type 2 diabetes, the most common metabolic disorder: Stay at a healthy weight Eat healthy foods, like vegetables, whole grains, beans, fruits, and lean meats Stay active — move every day Drink water instead of juice, soda, or other drinks with sugar.

There are several different types of metabolic disorders.

Comparisons between periods are appropriate as long as sampling weights and units are accounted for in statistical analyses. Our analysis included all non-Hispanic white, non-Hispanic black, and Mexican American adults aged 18 or older represented in the NHANES data set during the study period.

A total of 51, participants during the study period were included in this analysis; 18, participants for —, 18, participants for —, and 14, participants for — The University of Alabama at Birmingham Institutional Review Board considered this study exempt from review because of the use of publicly available, de-identified data.

We defined metabolic syndrome using the criteria and definition published in the joint scientific statement on metabolic syndrome We defined metabolic components using the NHANES questionnaire responses and laboratory responses listed in Appendix A. NHANES did not collect laboratory values for HDL cholesterol for survey years through Therefore, we relied on self-report of drug treatment for low HDL cholesterol.

In this analysis, we calculated the estimated proportion of adults who met each component criterion and who met the formal definition of metabolic syndrome across the study periods individuals with missing or unknown data were included in a separate response category.

Age was assessed as a continuous variable for participants aged 0 to 84 years, and those 85 or older were classified as 85 years of age NHANES codes individuals 85 or older as 85 years.

PIR was calculated as the ratio of total family income to poverty threshold values in dollars. Persons who reported having no income were assigned a zero value for PIR.

PIR values less than 1 are considered below the official poverty line, whereas PIR values greater than 1 are above the poverty level All analyses were performed in using NHANES-generated sampling statistical strata, clusters, and weights as designated and described in detail in the NHANES methodology handbook Thus, results may be generalizable to the US population.

Sociodemographic characteristics, prevalence of metabolic syndrome, and individual metabolic components were estimated while accounting for stratum, primary sampling units, and weights unique for each NHANES period by using SAS version 9.

We estimated the prevalence of metabolic syndrome and individual components over time —, —, and — , stratified by race and sex using weighted means and proportions. To determine the odds of metabolic syndrome adjusting for potential confounders such as level of education and PIR, we performed several logistic regression models for each period with metabolic syndrome as the outcome and sociodemographic variables as exposures.

We performed similar analyses examining each component of metabolic syndrome. As a sensitivity analysis, to assess whether the increase in prevalence of metabolic syndrome is driven solely by increasing rates of obesity among US adults, we determined the prevalence of metabolic syndrome across the study period, excluding participants with body mass index BMI calculated as weight in kilograms divided by height in meters squared of 30 or higher.

There were 51, participants representing an estimated ,, US adults aged 18 or older from through Table 1. During the observation period, the average age of study participants increased gradually, with mean age increasing from about 44 years during — mean, The proportion of both non-Hispanic blacks and Mexican Americans also increased during the observation periods by 9.

Mean PIR decreased over time from 3. In addition, mean BMI increased significantly during the study periods, from an average of The overall prevalence of metabolic syndrome in — was Among men, the prevalence of metabolic syndrome increased from Similarly, the prevalence of metabolic syndrome increased for women from Appendices B , C , and D , show the prevalence of each metabolic syndrome component stratified by race and sex.

The metabolic syndrome component with the most significant increase during the study period was elevated waist circumference among men, from Figure 1. Prevalence of metabolic syndrome among US adults, National Health and Nutrition Examination Survey NHANES , — Metabolic syndrome was defined by using the criteria agreed to jointly by the International Diabetes Federation; the National Heart, Lung, and Blood Institute in the United States; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity Abbreviation: SE, standard error.

Figure 2. Metabolic syndrome was defined by using the criteria agreed to jointly by the International Diabetes Federation; the US National Heart, Lung, and Blood Institute in the United States; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity After adjusting for education, PIR, and age, we found that non-Hispanic black men were less likely than non-Hispanic white men to have metabolic syndrome during — OR, 0.

Non-Hispanic black women were more likely than non-Hispanic white women to have metabolic syndrome only during the third period OR, 1. Compared with those with a college education or higher, those with lower levels of education had significantly increased odds of metabolic syndrome.

Among nonobese participants overall, the prevalence of metabolic syndrome appeared to remain stable during the study period Appendices E and F ; — prevalence, However, the prevalence of metabolic syndrome among the nonobese increased from Our study is one of the largest data are from almost 3 decades to use the harmonized criteria for metabolic syndrome in characterizing the prevalence, trends, and sociodemographic distribution of this condition among US adults.

We observed that by , more than one-third of all US adults met the criteria for metabolic syndrome, with the highest burden being among non-Hispanic black and adults with low socioeconomic status. Prevalence of metabolic syndrome increases rapidly with age, suggesting that given the demographic trend in the US population of increasing age, further increases in metabolic syndrome prevalence are to be expected, with concomitant increases in related chronic diseases and conditions.

Metabolic syndrome is a serious health condition that puts people at higher risk of heart disease, diabetes, stroke and diseases related to fatty buildups in artery walls atherosclerosis. Underlying causes of metabolic syndrome include overweight and obesity, insulin resistance, physical inactivity, genetic factors and increasing age.

Download our Answers by Heart sheet: What is Metabolic Syndrome? PDF Spanish PDF. Metabolic Syndrome. High blood pressure can also cause plaque, a waxy substance, to build up in your arteries. Plaque can cause heart and blood vessel diseases such as heart attack or stroke. High blood sugar levels : This can damage your blood vessels and raise your risk of getting blood clots.

Blood clots can cause heart and blood vessel diseases. High blood triglycerides : Triglycerides are a type of fat found in your blood. High levels of triglycerides can raise your levels of LDL cholesterol , sometimes called bad cholesterol. This raises your risk of heart disease.

Low HDL cholesterol , sometimes called good cholesterol: Blood cholesterol levels are important for heart health. FACT SHEET.