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
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
- 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?
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
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