Are you pre-diabetic? Metabolic Syndrome: A health time bomb

Millions of Malaysians today could unknowingly be having a silent condition that increases the chances of getting diabetes, heart disease, stroke, kidney problems, and even cancer, later. It’s a condition you cannot be sure about unless your doctor tells you. But your doctor may not even warn you about it, simply because he or she may think it’s not important — or worse, does not know how to look out for it!

But you cannot afford to be ignorant — 1 in 4 adults in some developed countries today suffer from it, and it is becoming increasingly common in developing countries too.

Your well-being and health cannot wait. The time to know, and act, is now. Be aware of, and alert to, Syndrome X, also known as Metabolic Syndrome or insulin resistance syndrome — a “pre-disease” state that warns you of approaching burdensome diseases.

CAP checks out the signs, and science, of this recent health threat, that has been described as a ticking time bomb worldwide.

Serious health problems and debilitating diseases are striking more and more Malaysians each day. Some 3.5 million Malaysians have diabetes today — a major health concern because 4 out of 5 people with diabetes will die of heart disease. 6 new cases of stroke occur every hour in Malaysia. And heart disease is the No. 1 killer in the country.

What are your risks of getting these dreaded diseases in the future? Your doctor would have told you that your food and lifestyle choices, and your genes, play a role. But did you know that certain indications in your current state of health, as well as that “spare tire” around your waist, are pretty strong determinants too?

If you have certain physical features — eg: central obesity (increased fat in the abdomen/waist), dark patches of skin on the back of the neck or underarms or skin tags (usually on the neck) — coupled with an unhealthy basic blood profile, watch your health. You could have Metabolic Syndrome — what most medical organisations around the world today recognise as MetSyn — a condition that puts you at risk for heart and kidney disease, diabetes and strokes.

Learn all about Metabolic Syndrome: when it happens, why it happens, what makes it worse, and what you can do to reverse the condition — and change your health for the better.

What is Metabolic Syndrome?

Metabolic Syndrome is not a disease. It’s a group of conditions (metabolic disorders) related to obesity — or more precisely, a cluster of 5 risk factors: central obesity defined by waist circumference, high blood pressure, low HDL (“good” cholesterol), high triglycerides, and high blood sugar — that increase your chance of developing heart disease, stroke, and diabetes.

The condition is also known by other names, including Syndrome X, insulin resistance syndrome, and dysmetabolic syndrome.

According to the World Health Organization (WHO), in addition to insulin resistance, a person with Metabolic Syndrome will usually have 2 or more of the following: glucose intolerance (impaired glucose tolerance or diabetes), dyslipidaemia (blood fat disorders — mainly high triglycerides and low HDL cholesterol that foster plaque buildups in artery walls), high blood pressure, central obesity and microalbuminuria (small amounts of protein in the urine, a marker for kidney disease) [Source: WHO, 1999].

Metabolic Syndrome is a serious human health issue because people with the syndrome are at increased risk of Type 2 diabetes and coronary heart disease and other diseases related to plaque buildups in artery walls (eg: stroke and peripheral vascular disease).

According to the University of Southampton School of Medicine in the UK, Metabolic Syndrome increases the risk of diabetes 5 fold, and heart disease, 3 fold.

According to a report, sufferers have a 4- to 20-fold in attack over people without these conditions.

According to foreign research, a person with Metabolic Syndrome has a cardiovascular risk similar to smoking 2 packs of cigarettes a day!

How common Is It?

Metabolic Syndrome is very common today and becoming more so with the increasing prevalence of obesity everywhere.

In developed countries, Metabolic Syndrome is present in approximately 20% of adult populations and in approximately 80% of people with Type 2 diabetes (University of Southampton School of Medicine, UK).

In the US and the UK, surveys estimate that as many as 1 in 4 adults has Metabolic Syndrome. In the US alone, 50 million people and roughly half of all Americans are predisposed to it (Science Daily, 19.7.07). About 7% of adults in their 20s and about 40% of adults over age 40 meet the criteria for the syndrome.

Children are also suffering from it — 1 out of 8 American children, aged 8-17, has been identified as having Metabolic Syndrome, placing them at greater risk for premature heart disease and diabetes (Medco).

In the Middle East, its prevalence has also spread to children. In Iran, a study by researchers from Shaheed Beheshti University of Medical Sciences’ Endocrine Research Center in Tehran found “a high prevalence of Metabolic Syndrome in Iranian adolescents, particularly among overweight adolescents (Obesity, Vol.14, 2006).

Metabolic Syndrome is also common in China — as more people there adopt Western diets and lifestyles, many are developing Metabolic Syndrome. Up to half of the participants in a recent Chinese study (Journal of the AmericanCollege of Cardiology, 18 April 2006) were found to have Metabolic Syndrome.

It is now becoming common even in developing countries. In South Asia (India, Pakistan, Sri Lanka, etc) some 20-25% of urban people have signs of the syndrome (Indian Journal of Medical Research, March 2007).

How Is It Diagnosed?

There are at least 6 definitions for Metabolic Syndrome, but there are currently no well-accepted criteria for diagnosing it.

Generally, however, a diagnosis of Metabolic Syndrome is made when a patient has at least 3 of the following symptoms: abdominal obesity, high triglyceride levels, low HDL (good) cholesterol, elevated blood glucose and hypertension.

Each is a risk factor for heart disease, but a person with several of these disorders — that is, a person with Metabolic Syndrome — is at greater risk.

