Metabolic Syndrome

Metabolic syndrome is a cluster of conditions that occur together, increasing the risk of heart disease, stroke, and type 2 diabetes. The condition is characterised by increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels. When these conditions develop together, they multiply a person’s risk for cardiovascular problems beyond what would be expected from any single factor.

Dr Ben Ng

Senior Consultant Endocrinologist

Dr Donovan Tay

Senior Consultant Endocrinologist

Symptoms of Metabolic Syndrome

Metabolic syndrome itself may not show noticeable symptoms until complications develop, but several measurable factors can indicate its presence.

Increased waist circumference

A waistline of 40 inches or more for men and 35 inches or more for women indicates excess abdominal fat, which is linked to metabolic syndrome. This fat, particularly visceral fat surrounding organs, produces hormones and other substances that can contribute to health problems.
Elevated blood pressure

Blood pressure readings of 130/85 mm Hg or higher suggest hypertension, a component of metabolic syndrome. Consistently elevated blood pressure forces the heart to work harder to pump blood, potentially damaging arteries over time.
High fasting blood glucose

Fasting blood sugar levels of 100 mg/dL or higher indicate insulin resistance, where cells do not respond normally to insulin. This resistance causes glucose to build up in the bloodstream instead of being absorbed by cells.
Insulin resistance

When cells become resistant to insulin, blood sugar levels rise, prompting the pancreas to produce more insulin. This cycle can lead to diabetes and contribute to other metabolic syndrome components. Insulin resistance affects how the body processes and stores energy.
High triglyceride levels

A triglyceride level of 150 mg/dL or higher reflects excess fat in the bloodstream. Triglycerides are a type of fat found in the blood that can contribute to arterial plaque buildup.
Low HDL cholesterol

HDL levels below 40 mg/dL in men or below 50 mg/dL in women indicate reduced “good” cholesterol. HDL cholesterol helps remove other forms of cholesterol from the bloodstream.

Causes and Risk Factors

Metabolic syndrome is caused by a combination of interrelated factors, with insulin resistance frequently acting as the central mechanism.

Obesity

Excess weight, particularly around the abdomen, increases the risk of metabolic syndrome. Body mass index (BMI) greater than 30 significantly raises the likelihood of developing the condition.

Sedentary lifestyle

Physical inactivity contributes to weight gain and worsens insulin resistance. Regular exercise helps muscles use glucose efficiently and maintain appropriate insulin sensitivity.

Age

The risk of metabolic syndrome increases with age, with prevalence rising significantly after age 60. Cellular functions and metabolic processes naturally change with age, making older adults more susceptible.

Genetics

Family history influences susceptibility to metabolic syndrome. Certain genetic variations affect how the body metabolises glucose and stores fat.

Hormonal imbalances

Conditions like polycystic ovary syndrome or low testosterone can contribute to metabolic abnormalities. These hormonal changes can affect how the body processes glucose and stores fat.

Diagnostic Methods

Physical examination

Doctors measure waist circumference, blood pressure, and body mass index. A waist measurement exceeding 40 inches for men or 35 inches for women (or ethnic-specific values) indicates abdominal obesity. This simple measurement provides valuable information about visceral fat, which is metabolically active and increases health risks.

Blood tests

Laboratory tests check fasting blood glucose, triglycerides, and HDL cholesterol levels. These tests require fasting for 8-12 hours beforehand to ensure accurate results. Abnormal values in two or more of these tests, along with elevated blood pressure and waist circumference, typically confirm metabolic syndrome.

Oral glucose tolerance test

This test measures how efficiently the body processes glucose and can identify insulin resistance. After fasting overnight, the patient drinks a glucose solution, and blood samples are taken at intervals to track glucose levels. The pattern of glucose changes helps detect abnormal glucose metabolism that might not be apparent from a single fasting test.

Insulin level testing

While not part of standard diagnostic criteria, measuring insulin levels can help evaluate insulin resistance. Elevated fasting insulin levels suggest the body is producing excess insulin to compensate for resistance. This test provides additional information about the underlying metabolic dysfunction.

Diagnosis of metabolic syndrome requires the presence of at least three of the five main risk factors: large waist circumference, high triglycerides, low HDL cholesterol, high blood pressure, and elevated fasting blood glucose.

Treatment Options

Treatment for metabolic syndrome focuses on addressing underlying risk factors through lifestyle changes and medication when necessary.

