Introduction and Definition of the Metabolic Syndrome
The metabolic syndrome is a common syndrome affecting about 20% of the adult population without known diabetes and cardiovascular disease (CVD) in Europe, and probably the prevalence is of the same magnitude in other industrialised countries worldwide. Th
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Introduction and Definition of the Metabolic Syndrome Henning Beck-Nielsen
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Introduction
The metabolic syndrome is a common syndrome affecting about 20 % of the adult population without known diabetes and cardiovascular disease (CVD) in Europe, and probably the prevalence is of the same magnitude in other industrialised countries worldwide. This syndrome, which is linked to leisure lifestyle and overeating/obesity, can develop into type 2 diabetes, CVD, cancer, gout, nonalcoholic fatty liver disease (NAFLD), polycystic ovary syndrome (PCOS), sleep apnoea and dementia and may result in increased mortality. The metabolic syndrome is mainly caused by western lifestyle resulting in abdominal obesity but also a genetic predisposition plays a role. Abdominal obesity leads to insulin resistance and hyperinsulinaemia, further resulting in glucose intolerance and dyslipidaemia (high plasma triglyceride and low high-density lipoprotein (HDL) cholesterol values) and arterial hypertension. These are all risk factors for the diseases mentioned above. Around 50 % of subjects suffering from the metabolic syndrome develop type 2 diabetes, including the problems and complications connected with this disease. Figure 1.1 describes our model for the pathophysiology of the metabolic syndrome and its consequences. As clinicians, we need to be aware of the syndrome and be able to treat the individual components in order to avoid the complications. The treatment should of course be based on the pathophysiology in order to change the lifestyle by reducing calorie intake (especially saturated fat and sugar) by an increase in physical activity (interval training seems to be effective) and by reduction of mental stress and tobacco use. However, pharmacological treatment
H. Beck-Nielsen (*) Department of Endocrinology, Odense University Hospital, Kloevervaenget 6, 4th floor, 5000 Odense C, Denmark e-mail: [email protected] H. Beck-Nielsen (ed.), The Metabolic Syndrome, DOI 10.1007/978-3-7091-1331-8_1, # Springer-Verlag Wien 2013
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H. Beck-Nielsen
Overeating and reduced physical activity
Visceral obesity Cancer Polyscystic ovary syndrome
Insulin resistance and hyperinsulinism
Non-alcoholic fatty liver disease
Arteriel hypertension
Dyslipidaemia
Glucose intolerance/ type 2 diabetes
Arterisclerosis/hypercoagulability
Cardiovascular disease (acute myocardial infarction, stroke, amputation)
Fig. 1.1 The pathophysiology of the metabolic syndrome
may be necessary in most subjects in order to avoid the consequences of the syndrome and therefore treatment of these components seems obligatory. Insulin resistance can be treated by metformin, which also seems to reduce the risk for CVD and cancer development. This drug seems to be a logic basis for treating the metabolic syndrome since it affects specifically insulin resistance. Also, thiazolidinediones (TZDs) seem to be specifically effective in subjects with metabolic syndrome since they improve peripheral insulin sensitivity, specifically in skeletal m
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