According to 2 institutions in the US — the American Heart Association and the National Heart, Lung, and Blood Institute — you need to have 3 of the following 5 markers:

1. INCREASED waist circumference*: Men — equal to or greater than 40 inches (102 cm); women — equal to or greater than 35 inches (88 cm)

2. HIGH triglycerides (a form of fat in your blood): Equal to or greater than 150 mg/dl

3. REDUCED HDL (“good”) cholesterol: MEN — less than 40 mg/dl; WOMEN — less than 50 mg/dl

4. RAISED blood pressure: Equal to or greater than 130/85 mm Hg

5. ELEVATED fasting glucose: Equal to or greater than 100 mg/dl

The World Health Organization (WHO) has slightly different criteria for the Metabolic Syndrome:

High insulin levels — indicated by a raised fasting blood glucose, or a raised post-meal glucose alone — with at least 2 of the following criteria:

• Abdominal obesity as defined by a waist-to-hip ratio of greater than 0.9, a body mass index (BMI*) of at least 30 kg/m² or a waist measurement over 37 inches
• Cholesterol readings that indicate a triglyceride level of at least 150 mg/dl or a HDL cholesterol lower than 35 mg/dl
• Blood pressure of 140/90 or above (or on treatment for high blood pressure).

For Asians, with their smaller body build, the western standards for Metabolic Syndrome in terms of waist circumference and BMI are not appropriate. The WHO and the International Diabetes Federation have adopted the following modified definitions instead for Asians:

• Overweight = BMI of 23 kg/ m² or above; Obesity = 25 kg/m² or above
• Abdominal or central obesity = a waist circumference of 80 cm (31.5 inches) or above for women and 90 cm (35.4 inches) or above for men.

According to the American Heart Association, other indicators are:

•A prothrombotic state, an increased tendency to make tiny clots in the blood (eg: high fibrinogen or plasminogen activator inhibitor–1 in the blood)
• A proinflammatory state, an increased tendency to inflammation (eg: elevated C-reactive protein in the blood)

Why Is It Harmful to Health?

“Few things surprise patients more when they are diagnosed with Metabolic Syndrome than realising that they have a risk equivalent to smoking 2 packs of cigarettes a day,” says Francisco Lopez-Jimenez from the Mayo Clinic College of Medicine (US Cardiovascular Disease 2007, Issue 1, July 2007).

Western research indicates that people with Metabolic Syndrome are 3.5 times more likely to die of coronary heart disease; as well as have an increased risk of liver and kidney disease, and possibly cancer.

If you have Metabolic Syndrome, chances are high that you have insulin resistance and pre-diabetes (blood glucose levels that are higher than normal but not high enough for a diagnosis of diabetes). (See also separate story on “What Causes Metabolic Syndrome” in Utusan Konsumer Nov-Dec 2007)

Consistently high levels of insulin and glucose are linked to many harmful changes to the body, including:

• Damage to the lining of coronary and other arteries, a key step toward the development of heart disease or stroke
• Changes in the kidneys’ ability to remove salt, leading to high blood pressure, heart disease and stroke
• An increase in triglyceride levels, resulting in an increased risk of developing cardiovascular disease
• An increased risk of blood clot formation, which can block arteries and cause heart attacks and strokes
• A slowing of insulin production, which can signal the start of Type 2 diabetes, a disease that can increase your risk for a heart attack or stroke and may damage your eyes, nerves or kidneys.

Do You Have It?

Go through the checklist for Metabolic Syndrome on Page 3 of Utusan Konsumer Nov-Dec 2007. Having one sign or symptom of Metabolic Syndrome means you are more likely to have other parts of the syndrome. The more symptoms you have, the higher is the risk that you will develop the syndrome and the serious illnesses that come with it.

As a general guide, if you have increased fat in the abdomen/waist, or have diabetes or a strong family history of diabetes, be on the alert.

Be extra suspicious if you also have dark patches of skin (usually on the back of your neck, elbows, knees, knuckles, and armpits) or if you get a dark ring around your neck. This condition is called acanthosis nigricans, a clinical feature of a severe form of insulin resistance.

To know for sure, you need to have the following tested and monitored: your blood pressure, lipid profile (triglycerides and HDL) and blood sugar.

What Causes Metabolic Syndrome

The causes of the syndrome are not yet fully understood. But there are several risk factors that contribute to it:

Genetics is a factor. A recent study has shown that a cluster of abnormalities similar to those in Metabolic Syndrome can be caused by a single mutation in a mitochondrial gene.

Physical inactivity is a factor.

Diets with high levels of fat (eg: fried foods, cookies, crackers, pastries, fast foods), carbohydrates (sugary foods, refined breads) and empty calories (eg: soft drinks) is a factor.

Age is a factor. The prevalence of Metabolic Syndrome increases with age. This is due to our tendency to gain weight and become less active as we age, both of which can negatively affect blood pressure and HDL levels, as well as triglyceride levels. If you are at least 35 years old, there is a 25% probability that you have the syndrome; by age 60, the probability increases to 40%.

Drug side-effects is a factor. The condition can also be a side effect of certain drugs (eg: corticosteroids, antidepressants, antipsychotics, protease inhibitors and antihistamines), all of which can lead to obesity and glucose intolerance.

For the following related articles, please see Utusan Konsumer Nov-Dec 2007:

• Obesity and Diabetes.
• Children and Adolescents Increasingly Getting It
• Prevent and Cure the Non-Drug Way

Read more about the dangers of this condition in the CAP Guide, Metabolic Syndrome