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Editorial


Let’s get serious about the metabolic syndrome

PCOS, preeclampsia, endometrial cancer, and gestational diabetes have something in common, and it’s a serious problem

December 2006 · Vol. 18, No. 12

The metabolic syndrome is one of our greatest public-health challenges. The metabolic syndrome is defined as the presence of 3 or more of these 5 factors1:

  • Findings from physical examination
  1. Findings from laboratory testing

The metabolic syndrome is a constellation of metabolic factors that appear to increase the risk for diabetes mellitus,3 cardiovascular disease,4 and all-cause mortality.5 Of particular interest, the metabolic syndrome is associated with an increased risk of death from cancer among women, but not among men.5

The tip of the metabolic iceberg

It is thought that insulin resistance and endothelial inflammation are inciting physiological factors that cause the metabolic syndrome. Metabolic syndrome is commonly associated with multiple biochemical abnormalities that are not directly assessed to make the diagnosis. In this respect, the metabolic syndrome is the “tip of the metabolic iceberg.”

A spectrum of adverse ObGyn outcomes

Although the metabolic syndrome is most tightly linked with adverse outcomes such as diabetes, cardiovascular disease, and mortality, the metabolic syndrome is also likely to be associated with a spectrum of diseases in obstetrics and gynecology.

More prevalent in African- and Mexican-American women than men

In the Third National Health and Nutrition Examination Survey (NHANES III), the prevalence of metabolic syndrome increased from 7% among participants 20 to 29 years of age to 44% for participants 60 to 69 years of age.11 The age-adjusted prevalence of the metabolic syndrome was nearly equivalent for men (24%) and women (23%). However, the risk of the metabolic syndrome was higher among African-American and Mexican-American women than men.

What can we do?

Practice recommendations

Once the metabolic syndrome is diagnosed, the initial approach to treatment is lifestyle changes, including reducing caloric and saturated fat intake, increasing the consumption of fruits, vegetables, and whole grains, and increasing exercise. A widely accepted recommendation for reducing the development of diabetes is to try to guide patients to lose 5% to 7% of their body weight in the year after the diagnosis by both reducing calorie intake and increasing exercise to 150 minutes or more per week.12,13

ObGyns can light the way

As obstetrician–gynecologists and women’s health-care physicians, we will need to be leaders in stemming the epidemic of metabolic syndrome.

*International investigators propose these ethnic/racial-specific measurements to define abdominal obesity: >80 cm in Europid, South Asian, Chinese, South American, Sub-Saharan African, and Eastern Mediterranean women, and >90 cm in Japanese women.2

REFERENCES

1. Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung and Blood Institute Scientific Statement. Circulation. 2005;112:2735-2752.

2. George K, Alberti MM, Zimmet P, Shaw J. for the IDF Epidemiology Task Force Consensus Group. The metabolic syndrome—a new worldwide definition. Lancet. 2005;366:1059-1062.

3. Haffner SM, Valdez RA, Hazuda HP, Mitchell BD, Morales PA, Stern MP. Prospective analysis of the insulin resistance syndrome (syndrome X). Diabetes. 1992;41:715-722.

4. Isomaa B, Almgren P, Tuomi T, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care. 2001;24:683-689.

5. Trevisan M, Liu J, Bahsas FB, Menotti A. Syndrome X and mortality: a population-based study. Am J Epidemiol. 1998;148:958-966.

6. Noussitou P, Monbaron D, Vial Y, Gaillard RC, Ruiz J. Gestational diabetes mellitus and the risk of metabolic syndrome: a population-based study in Lausanne, Switzerland. Diabetes Metab. 2005;31:361-369.

7. Ray JG, Vermeulen MJ, Schull MJ, McDonald S, Redelmeier DA. Metabolic syndrome and the risk of placental dysfunction. J Obstet Gynaecol Can. 2005;27:1095-1101.

8. Lauenborg J, Mathiesen E, Hansen T, et al. The prevalence of the metabolic syndrome in a Danish population of women with previous gestational diabetes mellitus is three fold higher than in the general population. J Clin Endocrinol Metab. 2005;90:4004-4010.

9. Rodie VA, Freeman DJ, Sattar N, Greer IA. Preeclampsia and cardiovascular disease: metabolic syndrome of pregnancy? Atherosclerosis. 2004;175:189-202.

10. Azziz R. How prevalent is metabolic syndrome in women with polycystic ovary syndrome. Nat Clin Pract Endocrinol Metab. 2006;2:132-133.

11. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults. Findings from the Third National Health and Nutrition Examination Survey. JAMA. 2002;287:356-359.

12. Lindstrom J, Louheranta A, Mannelin M, et al. The Finnish diabetes prevention study. Diabetes Care. 2003;26:3230-3236.

13. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403.

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