​Kembara Xtra - Medicine - Metabolic Syndrome

​Kembara Xtra - Medicine - Metabolic Syndrome 
The metabolic syndrome (MetS), rather than being a single disease, is a collection of risk factors that, when taken together, increase the risk of premature morbidity, including complications related to COVID-19, type 2 diabetes mellitus (T2DM), cardiovascular disease, stroke, nonalcoholic fatty liver disease (NAFLD), specific cancers, and all-cause mortality.
 There are several definitions for MetS; the most widely used ones are from the International Diabetes Federation (IDF) in 2006, National Cholesterol Education Program (NCEP), and WHO in 1999.  A collection of persistent metabolic disorders exhibiting insulin resistance, an inflammatory prothrombotic condition, and at least three of the following: - A larger waist circumference (WC) (necessary IDF criterion; optional NCEP; waist:hip ratio >0.9 males, > 0.85 women, or WHO BMI >30 kg/m2) - High blood pressure (BP) (>130/85 for NCEP and IDF; >140/90 for WHO) - Triglyceride (TG) elevation >150 mg/dL or therapy (consistent with WHO, NCEP, and IDF) - Lower levels of high-density lipoprotein (HDL-C) in men and women (men: 35 mg/dL, women: 30 mg/dL, WHO; males: 40 mg/dL, women: 50 mg/dL, NCEP, IDF). - Fasting glucose >100 mg/dL elevation

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Incidence
compares the prevalence of T2DM and obesity.
Prevalence
Global prevalence was projected to affect almost a quarter of the world's population in 2015 and more than a third of adult Americans in 2016.


Pathophysiology and Etiology 
Adipose tissue malfunction, hormonal dysregulation, insulin resistance, and leptin resistance are all associated with an increase in intra-abdominal and visceral adipose tissue. Decreased levels of ghrelin, which is linked to T2DM, insulin resistance, and obesity; decreased levels of adiponectin, an adipocytokine known to protect against T2DM, HTN, atherosclerosis, and inflammation. A prothrombotic state (increased tissue plasminogen activator inhibitor-) and abnormal fatty acid metabolism are also linked, as are vascular endothelial dysfunction, systemic inflammation (increased IL-6, tumor necrosis factor [TNF-], resistin, and CRP), oxidative stress, elevated reninangiotensin system activation, and a prothrombotic state. These are the primary etiologic factors: - Endocrine abnormalities, insulin resistance, and leptin resistance - Central obesity (especially abdominal)/excess visceral adipose tissue - Additional contributing elements
 Growing older and the corresponding hormonal changes Pro-inflammatory state
Parental obesity, genetics, and epigenetics
Sedentary behavior, irregular sleep patterns, a diet high in ultraprocessed foods and sugar-sweetened drinks (SSB), and prescription drugs (such as corticosteroids, antipsychotics, and beta-blockers). Genetics
It appears that genetic variables play a role in the tendency for obesity and MetS. With evidence of intricate interactions between heredity and environment, transcription factors and regulators of transcription and translation make up the majority of discovered genes. Epigenetic alterations and parental obesity at the time of conception may have a major impact on the promotion of MetS in offspring.

Risk factors include: smoking; low socioeconomic status; high levels of chronic stress; altered gut microbiome; inactivity; childhood obesity; intra-abdominal obesity; gestational diabetes mellitus; insulin resistance; older age; postmenopausal status; family history; ethnicity; high consumption of sugar, fructose, and SSB; and high consumption of processed or excessive carbohydrates.

Basic Prevention 

Maintaining a healthy weight; creating a built environment that encourages healthy lifestyle decisions and cuts down on inactive time; and engaging in regular, sustained physical activity (3)[A]
Limiting sugars and processed carbs; avoiding SSB; and consuming less alcohol

Acanthosis nigricans, PCOS, Nonalcoholic Fatty Liver Disease (NAFLD), Nonalcoholic Steatohepatitis, Obstructive Sleep Apnea (OSA), Asthma, Osteoarthritis, Depression, Anxiety, Alzheimer's, Gallstones, Chronic Renal Disease, Erectile Dysfunction, Hyperuricemia, and Gout, Vitamin D deficiency, and Subclinical Hypothyroidism are all associated conditions 

Diagnosis 

Identifying danger signs
Symptoms of cardiovascular disease, diabetes, PCOS, or sleep apnea; family history of MetS, T2DM, stroke, and cardiovascular disease; and a detailed lifestyle history. - Diet, which includes timing (eating at night), frequency (grazing), and intake of proteins, lipids, carbs, particularly processed foods, added sugars, and calorie-dense beverages. - Weight history, including the beginning of obesity and prior attempts to lose weight - A detailed medication history - A daily exercise routine - A history of alcohol, tobacco, cannabis, and illicit drug usage - Sleeping habits, quantity, and quality - Stressors felt and social support
● Heart disease risk assessment instrument 

clinical assessment 
In Caucasian, African-American, Hispanic, and Native American communities, men's waist circumference with abdominal obesity is 102 cm, women's is 88 cm, and in East Asian and South Asian populations, it is 90 cm and 80 cm, respectively. Additional exam findings indicative of insulin resistance, such as acanthosis nigricans, hirsutism, and acrochordons, should be treated if blood pressure is below 130/85 mm Hg.

Multiple Diagnoses 
OSA, PCOS, thyroid abnormalities, Cushing syndrome, and pharmaceutical effects (particularly neuropsychiatric, certain anticonvulsants, chronic steroids, -blockers, and thiazide diuretic medications) should be taken into consideration in the differential. Prediabetes and T2DM are related with MetS.