Lifestyle modifications

Dietary changes, increased physical activity, and weight loss form the foundation of metabolic syndrome treatment. A Mediterranean or DASH diet emphasising fruits, vegetables, whole grains, and lean proteins helps improve multiple metabolic parameters. Even modest weight loss of 5-10% can significantly reduce risk factors and improve insulin sensitivity.

Blood pressure management

Medications such as ACE inhibitors, ARBs, or calcium channel blockers may be prescribed to control hypertension. These medications work through different mechanisms to reduce blood pressure and protect organs from damage. Regular monitoring helps ensure blood pressure remains within target ranges.

Lipid-lowering therapy

Statins or fibrates can help manage cholesterol and triglyceride levels. Statins primarily reduce LDL cholesterol, while fibrates are more effective for lowering triglycerides and raising HDL cholesterol. These medications help prevent atherosclerosis and reduce cardiovascular risk.

Glucose control

In certain cases, medications may be prescribed to improve insulin sensitivity and manage blood glucose.

Anti-obesity medications

For patients with significant obesity, medications that reduce appetite or fat absorption might be considered. These medications work through various mechanisms, including affecting hunger signals in the brain or preventing dietary fat digestion. They are typically used alongside lifestyle changes for greater effectiveness.

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Prevention and Management

Prevention and management of metabolic syndrome centre on maintaining a healthy lifestyle. Regular physical activity of at least 150 minutes of moderate exercise weekly helps maintain weight and improve insulin sensitivity. Following a balanced diet rich in fruits, vegetables, whole grains, and lean proteins while limiting processed foods, sugary beverages, and excessive alcohol consumption supports metabolic health. Regular medical check-ups allow for monitoring of blood pressure, cholesterol, and glucose levels, enabling early intervention when values begin trending toward unhealthy ranges. Stress management techniques such as meditation, adequate sleep, and social connections also contribute to overall metabolic health by reducing stress hormones that can exacerbate insulin resistance.

Frequently Asked Questions

Can metabolic syndrome be reversed?

Metabolic syndrome can be reversed, particularly in its early stages, through comprehensive lifestyle changes. Research shows that losing 7-10% of body weight can normalise many metabolic parameters. Sustained lifestyle modifications, including regular physical activity and dietary changes, produce the most lasting improvements in metabolic health.

How does metabolic syndrome affect pregnancy?

Women with metabolic syndrome face higher risks during pregnancy, including gestational diabetes, preeclampsia, and complications during delivery. These conditions can affect both maternal and foetal health. Addressing metabolic syndrome before conception improves pregnancy outcomes, and women with risk factors benefit from additional monitoring throughout pregnancy.

How quickly can lifestyle changes impact metabolic syndrome?

Positive changes in metabolic markers can begin within weeks of implementing lifestyle modifications. Blood pressure may respond within days, while glucose metabolism typically shows improvement within 2-4 weeks. Lipid profiles generally take 1-3 months to show significant changes. These improvements continue and stabilise with consistent healthy habits.

Dr Ben Ng

Senior Consultant Endocrinologist

As a senior consultant endocrinologist with over 20 years of clinical experience, Dr Ben Ng provides comprehensive care for patients managing various endocrine conditions. His expertise includes the diagnosis and treatment of diabetes, thyroid disorders, obesity, and a range of other metabolic and endocrine conditions.

Adj Asst Professor Dr Ben Ng Jen Min graduated from the Queens University of Belfast Northern Ireland, United Kingdom (UK).
He completed his postgraduate training with the certificate of completion of training (CCT) from the Royal College of Physicians (UK) with dual accreditation in diabetes and endocrinology and in general internal medicine.
In 2010, he was awarded an MD with honours by the University of Hull, UK, in recognition for his research in diabetes mellitus

Dr Donovan Tay

Senior Consultant Endocrinologist

As a senior consultant endocrinologist with over 20 years of clinical experience, Dr. Donovan Tay provides comprehensive care for patients managing various endocrine conditions. His expertise includes the diagnosis and treatment of diabetes, thyroid disorders, osteoporosis, and a range of other metabolic and endocrine conditions.

Dr. Donovan Tay graduated from the National University of Singapore (NUS) and obtained his membership in the Royal College of Physicians (UK), Master of Medicine (NUS), and Master of Clinical Investigation (NUS).
After completing training in endocrinology, he was conferred as a Fellow of the Academy of Medicine, Singapore (FAMS).
He further specialised in endocrinology with a fellowship at the prestigious Columbia University Medical Centre in New York City.

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