Metabolic syndrome

Metabolic syndrome is the term used to describe the simultaneous occurrence of several health problems that increase the risk of developing type 2 diabetes as well as diseases of the cardiovascular system and blood vessels.

These diseases, in turn, increase the likelihood of life-threatening complications such as heart attack and stroke.

The following factors are typical of metabolic syndrome:

• obesity (severe overweight)
• high blood pressure (hypertension)
• high blood sugar
• high cholesterol – specifically, a high level of triglycerides in the blood
• low HDL cholesterol (known as “good” cholesterol)

Carrying excess weight can be a sign of metabolic syndrome, especially if most of the weight is carried around the abdomen (belly fat).

Metabolic syndrome initially causes no symptoms. Often, it is only detected when it leads to complications and secondary diseases. These include, for example, heart problems and even heart attack.

The precise cause of metabolic syndrome is unknown.

It is known, however, that being overweight and carrying a lot of abdominal fat (belly fat) plays an important role, as does genetic predisposition.

Excess fatty tissue in particular is a risk factor for developing metabolic syndrome – it disrupts metabolic processes and makes the body’s cells insensitive to insulin. The medical term for this is insulin resistance.

As a result, more insulin is produced, leading to increased feelings of hunger. This causes a vicious cycle of eating more and putting on even more weight. The body’s lipid metabolism also changes.

It is not possible to make a clear distinction between the causes of metabolic syndrome and the risk factors associated with it.

In addition to excess belly fat, lack of exercise and genetic predisposition, there are other factors that make the condition more likely to occur. For example:

• lack of sleep, for example, due to obstructive sleep apnea
• a diet high in carbohydrates
• frequent consumption of sugary drinks
• poor physical fitness

In Germany, 20 percent of people on average have metabolic syndrome.

The number of people affected increases with age – among those aged between 50 and 70, up to 40 percent meet the diagnostic criteria for metabolic syndrome. The condition affects slightly more men than women.

According to the Robert Koch Institute, 25 percent of adults in Germany are severely overweight (obese) and are therefore at risk of developing metabolic syndrome.

However, the condition can also occur in people of normal weight if they are carrying deposits of fatty tissue around their abdominal area.

Metabolic syndrome leads to the development of other conditions, especially diseases of the cardiovascular system and the blood vessels (e.g., arteriosclerosis). These, in turn, increase the risk of stroke and heart attack.

In addition, metabolic syndrome can lead to the development of type 2 diabetes and the kidneys can be damaged to such an extent that they no longer work correctly and renal insufficiency develops.

Furthermore, non-alcoholic fatty liver disease (NAFLD) often develops as a result of or alongside metabolic syndrome. It can also cause diabetes or occur as a result of diabetes.

Metabolic syndrome is also a risk factor for mental health conditions, such as depression and Alzheimer’s disease.

Leading a healthy lifestyle can prevent many illnesses, among them metabolic syndrome.

A healthy lifestyle includes:

• exercising regularly
• eating a balanced diet
• drinking little to no alcohol
• not smoking

To avoid metabolic syndrome, it is particularly important to take measures to maintain a normal body weight – in other words, to eat well and get plenty of exercise.

If anyone is unsure of what this means for them personally, they should consult their family doctor.

A health check-up is available in Germany to detect risk factors for metabolic syndrome at an early stage and prevent it from developing.

People aged between 18 and 34 can avail of this check-up once only. From the age of 35 onwards, people can avail of a check-up with a family doctor every three years.

When seeking to determine whether a person has metabolic syndrome, doctors begin by taking the patient’s medical history and asking whether they are aware of any risk factors that apply to them – for example, high blood pressure, diabetes or metabolic disturbances.

Questions about lifestyle

Questions about lifestyle and diet are also important – for example:

• whether they smoke
• how much alcohol they drink
• what they eat
• how regularly they exercise

Physical examination

The next step is a physical examination, during which the doctor measures the following:

• body weight
• height – which is used in combination with body weight to calculate the patient’s body mass index (BMI)
• waist circumference
• blood pressure

The doctor also takes a blood sample to determine the patient’s blood sugar and blood lipid levels.

Diagnostic criteria

Metabolic syndrome is diagnosed if at least three of the following five criteria are met:

• Severe overweight (obesity): based on waist circumference
• High blood pressure: systolic blood pressure of 130 mmHg or higher and/or diastolic blood pressure of 85 mmHg or higher
• High fasting blood sugar level: 100 mg/dl or more
• High blood lipid level: triglycerides 150 mg/dl or more
• Low HDL cholesterol (“good cholesterol”): below 40 mg/dl in men, below 50 mg/dl in women

The most important treatment for metabolic syndrome is to reduce risk factors and weight in particular. This often means making radical lifestyle changes.

Making lifestyle changes

The most important lifestyle changes include:

• getting plenty of exercise: at least 30 minutes of moderate physical exercise each day
• eating a healthy diet: lots of fruit, vegetables, wholegrain products and several unsaturated fatty acids should be on the menu every day (Mediterranean diet)
• avoiding saturated fatty acids and sugar
• drinking little to no alcohol
• not smoking

Medication

Medication may be used to treat very high blood pressure, blood glucose or blood lipid levels. Doctors decide whether and which medication is required based on each patient’s individual situation.

Surgery

If a person is obese and the measures described above fail to achieve the required weight loss, gastric surgery may be considered. A gastric balloon or gastric bypass can reduce the size of the stomach. As a result, the person feels less hungry and reduces their food consumption. Many people can successfully lose weight and counteract metabolic syndrome in this way.