Laboratory Results 

Initial examinations (lab, imaging)
Treatment or fasting TGs 150 mg/dL HDL: men 40 mg/dL, women 50 mg/dL, or therapy  Hemoglobin A1C >5.7%, therapy, or fasting glucose 100 mg/dL
Tests in the Future & Special Considerations
 Evaluations of lean tissue and fat mass using assessments of body composition. Bodybuilders and athletes may have elevated BMIs despite having low body fat levels. Sarcopenia-related obesity in older, more fragile people may show a normal BMI.
Consider measuring fasting insulin levels and/or computing the TGA:HDL ratio (elevated in insulin resistance) or HOMA-IR. Formal 75-mg oral glucose tolerance test or hemoglobin A1C for diagnosis of impaired glucose tolerance (IGT) or prediabetes.
Consider getting your liver function tested to check for NAFLD and OSA.
 Take into account testing for microalbuminuria, hs-CRP, and hyperuricemia.
Think about performing a thorough cholesterol analysis and an APOE-4 genotyping test.
Other/Diagnostic Procedures
White coat HTN may be ruled out by home blood pressure monitoring or 24-hour blood pressure monitoring.
ECG, stress testing, coronary calcium score, and liver ultrasound to check for fatty livers are all recommended. Interpretation of Tests
Evaluations are done for the purpose of managing and further assessing cardiometabolic risk factors.

Management 

Obesity prevention or risk factor reduction is the main therapy objective. The most clinically successful treatment for MetS is aggressive lifestyle change (diet, exercise, and sleep). >7% weight loss and/or considerable dietary carbohydrate restriction can reduce or eliminate risk factors related to MetS. There is evidence to suggest that time-restricted feeding may benefit each MetS component separately.


General Actions 
Increase your everyday exercise.
 Give up smoking.
 Limit your alcohol consumption.
Promote a low-carb, low-glycemic-load diet, steering clear of sweets and starchy carbs, and/or the Mediterranean diet.
Avoid beverages with added sugar. Be aware that some artificial sweeteners may also affect how sweet tastes are perceived, how gut hormones are secreted, how the gut flora is balanced, and how insulin resistance is promoted.
 You might want to employ time-restricted feeding. (Those who have a history of eating disorders should avoid.)
 Continue to practice regular stress management and healthy sleep habits.

Optional medications include GLP1 receptor agonists (GLP1RA) to treat insulin resistance and metformin (Glucophage) to avoid type 2 diabetes. Treat as directed if CAD or T2DM are already obvious. If necessary, consider taking vitamin B12 supplements together with metformin (Glucophage).

Initial Line

When a person has a low 10-year risk of developing coronary artery disease (CAD), lifestyle modification alone can be an effective first step. In addition to lifestyle changes, a more aggressive risk factor-based strategy is advised for people with higher 10-year risks:  Being obese: Aim for a weight loss of between 5 and 10%, as this has a lot of advantages.
Exercise should consist of 30 to 60 minutes of moderate-intensity aerobic activity, such as brisk walking, five to seven days per week; in addition, weight training should be done one to two days per week. To help with activity prescription in individuals with established CAD, evaluate a complete history of physical activity and exercise tolerance. Encourage the use of medically supervised programs for at-risk groups. Exercise in shorter bursts throughout the day also benefits health.
 Quitting smoking
Assess any potential obstructive sleep apnea.
 Address MetS-related cardiac risk factors such low HDL and high triglycerides.
In order to reduce the risk of developing T2DM, comprehensive lifestyle therapies for IGT and/or prediabetes should include low-carbohydrate diets (5)+/metformin +/GLP1RA. If hypertension is present, aim for similar BP objectives to patients with diabetes.

Referral concerns include: suspected OSA; managing obesity; nutrition therapy; decreasing mobility; mobility impairment; liver function tests suggesting liver disease.

Surgical Techniques 

Body mass index (BMI) >40 or BMI >35 with obesity-related comorbidities can be treated with bariatric surgery in highly obese patients who have tried lifestyle adjustment and medication without success.


Alternative Therapies 

There is insufficient or no evidence to support the benefits of taking supplements of zinc, plant sterols, green tea, L-carnitine, garlic, or cinnamon for enhancing insulin sensitivity. 

Take Action 
All aspects of MetS will improve with regular exercise.
Small amounts of exercise spread throughout the day have a big health impact. Encourage slow, gradual increases in physical activity.
Encourage people to substitute more active options (such as standing at a desk, walking, cycling, or stationary walking during commercials) for inactive ones (such as sitting at a desk, driving a car, using an elevator, and the like). Break up periods of inactivity with physical exercise, such as getting out of a chair, walking, or stretching.
● Monitoring WC, BP, and weight on a regular basis. Fasting TG, HDL, and sugar levels may be routinely checked to evaluate development and target treatment strategies.
Regular long-term follow-up and monitoring may lead to greater adherence to constructive behavioral modifications.
patient observation
Monitor for low blood sugars, blood pressure, and de-escalate medications as necessary, especially with significant weight reduction, intermittent fasting, or a low-carbohydrate diet.

Diet
Limiting sweets and simple carbs in the diet, time-restricted meals, intermittent fasting, and following a low-carb, Mediterranean, or DASH (Dietary Approaches to Stop Hypertension) diet are some examples of dietary suggestions.
Encourage increased consumption of vegetables and fiber, limiting fruit, and consuming alcohol in moderation to lower the chance of getting T2DM.
 Steer clear of processed cereals, fruit juice, and beverages with added sugar.


Education of Patients 
Exercise and diet are essential. This disorder is treatable.

Complications 
progression of CVD and T2DM, a higher risk of NAFLD, stroke, chronic kidney disease, cognitive decline, and a higher chance of getting some cancers, like colon cancer, breast cancer in women, pancreatic cancer, and others, among others

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