Risk of Developing Metabolic Syndrome

Citation:

Grundy SM, Brewer HB, Cleeman JI, Smith SC, Lenfant C, for the Conference Participants. Definition of the Metabolic Syndrome, Report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on Scientific Issues Related to Definition. Circulation. 2004;109:433-438.

 
Study Design:
Consensus Statement
Class:
R - Click here for explanation of classification scheme.
Quality Rating:
Negative NEGATIVE: See Quality Criteria Checklist below.
Research Purpose:

To review the scientific evidence related to definition of the metabolic syndrome

Inclusion Criteria:
Exclusion Criteria:
Description of Study Protocol:

 

Data Collection Summary:

 

Description of Actual Data Sample:

Summary of Results:

Clinical Outcomes of Metabolic Syndrome- CVD and type 2 diabetes are the primary clinical outcome of the metabolic syndrome however individuals are also susceptible to other conditions including polycystic ovary syndrome, fatty liver, cholesterol gallstones, asthma, sleep disturbances, and some forms of cancer.

Components of the Metabolic Syndrome

ATP III identified 6 components that relate to CVD

  • Abdominal obesity
  • Atherogenic dyslipidemia
  • Raised blood pressure
  • Insulin resistance +/- glucose intolerance
  • Proinflammatory state
  • Prothrombotic state

Pathogenesis of Metabolic Syndrome- obesity and disorders of adipose tissue; insulin resistance; and a constellation of independent factors (i.e. molecules of hepatic, vascular and immunologic origin)

Criteria for Clinical Diagnosis of Metabolic Syndrome

ATP III

Abdominal obesity
   Men;  >102 cm (>40 in)
   Women; >88 cm (>35 in)
Triglycerides; >/=150 mg/dL
HDL-C
   Men; <40 mg/dL
   Women; <50 mg/dL
Blood pressure; >/=130 / >/=85 mmHg
Fasting glucose; >/=110 mg/dL

WHO

Insulin resistance, identified by one of the following

  • Type 2 DM
  • Impaired fasting glucose
  • Impaired glucose tolerance
  • or for those with normal fasting glucose, glucose uptake below the lowest quartile for background population under investigation under hyperinsulinemic, euglycemic conditions

Plus any 2 of the following:

  • Antihypertensive medication and/or high blood pressure (>/=140 / >/= 90 mmHg
  • Plasma triglycerides >/=150 mg/dL
  • HDL-C <35 mg/dL in men or <39 mg/dL in women
  • BMI >30 and/or waist:hip ratio >0.9 men, >0.85 in women
  • Urinary albumin excretion rate >/=20 microgram/min or albumin:creatinine ratio >/=30 mg/g

Therapeutic Implications- target obesity, insulin resistance and specific metabolic risk factors (atherogenic dyslipidemia, elevated blood pressure, prothrombotic state, proinflammatory state, hyperglycemia)

-first line of therapy should be weight reduced reinforced with increased physical activity

Author Conclusion:
"Conference participants agreed that CVD is the primary clinical outcome of metabolic syndrome"
Funding Source:
Not-for-profit
0
Foundation associated with industry:
Reviewer Comments:
Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? No
  4. Will the information, if true, require a change in practice? No
 
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? No
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? No
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? No
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? No
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? No
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? No
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? No
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? No
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? No
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? No
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? No
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? No
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? No
  10. Was bias due to the review's funding or sponsorship unlikely? No