Symptoms of metabolic syndrome include central obesity, poor response to insulin, high blood pressure and unfavourable fat and cholesterol profiles, writes Claire O'Connell
MANY ADULTS in Ireland are walking around with a cluster of symptoms that increase their risk of diabetes, but they don’t even know it.
The biggest outward clue may be a large waistline, but the more silent markers are harder to spot unless you go looking for them.
Known as the “metabolic syndrome”, the symptoms can include central obesity, poor response to insulin (a hormone in the body that controls blood sugar levels), high blood pressure and unfavourable fat and cholesterol profiles in the blood.
If you score three out of five on that list, you could have the metabolic syndrome, or insulin resistance, which if left unchecked vastly increases your risk of developing type 2 diabetes.
It’s hard to get a handle on just how prevalent the condition is, but consultant endocrinologist Dr Donal O’Shea refers to some arresting statistics from the 2007 Slán survey of health and lifestyles in Ireland.
“If you take waist circumference, which is part of the metabolic syndrome, the Slán study indicates that half of the Irish population [have that risk factor],” he says.
A large waist circumference is linked with excess abdominal fat, which is metabolically active, and the fat can literally fail to work properly, says O’Shea.
He works with obese patients at the weight management clinic in Loughlinstown Hospital, but he points out that you don’t have to be obese to have the metabolic syndrome, and he cautions to watch for other signals such as family history and blood pressure.
“I think if the blood pressure is perfect and you are overweight and not obese then you can be fairly comfortable with things. But there’s no doubt that you can be in the overweight category and have significant blood pressure and lipid and cholesterol problems, you really can,” he says. “If you are overweight, over 40 and have a family history [of diabetes] then I think go and get the blood pressure checked, which you can do now at many chemists. And I think everyone over 40 should know their cholesterol anyway.”
The good news is that the metabolic syndrome is reversible, and taking action before a more serious situation develops is key, according to O’Shea.
“Definitely physical activity and losing the weight are out on their own for reversing the metabolic syndrome, and it can absolutely be reversed. You can intervene,” he says.
In many cases, shedding even a few excess pounds can help, says Helen Roche, professor of nutrigenomics at University College Dublin.
“In Ireland the metabolic syndrome tends to show up in people who are overweight or obese,” she explains. “And even losing a pound or two could improve the situation a lot. If you lost two pounds and kept those two pounds off, there would be a physiological benefit.”
Roche co-ordinated LipGene, a five-year EU-wide project that looked at the interactions of genes and diet in the metabolic syndrome. The research found that being even slightly overweight and having a diet high in saturated fats were associated with the condition.
Diets low in saturated fat and enriched with omega-3 fish oils or monounsaturated fats (found in olive oil) improved symptoms in people on the LipGene study with the metabolic syndrome, explains Roche, but whether a person responds better to diet or exercise for the condition appears to depend on their genes.
“We are not at the stage of genetic clinics in the context of metabolic syndrome but down the road we could be,” she says. “There could be some people who would respond well to dietary intervention, and if you can say you are particularly susceptible to saturates, reduce them. And we can say to others that they would respond well to physical activity. Because there’s nothing worse than going on a diet and it not working. So you can be more defined in terms of your therapy.”
Roche believes individuals should be aware that if left untreated, insulin resistance can develop into diabetes, where poorly controlled levels of blood sugar can damage organs and blood vessels.
“Diabetes is a rotten disease, which you just don’t want. You wouldn’t wish it on your worst enemy so you should be quite vigilant and not be too scared to broach the subject,” she says.
But people who have the metabolic syndrome risk factors tend not to go to their doctor looking for information about it, according to Dr Mel Bates, spokesman for the Irish College of General Practitioners (ICGP).
“Doctors are very aware of metabolic syndrome. But people with the condition tend to be a happy group – they think they have put on a bit of weight but they are not going to the doctor about it,” says Bates, who would welcome increased patient awareness about the syndrome.
Recognising metabolic syndrome
If you have three or more of the symptoms listed here, you could have the metabolic syndrome and be at increased risk of type 2 diabetes.
Health authorities vary on their exact thresholds for the symptoms, but in the US, where an estimated 50 million people have the metabolic syndrome, the American Heart Association cutoffs are:
* Central obesity – a waist circumference of 40 inches or greater in men, of 35 inches or greater in women. Some health agencies use a body mass index or waist-to-hip ratio here instead
* Reduced levels of “good” HDL cholesterol, 40mg/dL or less for men, 50mg/dL or less for women
* High levels of triglyceride fats in the blood, 150mg/dL or more
* Fasting blood glucose levels of 100mg/dL or over
* High blood pressure, 130/85 mmHg or over
If you have any concerns, visit your GP