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| Sunday, 26 December 2004 |
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Features |  |
| News Business Features Editorial
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Metabolic Syndrome : A lifestyle issue The term metabolic syndrome may be new to many, but it has almost certainly been around for thousands of years. It was only in 1988, when it was named "Syndrome X" by Dr. Gerald Reaven, a professor of medicine at Stanford University School of Medicine, that we really began to hear about it and how lifestyle can work for or against individual risk of developing this syndrome. Metabolic syndrome (also sometimes referred to as 'insulin resistance syndrome') is diagnosed when a person has three or more of the following conditions: abdominal obesity, high triglyceride levels, low high-density lipoprotein (HDL) levels, high blood pressure, and high fasting blood glucose levels. Together, the symptoms of metabolic syndrome place a person at high risk of developing Type 2 diabetes and cardiovascular diseases (1). Who is at risk? Genetics: According to researchers about 50 per cent of a person's degree of insulin resistance can be attributed to genetics and 50 per cent can be attributed to lifestyle factors. Interestingly, there appears to be some differences in the way men and women respond to heritable risk factors: a study conducted in 11 provinces in China found that the most significant risk factors of metabolic syndrome in men were waist circumference and a family history of diabetes mellitus; in women, primary risk factors were waist circumference and a family history of high blood pressure. Obesity: Obesity, especially abdominal obesity, is fundamental to metabolic syndrome. It is believed that free fatty acids and their metabolites from abdominal fat play a role in triggering insulin resistance. Scientists still aren't sure what gene gives rise to metabolic syndrome, but believe there is a link with those genes which predispose to obesity and overweight. Physical inactivity: Physical inactivity goes hand in hand with obesity, and is an important risk factor for the development of metabolic syndrome. Physical inactivity not only increases the risk of developing metabolic syndrome, but further increases health risks associated with metabolic syndrome because of its negative effect on cardiovascular fitness. Age: A study in the US has revealed that cases of metabolic syndrome increase significantly with age, from 6.7per cent in 20 to 29 year olds, to about 43.5per cent and 42.0per cent for those aged 60 to 69 years, respectively. The age adjusted prevalence was similar for men (24.0 per cent) and women (23.4 per cent). Prevention and Treatment As weight gain and sedentary lifestyles are both common factors in the development of metabolic syndrome, the American Heart Association recommends that treatment and prevention of metabolic syndrome should include achieving ideal body weight and increasing physical activity. Both are also time-tested methods of improving insulin sensitivity, blood pressure and lipoprotein levels. The Diagnosis Metabolic syndrome can be diagnosed if an individual has any three of the following conditions: . Central fat distribution: A waist circumference greater than 40 inches (102 cm) in men and 35 inches (88 cm) in women. (Abdominal obesity appears to more highly correlated with the metabolic risk factors than measures of total body weight such as Body Mass Index (BMI). . Raised blood pressure: Pressure at or above 135/85 mm Hg. . Serum triglyceride levels at or above 150 mg/dl (1.7 mmol/L). .'Good' cholesterol (HDL) levels at or below 40 mg/dl (1.04 mmol/L) in men and at or below 50 mg/dl (1.29 mmol/L) in women. . Fasting blood glucose levels at or above 110 mg/dl (6.1 mmol/L). **** Preventing a heart attack Over the last four decades there has been a steadily increasing mortality and morbidity from coronary heart disease (CHD) in Sri Lanka, and the disease now seems to be taking its fearsome toll among people of progressively younger age groups. by Dr. D. P. Atukorale Can a Heart Attack be prevented? By the time symptoms of CHD such as angina appear, the underlying heart disease is likely to be far advanced, as CHD often starts in youth and develops slowly. So prevention must start early in life. Some of the risk factors which have been identified are almost causal and preventable. The major risk factors for CHD are: 1. Hypertension (high