,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Obesity and Metabolic Syndrome,Steven M.Haffner,MD,Obesity and Metabolic Syndrom,Conceptual Framework for the Metabolic Syndrome,Environmental causes are responsible for the epidemic of the metabolic syndrome(NCEP),Treatment:,reduce obesity and increase activity,Insulin resistance is the underlying cause of the metabolic syndrome(WHO),Treatment:,a)reduce obesity and increase activity b)insulin sensitizers,Inflammation is the underlying cause of the metabolic syndrome,Treatment:,a)reduce obesity and increase activity b)insulin sensitizers c)statins,ACE Inhibitors,ARBs,Conceptual Framework for the M,Metabolic Syndrome Increases Risk for CHD and Type 2 Diabetes,Expert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol in Adults.,JAMA,2001;285:2486-2497.,Coronary Heart Disease,Type 2Diabetes,HighLDL-C,MetabolicSyndrome,Metabolic Syndrome Increases R,The Metabolic Syndrome:,Historical Perspective,Reaven G.Diabetes.1988;37:1565-1607.,InsulinResistance,GlucoseIntolerance,Hyperinsulinemia,TG,HDL-C,Hypertension,1988:Syndrome X,CORONARY HEART DISEASE,The Metabolic Syndrome:Histor,The Metabolic Syndrome:,Current Perspective,Adapted from Reaven G.Drugs.1999;58(suppl):19-20,Body Size,BMI,Central Adiposity,GlucoseMetabolism,Uric AcidMetabolism,Dyslipidemia,Hemodynamic,Novel RiskFactors,CORONARY HEART DISEASE,Insulin Resistance,Hyperinsulinemia,+,TG,PP lipemia,HDL-C,PHLA,Small,dense LDL,Glucoseintolerance,Uric acid,Urinary uricacid clearance,SNS activity,Na retention,Hypertension,CRP,PAI-1,Fibrinogen,The Metabolic Syndrome:Curren,ATP III:The Metabolic Syndrome*,*Diagnosis is established when,3 of these risk factors are present,*,The Expert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol in Adults.,JAMA,.2001;285:2486-2497.,*The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus:Follow-up report on the diagnosis of diabetes mellitus.Diabetes Care 26:3160-3167,2003,Risk Factor,Defining Level,Abdominal obesity,(Waist circumference,),Men,102 cm(40 in),Women,88 cm(35 in),TG,150 mg/dL,HDL-C,Men,40 mg/dL,Women,130/,85 mm Hg,Fasting glucose,110,(,100)*,mg/dL,*,2003 New ADA IFG criteria(Expert Panel,Diabetes Care 26:3160-3167,2003),ATP III:The Metabolic Syndrom,WHO Metabolic Syndrome Definition 1999:,Based on Clinical Criteria,Insulin resistance(type 2 diabetes,IFG,IGT),*,Plus any 2 of the following:,Elevated BP(,140/90 or drug Rx),Plasma TG,150 mg/dl,HDL 35 mg/dl(men);30 and/or W/H 0.9(men),0.85(women),Urinary albumin 20 mg/min;Alb/Cr 30 mg/g,WHO.,Definition,Diagnosis and Classification of Diabetes Mellitus and Its Complications:Report of a WHO Consultation.,Geneva:WHO,1999.,*,Note that 1999 WHO uses hyperinsulinemic euglycemic clamp whereas 1998 WHO and EGIR use HOMA-IR.,WHO Metabolic Syndrome Definit,IRS:AACE Criteria,Diagnosing Insulin Resistance SyndromeIs as Simple as,1,plus,2,Choose:,One,Risk+,Two,Parameters,IRS:AACE CriteriaDiagnosing I,IRS:AACE Criteria Risks(Choose 1),BMI,25 kg/m,2,Waist circumference,Men 40”,Women 35”,Sedentary Lifestyle,Age 40,Non-Caucasian ethnicity,Family History of DM,HTM,or CVD,History of glucose intolerance or gestational diabetes,Personal Dx of HTN,TGL,low HDL or CVD,Acanthosis nigricans,Polycystic ovarian syndrome(PCOS),Nonalcoholic fatty liver disease(NAFLD),Cancer(obesity related),IRS:AACE Criteria Risks(Ch,IRS:AACE Criteria Parameters(Choose 2),Triglycerides 150 mg/dl,HDL cholesterol,Men 40 mg/dl,Women,135/85,Blood glucose,2-hour 140 mg/dl,OR,Fasting 110 125 mg/dl,IRS:AACE Criteria Parameter,4049,20,70+,Age,years,2029,30,39,5059,60,69,70,Ford ES et al.,JAMA,2002;287:356-359.,Prevalence,%,Men,Women,24%,23%,8%,6%,44%,44%,Prevalence of the NCEP Metabolic Syndrome:,NHANES III by Age,40492070+Age,years2029303,Ford ES et al.,JAMA,2002;287:356-359.,White,African American,25%,Prevalence of the NCEP Metabolic Syndrome:,NHANES III by Sex and Race/Ethnicity,Men,Women,16%,28%,Mexican American,Other,21%,23%,26%,36%,20%,Ford ES et al.JAMA 2002;287:3,DM,(n=1,430),NGT,(n=1,808),IFG/IGT,(n=685),All,(n=3,928),Isomaa B et al.,Diabetes Care,.2001;24:683-689.,Prevalence of CHD(%),Yes,No,P=.04,Botnia Study,Prevalence of CHD in Patients with the Metabolic Syndrome,9.2%,Metabolic Syndrome,4.1%,11.0%,5.3%,27.1%,P=.06,P.001,13.5%,21.4%,P.001,5.5%,DMNGTIFG/IGTAllIsomaa B et al.,Cardiovascular Disease Mortality Increased in the Metabolic Syndrome:,Kuopio Ischemic Heart Disease Risk Factor Study,Lakka HM et al.,JAMA,2002;288:2709-2716.,Cumulative Hazard,%,0,2,6,8,12,Follow-up,year,YES,Metabolic,Syndrome:,NO,Cardiovascular Disease Mortality,RR(95%CI),3.55(1.986.43),4,10,Cardiovascular Disease Mortali,Prevalence of CHD by the Metabolic Syndrome and Diabetes in the NHANES Population Age 50+,CHD Prevalence,%of Population=,No MS/No DM,54.2%,MS/No DM,28.7%,DM/No MS,2.3%,DM/MS,14.8%,8.7%,13.9%,7.5%,19.2%,Alexander CM et al.,Diabetes,2003;52:1210-1214