Metabolic syndrome - Causes, symptoms and treatment. MF.

Currently, cardiovascular diseases( myocardial infarction, stroke, etc.) and type 2 diabetes are leading among the causes of death, so the prevention of these diseases is an important problem of our time. The prevention of any disease is based on the fight against risk factors. The term metabolic syndrome is used in medicine specifically for the purpose of early detection and elimination of risk factors for cardiovascular diseases and diabetes.

Metabolic syndrome is a group of risk factors for cardiovascular diseases and diabetes mellitus. The disorders within the metabolic syndrome remain unnoticed for a long time, often begin to form in childhood and adolescence, inevitably leading to atherosclerotic diseases, diabetes, arterial hypertension. Often, patients with obesity, a "little" elevated glucose level, arterial pressure at the upper limit of the norm is not given proper attention. Only when these risk factors turn into a serious disease, the patient is paid attention to health.

It is important that risk factors are identified and corrected as early as possible, before they lead to cardiovascular disasters. In this huge role is played by the introduction and application of such a concept as the metabolic syndrome.

For the convenience of patients and practitioners, clear criteria have been established, allowing a diagnosis to be made with a minimal examination of the metabolic syndrome. At the moment, most doctors use a single definition of the metabolic syndrome suggested by the International Diabetes Federation: a combination of abdominal obesity and any two additional criteria( dyslipidemia, carbohydrate metabolism disorders, arterial hypertension) .

Symptoms of the metabolic syndrome

Consider all the criteria for the metabolic syndrome:

The main and mandatory criterion is abdominal obesity , i.e.obesity, in which fatty tissue is deposited mainly in the abdomen. Sometimes this obesity is called obesity "by type of apple" or "android".Fat deposition mainly in the thigh and buttocks( "pear-type", "gynoid") does not have such unfavorable consequences and is not considered as a criterion of the metabolic syndrome. To determine abdominal obesity is very simple, it is enough to measure the waist at the midpoint of the distance between the edges of the ribs and ileal bones. For the european nation, abdominal obesity is defined as the waist size in men over 94 cm, in women over 80 cm. For the Asian population, obesity in men is more stringent - the waist is more than 90 cm, and for women is also more than 80 cm.

Volume measurementwaistline

It should be remembered that obesity can be not only a consequence of overeating and a wrong lifestyle, but also a symptom of a serious genetic or endocrine disease. Therefore, when combining obesity and symptoms such as swelling, dry skin, constipation, bone pain, stretch marks on the skin, skin discoloration, and visual impairment, should consult the endocrinologist as soon as possible to eliminate the secondary forms of obesity .

Abdominal obesity Adolescent-adipose obesity

Additional criteria:

1. Hypertension is diagnosed if the systolic blood pressure is more than or equal to 130 mmHg.diastolic is greater than or equal to 85 mm. Hg, or in the case of a patient taking antihypertensive drugs.

2. Disorders of the lipid spectrum of .For diagnosis, a biochemical blood test will be required: the determination of the level of triacylglycerides and high-density lipoprotein cholesterol. The criteria for the syndrome include the level of triacylglycerides more than 1.7 mmol / l, the level of high-density lipoproteins less than 1.03 mmol / l in men and less than 1.2 mmol / l in women, or the established fact of treatment of dyslipidemia.

3. A violation of the carbohydrate metabolism of is the fasting blood glucose level of more than 5.6 mmol / l, or treatment with sugar-lowering medications.

Diagnosis of metabolic syndrome

If necessary, the physician will prescribe an additional examination:

- daily monitoring of arterial pressure, ECG study, ultrasound examination of the heart and blood vessels, determination of biochemical parameters of blood lipids, liver and kidney function tests, determination of blood glucose 2 hours after meals or after an oral glucose tolerance test.

Treatment of the metabolic syndrome

Treatment of the metabolic syndrome consists in the management of a healthy lifestyle and drug therapy.

A change in lifestyle means changing diet, exercise, and avoiding bad habits. Pharmacotherapy( prescribing drugs) will not have an effect if the patient does not follow the rules of nutrition and physical activity.

