Conditions

Metabolic syndrome, which is also called Syndrome X, is increasingly prevalent in the Western world.

Metabolic syndrome, which is also called Syndrome X, is increasingly prevalent in the Western world.

It is estimated that one in five American adults already suffer from it, and it is very plausible that more or less the same figures will apply in all population groups in South Africa who follow a Western lifestyle.

Symptoms

The metabolic syndrome is a cluster of important risk factors that include:

  • raised blood-fat levels - low-density lipoprotein cholesterol (LDL-C), which is also called 'bad cholesterol', triglycerides and other fat fractions;
  • decreased high-density lipoprotein cholesterol (HDL-C), which is also referred to as 'good cholesterol';
  • hypertension or high blood pressure;
  • high glucose and insulin levels, or insulin resistance; and
  • obesity, defined as a BMI of 30 or more.

A patient is defined as suffering from metabolic syndrome if he or she has three or more of the above-mentioned conditions.

Metabolic syndrome is also linked to conditions such as polycystic ovarian syndrome (PCOS), menopause and advancing age.

Research

A recent study out of Columbia University in New York, conducted among more than 12 000 people aged 20 or older, of both sexes and different ethnic origins, found the following in relation to metabolic syndrome:

  • nearly 23 percent of both the male and female subjects were classified as suffering from metabolic syndrome;
  • Hispanic and white men were more prone to metabolic syndrome than black men;
  • Hispanic women were more prone than white or black women;
  • the incidence of metabolic syndrome increased with advancing age;
  • additional risk factors for developing metabolic syndrome included smoking, high refined-carbohydrate intake and physical inactivity in men, as well as smoking, non-drinking, low household income and postmenopausal status in women;
  • the predominant risk factors associated with metabolic syndrome predispose adults to developing heart disease, stroke and type 2 diabetes;
  • 'central adiposity' or abdominal fat increases the risk of metabolic syndrome, that is, individuals with a 'beer boep' are more likely to develop this syndrome than individuals with other fat distributions (for instance, on the hips and breasts); and
  • menopause is associated with a shift in body fat from the hips and breast to the abdominal area and an increase in metabolic syndrome.

Prevention

Research has shown that the most potent lifestyle change anyone can make to counteract metabolic syndrome is to do more exercise. The next best thing is to lose weight.

Researchers have found that even a modest loss of 5 percent or more of body weight (for example, an obese women weighing 70 kg would only have to lose 3,5 kg) will improve many of the risk factors associated with metabolic syndrome.

Patients who have been diagnosed with metabolic syndrome should, therefore, strive to do two things:

  • Increase their physical activity by doing 30 minutes of exercise a day. The simplest way to achieve this, is to go for a brisk walk for half an hour every day of the week. Most people should be able to fit this type of exercise into their schedules and one does not need complicated equipment, or have to join a gym. Other inexpensive options are to cycle or swim. However, if you need encouragement to get active, then it may be an idea to join Run/Walk for Life or a good gym so that the instructors can keep you motivated and monitor your progress. Always check with your medical doctor if you are allowed to do exercise, and if walking is indicated. Don't start off with 10 km a day – ease into exercise slowly and listen to your body while you gradually increase the intensity and duration of your exercise.
  • Lose 5 percent or more of your weight. The most sensible way to do this is to consult a clinical dietician. You will need a diet that is low in total fat, saturated fat and cholesterol (to lower 'bad cholesterol') and high in foods with a low glycaemic index (GI). Such a diet is not easy to compile and you may find it difficult to apply - this is where the dietician will come in useful. He or she will firstly work out a diet that is tailored to your unique set of circumstances (for instance, obesity, raised blood glucose and insulin levels, high blood pressure and raised blood fats). Then the dietician will assist you with correct food choices and steer you through the problems you may encounter with purchasing the right foods and working out portion sizes and distribution of certain foods over the day (for example, intake of carbohydrates with a low GI at each meal in combination with other foods that lower your blood glucose and insulin levels). Such a diet will also decrease your blood fat levels and help you to lose weight.

Your doctor may also prescribe certain medications (blood pressure pills, or statins to lower cholesterol, or diabetic medicines), which you would use in combination with exercise and diet.

If you have been diagnosed with metabolic syndrome, there is no need to panic: follow your doctor's instructions, get active, and consult a dietician. Once you have got into the habit of exercising on a daily basis, eating correctly and taking the correct medications, your symptoms will improve dramatically.

Treatment

A change of lifestyle, like regulating kilojoule intake and increasing physical activity, is usually suggested. Medicinal therapy like diuretics, ACE inhibitors and cholesterol drugs may be used to treat hypertension and cholesterol/triglyceride levels respectively.

(Dr Ingrid van Heerden)

Further publications on the topic