THE METABOLIC SYNDROME

What on Earth is that?

Well, it is a rather important cluster of some of the conditions which I have described previous blogs – and will do in future blogs. This combination of conditions, known as metabolic syndrome, make you prone to arterial problems, particularly coronary disease. There are five components of the metabolic syndrome, also known as “Syndrome X”. They are:  abdominal or central obesity, raised blood pressure, insulin resistance (prediabetes), raised blood triglycerides (a fat fraction) and low HDL cholesterol (see above in Dyslipidaemia). If you’ve got three of these or more you have the metabolic syndrome. Insulin resistance seems to be the major component of the syndrome. This was described in the Diabetes blog two weeks ago.

Causes of Metabolic Syndrome

The metabolic syndrome (MetSyn) has been recognised for the past 50 years or so. It is caused by a combination of unhealthy (over-) eating, lack of exercise, sedentary behaviour, getting older and being under stress. Metabolic Syndrome is common, affecting about one in four adults in the UK. Approximately 50% of heart attack patients have the syndrome and it increases the risk of dying from heart disease about threefold.

Exercise in the prevention of Metabolic Syndrome

Since lack of exercise is an important risk factor for developing the MetSyn it does not take a genius to work out that taking exercise is a sensible way of keeping the condition at bay. So it has been demonstrated. In the Ely study of 604 healthy middle aged men and women followed up for 5.6 years, objectively measured physical activity predicted the development of MetSyn in a dose dependent way. The less the exercise taken the higher the risk of the syndrome. The beneficial effect of exercise in this respect is found at all levels of obesity.

Similarly the level of physical fitness, which itself is largely determined by levels of physical activity, is a strong predictor of MetSyn. In a study of fitness level in 9666 men aged 20 to 69 the overall prevalence of the syndrome was 25% and the unfit men were twice as likely to have MetSyn as the fit men. The association has been studied in older men and women and been found to be even more dramatic. MetSyn is up to ten times more common in the unfit compared with the very fit older person.

Exercise in the treatment of Metabolic Syndrome

Exercise is effective in improving each one of the components of metabolic syndrome. So again no surprises to hear that exercise has been shown to be effective in treating the whole syndrome. One trial of exercise in 621 apparently healthy but sedentary individuals found that 105 had MetSyn at the start of the programme.  Thirty two of these were free of the syndrome by the end of the programme. Improvements in all components were found. There is evidence of an exercise dose relationship with high-dose, vigorous intensity exercise being more effective than lower doses.

The multiple components of metabolic syndrome make it particularly prone to recur after successful treatment with diet and exercise. Long term freedom from disease requires long-term commitment to the lifestyle changes used for its treatment.

PS
Zoanthropy (not related to exercise)

One advantage of writing a regular Blog is the need to keep an eye on current medical literature. A consequent bonus is coming across unexpected diagnostic gems. Zoanthropy is one such, a very rare condition in which people think they are an animal. Unsurprisingly it is often not recognised. Zoanthropy can include people believing they are, or behaving like, any kind of animal: from a dog, to a lion or tiger, crocodile, snake, or bee. The case is described of a woman who, for 24 hours, believed that she was a chicken¹. She perspired profusely, trembled, blew up her cheeks, and…seemed to imitate a chicken, with clucking, cackling, and crowing like a rooster. An important aspect of zoanthropy is that it may be a symptom of unidentified epilepsy.So, next time you hear your neighbour clucking, braying or buzzing please take it seriously.

1. Tijdschr Psychiatr 2020;62(7):582-586.