Metabolic syndrome is widespread and linked to mortality

By Liz Meszaros, MDLinx
Published April 17, 2017

Key Takeaways

Overweight and obesity may contribute to the development of metabolic syndrome—three or more risk factors including abdominal obesity, high triglycerides, high blood pressure, abnormal lipids, and insulin resistance—which may be the new ‘silent killer’ of the current era, according to researchers from the Charles E. Schmidt College of Medicine at Florida Atlantic University (FAU) in Boca Raton, FL, who published a commentary in the Journal of Cardiovascular Pharmacology and Therapeutics.

“The major factor accelerating the pathway to metabolic syndrome is overweight and obesity,” said senior author Charles H. Hennekens, MD, DrPH, first Sir Richard Doll Professor and senior academic advisor to the dean, FAU’s Charles E. Schmidt College of Medicine. “Obesity is overtaking smoking as the leading avoidable cause of premature death in the United States and worldwide.”

In fact, experts estimate that metabolic syndrome may currently affect up to 40% of Americans aged 40 and older and is currently both underdiagnosed and undertreated.

Visceral fat leads to insulin resistance as well as the release of non-esterified free fatty acids from the adipose tissue, and lipids may then accumulate in the liver and muscle, increasing the risk for insulin resistance and dyslipidemia, as well as producing adipokines that may affect insulin resistance and cardiovascular disease risk factors.

Waist measurements, therefore, should be less than 40 inches in men and less than 35 inches in women for optimal health.

“Visceral fat and its clinically more easily measured correlate of waist circumference are gaining increasing attention as strong predictors of metabolic syndrome even if you remove body mass index from the equation,” said first author Dawn H. Sherling, MD, assistant professor, integrated medical science, FAU Charles E. Schmidt College of Medicine. “There are patients who have a normal body mass index yet are at high risk. These patients represent an important population for clinicians to screen for metabolic syndrome.”

Currently, approximately two-thirds of adults age 20 or older are overweight or obese, with a body mass index (BMI) greater than 25, and nearly one-third have BMIs greater than 30, according to the US National Institutes of Health. Less than one-third of them are at a healthy weight (BMI: 18.5 to 24.9). In 2008, the estimated medical costs of obesity were as high as $147 billion a year, accounting for nearly 10% of all medical spending.

Third author Parvathi Perumareddi, DO, assistant professor, integrated medical science, also at the Charles E. Schmidt College of Medicine, also noted: “The pandemic of obesity, which begins in childhood, is deeply concerning. Adolescents today are more obese and less physically active than their parents and already have higher rates of type 2 diabetes. It is likely that the current generation of children and adolescents in the US will be the first since 1960 to have higher mortality rates than their parents due mainly to cardiovascular disease, including coronary heart disease and stroke.”

Along with increasing risks for cardiovascular disease, obesity is also a major risk factor for many cancers, including colorectal, breast, and prostate. Those with metabolic syndrome may have a 10-year risk of a first coronary event that is almost as high as someone who has already experienced a previous coronary event.

“In the US, cardiovascular disease will remain the leading killer due largely to obesity and physical inactivity,” said Dr. Hennekens. “Unfortunately, most people prefer prescription of pills to proscription of harmful lifestyles. The totality of evidence indicates that weight loss of 5% or more of body weight combined with a brisk walk for 20 or more minutes daily will significantly reduce cardiovascular events and deaths.”

All three authors emphasized the importance of therapeutic lifestyle changes that begin as early as childhood.

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