Recommendations for nutrition in the metabolic syndrome

- Extremely strict diets and fasting are not strongly recommended. The decrease in body weight should be gradual( by 5-10% for the first year).With a fast rate of weight loss, it is difficult for a patient to keep the result, almost always lost pounds are also quickly returned.
- It will be more useful and effective to change the composition of food: reduce the intake of animal fats, replace animal fats with vegetable, increase the consumption of plant fiber, fiber and reduce consumption of table salt.
- It should almost completely eliminate the sweet fizzy drinks, confectionery, fast food.
- Use bread is better limited to 150-200 grams per day,
- Soups should be predominantly vegetable.
- From meat products it is better to choose low-fat varieties of beef, poultry or fish in boiled or jellied form.
- It is better to use buckwheat and oatmeal from cereals, rice, pine, pearl barley, cereals are also possible, manna is better to limit as much as possible.
- Potatoes, carrots, beets, it is recommended to use no more than 200 grams per day. Vegetables rich in fiber( tomatoes, cucumbers, bell peppers, cabbage, lettuce, radishes, zucchini) and greens can be used almost without restrictions in raw and cooked or baked form.
- Eggs are recommended to use no more than 1 piece per day.
- Fruits and berries can be consumed up to 200-300 grams a day.
- Milk of minimum fat content, low-fat dairy products and cottage cheese - 1-2 glasses a day. Cream, fatty cheeses, sour cream is recommended to use occasionally.
- From drinks are allowed tea, loose coffee in moderate quantities, tomato juice, compotes and juices from berries and fruits of acidic varieties, better home-made sugar-free.

Combating bad habits: alcohol restriction, quitting.

Recommendations for the physical activity regimen in the metabolic syndrome

A gradual increase in physical activity is recommended. You should prefer such sports as walking, running, gymnastics, swimming. The main thing is that the physical activities are regular and correspond to your capabilities.

Drug treatment of the metabolic syndrome

The pharmacotherapy of the metabolic syndrome is aimed at treating obesity, disorders of carbohydrate metabolism, arterial hypertension and dyslipidemia.

To date, metformin( Siofor, Glucophage) is used to treat disorders of carbohydrate metabolism in the metabolic syndrome. The dose of Metformin is selected under the control of blood glucose level. The initial dose is usually 500-850 mg, the maximum daily - 2.5-3 g. With caution, the drug should be prescribed to elderly patients. Metformin is contraindicated in patients with impaired renal and hepatic function. Usually, metformin is well tolerated, gastrointestinal disorders predominate among side effects, so it is recommended to take it during or immediately after a meal.

When an overdose of the drug or a violation of diet can cause hypoglycemia - a decrease in blood sugar. Hypoglycemia manifests weakness, trembling in the body, a feeling of hunger, anxiety. In this regard, it is important to carefully monitor blood glucose levels when taking metformin. It is best if the patient has a glucometer - a device for self-measurement of blood sugar at home.

For the treatment of obesity, Orlistat( Xenical) is widely used. The dose is 120 mg during or during the hour after the main meal( but no more than three times a day).In the case of a small amount of fats in food, the intake of orlistat is allowed to be missed. This drug reduces the absorption of fats in the intestine, so if the patient increases the amount of fat in the diet, then there are unpleasant side effects: oily discharge from the anus, flatulence, frequent urges to defecate.

Patients with dyslipidemia, with ineffectiveness of diet therapy for at least 3-6 months, are prescribed lipid-lowering drugs, which include statin or fibrates. These drugs have significant limitations in the use and serious side effects, should be prescribed only by the attending physician.

Antihypertensives recommended for metabolic syndrome include angiotensin-converting enzyme( enalapril, lisinopril) inhibitors, calcium channel blockers( amlodipine) and imidazaline receptor agonists( rilmenidine, moxonidine).The choice of drugs is performed by the therapist or cardiologist individually, based on a specific clinical situation.

Complications of the metabolic syndrome

As mentioned above, the metabolic syndrome is a risk factor for the development of serious cardiovascular diseases and diabetes, so care should be taken to prevent and treat it.

Doctor endocrinologist Fayzulina N.М.