Metabolic Syndrome: Diagnosis and Treatment at K+31
Metabolic syndrome (MS) is not a single disease, but a cluster of interconnected metabolic disorders that together dramatically increase the risk of cardiovascular disease, type 2 diabetes, and related mortality. The key factor is insulin resistance: the body's cells respond poorly to insulin, the pancreas produces increasing amounts of it, and carbohydrate and fat metabolism are increasingly disrupted.
According to research, metabolic syndrome is diagnosed in 20–25% of the adult population in developed countries. However, most patients are unaware of it: there are no symptoms that clearly indicate MS. It is detected during a routine examination or at the stage of complications.
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Diagnostic Criteria
According to the IDF/AHA/NHLBI consensus criteria (current standard), metabolic syndrome is diagnosed in the presence of central obesity and two more of four criteria:
| Criteria | Threshold Value |
|---|---|
| Central Obesity (Required Criterion) | Waist: ≥94 cm in men, ≥80 cm in women (European values) |
| Hypertriglyceridemia | Triglycerides ≥1.7 mmol/L (or taking lipid-lowering drugs) |
| Decreased HDL ("good cholesterol") | <1.0 mmol/L in men, <1.3 mmol/L in women |
| Arterial hypertension | BP ≥130/85 mmHg (or taking antihypertensive medications) |
| Impaired fasting glucose | Glucose ≥5.6 mmol/L (or treatment for type 2 diabetes) |
Important: MS is not an ICD diagnosis, but a clinical syndrome. If diagnosed, the doctor also examines the patient for NAFLD (non-alcoholic fatty liver disease), obstructive sleep apnea syndrome (OSA), and hyperuricemia—common comorbidities of MS.
Pathogenesis: Why It's Dangerous
Central (visceral) fat is not a passive storage depot. It is an active endocrine organ: it secretes proinflammatory cytokines, impairs insulin sensitivity, increases blood pressure, and accelerates atherosclerosis. That's why waist circumference is more important than overall weight.
Main target organs in MS:
- Heart and blood vessels: accelerated atherosclerosis, coronary heart disease, heart attack, stroke (risk is 2-4 times higher)
- Pancreas: gradual depletion of β-cells → type 2 diabetes
- Liver: fat accumulation → NAFLD → possible cirrhosis
- Kidneys: glomerulosclerosis, chronic kidney disease
- Reproductive system: PCOS in women, hypogonadism in men
Frequently Asked Questions (FAQ)
I have a normal weight, but my waist is wide - is this metabolic syndrome?
Possibly. "Normal weight" with a high percentage of visceral fat ("skinny fat") is an independent risk factor. The defining criterion for MS is waist circumference, not BMI.
How is metabolic syndrome different from obesity?
Obesity is one of the causes of MS, but not its synonym. MS is a combination of disorders: dyslipidemia, hyperglycemia, hypertension, and central obesity. A person can be obese without meeting the full criteria for MS, and conversely, have several of its components while at a relatively normal weight.
Is Metabolic Syndrome a Death Sentence?
No. MS is completely reversible in the initial stages with lifestyle changes. Even after many years of treatment, treatment significantly reduces cardiovascular risk.
How are MS and PCOS related?
Polycystic ovary syndrome in women is largely caused by insulin resistance—the same mechanism that underlies MS. Therefore, testing for MS components is essential for PCOS, and metformin is used for both PCOS and MS/prediabetes.
Can children have metabolic syndrome?
Yes. Pediatric MS is a growing problem due to the rise in childhood obesity. Diagnostic criteria for children under 16 differ from those for adults.
How often should you undergo examinations if you have established MS?
As a rule: complete blood count and biochemistry every 6 months; lipid profile every 6-12 months; HbA1c and blood glucose every 6 months (more often in prediabetes). ECG annually. Abdominal ultrasound annually in NAFLD.
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Laboratory diagnostics at K+31
To assess MS and its components, the following are performed:
Required:
Additional (as indicated):