What Are the Signs of Metabolic Syndrome?

Contributing factors for metabolic syndrome include insulin resistance leading to obesity

Metabolic syndrome (also called syndrome X, insulin resistance syndrome, and obesity syndrome) is a multifactorial disease that refers to a number of risk factors that raise a person’s risk for heart disease, stroke, diabetes, fatty liver, and several cancers.

Signs of metabolic syndrome include:

• Large waistline (abdominal obesity)
• High blood pressure (hypertension)
  • Symptoms of high blood pressure may include headache, dizziness, and nosebleeds
• High blood sugar (hyperglycemia)
  • Symptoms of high blood sugar include increased thirst, increased urination, fatigue, and blurred vision
• High blood levels of triglycerides (fats) (hypertriglyceridemia)
• Reduced high-density lipoprotein (HDL) cholesterol (the “good” cholesterol)
• Cardiovascular problems
  • Chest pain 
  • Shortness of breath
• Dark skin discoloration in the body’s skin folds (acanthosis nigricans)
• Excess body hair 
• Numbness and tingling of extremities
• Retina damage (in patients with insulin resistance and hyperglycemia or diabetes mellitus)
• Fatty growths under the skin (xanthomas or xanthelasmas) (in patients with very high levels of fats in the blood)

The cause of the metabolic syndrome is unknown but there are a number of risk factors, such as:

• Family history
• Poor diet
• Sedentary lifestyle
• Certain psychological characteristics, such as anger, depression, anxiety, and hostility

Contributing factors for metabolic syndrome include:

• Insulin resistance leading to obesity 
• Cellular dysfunction by protein kinases and phosphatases 
• Suppression of insulin receptor function 
• Pancreatic dysfunction
• Genetics
• High triglycerides in the blood
• Oxidative stress on cells
• Chronic glucose toxicity 
• Chronic systemic inflammation 
• Disrupted sleep cycles and chronic fatigue 
• Gut microbial imbalance 

Metabolic syndrome is diagnosed when a patient has at least 3 of the following 5 conditions:

• Fasting glucose 100 mg/dL or greater (or receiving drug therapy for hyperglycemia)
• Blood pressure 130/85 mm Hg or greater (or receiving drug therapy for hypertension)
• Triglycerides 150 mg/dL or greater (or receiving drug therapy for hypertriglyceridemia)
• HDL-C less than 40 mg/dL in men or less than 50 mg/dL in women (or receiving drug therapy for reduced HDL-C)
• Waist circumference 102 cm (40 in) or greater in men or 88 cm (35 in) or greater in women; OR 90 cm (35 in) or greater in men or 80 cm (32 in) in women or greater in Asian Americans

If patients meet the criteria for metabolic syndrome and also have complaints of chest pain, shortness of breath, or difficulty walking, additional tests for complications may include:

• Electrocardiography (rest/stress ECG)
• Ultrasonography (vascular, or rest/stress echocardiography)
• Stress single-photon emission computed tomography (SPECT) or cardiac positron emission tomography (PET)
• CT Angiogram of the heart

Other tests may be indicated for other causes or factors that can contribute to worsening symptoms, for example, sleep investigations for sleep-related breathing disorders, such as obstructive sleep apnea. 

Weight loss and lifestyle modifications are essential in treating metabolic syndrome. The goal is to reduce the risk for heart disease, stroke, and diabetes and may include lifestyle changes such as: 

• Following a low-fat heart-healthy diet
• Plant-based eating plans
• Exercising regularly
• Quitting smoking
• Managing stress

Medications used to treat high levels of fat in the blood (dyslipidemia) associated with metabolic syndrome include:  

• Statins to reduce elevated LDL-C (“bad” cholesterol) levels
• Niacin to increase lowered HDL-C (“good” cholesterol) levels
• Niacin, fibrates, and omega-3 fatty acids to treat elevated triglyceride levels
• Insulin-sensitizing agents, such as metformin to treat high blood sugar (hyperglycemia)

Patients may also be prescribed a CPAP or BiPAP to treat obstructive sleep apnea if that condition is present.

There are numerous complications of metabolic syndrome, including:

• Cardiovascular complications 
  • Coronary heart disease
  • Atrial fibrillation
  • Heart failure
  • Aortic stenosis
  • Ischemic stroke
  • Venothromboembolic disease
• Nonalcoholic fatty liver disease
• Obstructive sleep apnea
• Psoriasis
• Certain cancers
  • Breast 
  • Colon
  • Gallbladder
  • Kidney
  • Prostate gland
• Pregnancy complications (preeclampsia)
• Accelerated cognitive aging 

Metabolic syndrome may be prevented with:

• Eating a balanced, nutritious diet, especially low-fat or plant-based
• Maintaining a healthy weight
• Getting adequate exercise
• Not smoking