blood pressure) 2. Abnormalities in serum lipids (fats) - e.g.: (a) high serum LDL (bad) cholesterol (b) low serum HDL (good) cholesterol, (c) high serum triglycerides 3. Heavy cigarette smoking 4. Obesity 5. Diabetes mellitus 6. Heredity 7. Homocysteinaemia (high plasma levels of homocyste) 8. Physical inactivity 9. Stress 10. Male sex 11. Old age A person who scores the highest number of points in the list of risk factors is most likely to have a heart attack. Thus a person who has hypertension and high LDL cholesterol and who smokes has a greater risk of developing a heart attack than a person who has hypertension and high LDL cholesterol and never smokes. In the same way a diabetic patient who lives a sedentary life and is obese has a higher risk of getting a heart attack than a diabetic who lives an active life and has a normal body mass index (BMI). Some of the risk factors such as heredity, male sex and old age are not under our control. But majority of the risk factors such as smoking, hypertension, obesity and high LDL cholesterol are under our control. Prevention The first step you should take to prevent a heart attack is to undergo a medical check-up by your GP who will check your height, weight and blood pressure and you will be referred to a reliable lab, to do certain tests such as ECG, lipid profile and blood sugar. Hypertension (high blood pressure): If hypertension is not diagnosed in time, it can lead to CHD, strokes heart failure and kidney failure. Irrespective of your age physicians maintain systolic BP below 145 mmHg and diastolic BP. below 90 mmHg. Smoking: This is a very common risk factor for heart attacks and nicotine and carbon-monoxide and other poisonous substances in cigarette smoke bring down your good cholesterol (HDL) level, raises your LDL (bad) cholesterol level, increases clotting tendency of blood, causes elevation of your BP and makes the heart beat fast. High serum LDL cholesterol: If serum LDL level is over 100mg/dl your GP will advise you how to reduce the LDL level. If there is no response to diet and exercise your GP will prescribe a cholesterol lowering drug such as a statin. Low serum HDL cholesterol: Your HDL (good) cholesterol should be above 40mg/dl. Asians usually have lower HDL levels than Europeans. If your serum HDL level is below 40mg/dl, your GP will advise you to stop smoking (if you are a smoker) take regular exercise and give dietary advise if you are obese. Excessive consumption of polyunsaturated vegetable oils and deep frying of dietary items with vegetable oils reduce your HDL level. High serum of triglycerides: High serum levels of triglycerides is a well known risk factor for heart attacks. People with high triglycerides usually have low levels of HDL (good) cholesterol. If your serum triglycerides are high (normal level is below 150mg/dl) your GP will advise you: (i) to take regular exercises (ii) keep your blood sugar within normal limits if you have diabetes (iii) avoid excessive consumption of alcohol and (iv) reduce your weight if you are obese. Diabetes mellitus: Diabetes is a risk factor for CHD and diabetes is one of the diseases that your GP can diagnose (by doing a blood sugar test) long before you develop symptoms of diabetes. Diabetes are prone to get atherosclerosis (thickening of arteries) as they are prone to get high blood levels of LDL cholesterol and high blood levels of triglycerides. Obesity: Obese people are more prone to heart attacks, hypertension, high levels of cholesterol and high triglycerides. If you are overweight or obese, your GP will advise you to reduce consumption of high calorie and high fat diet and take regular exercises. Physical inactivity: People who don't take regular exercise are prone to heart attacks. It is common knowledge that CHD is less common among manual workers. Regular exercises have a beneficial effect on your cholesterol and triglycerides. Stress: Day-to-day stresses and anxieties affect your heart, and these affect men more than women. Pent-up emotions harm the heart. Aggressive, competitive way of living may, over the years, lead to CHD. Homocysteinaemia: High blood levels of homocysteine is a well-known risk factor for CHD, and that is why doctors prescribe vitamin folic acid to people who are prone to CHD. So if you are over 40 or if you have a family history of heart attacks, hypertension or diabetes it is advisable for you to consult your GP and get a check-up. |
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