Metabolism is a combination of all metabolic processes in living organisms. Syndrome is the most characteristic combination of individual symptoms (signs) for a particular pathological condition or a specific disease. Metabolic syndrome - interrelated metabolic, hormonal and clinical disorders, which are factors of a high risk of developing diseases of the cardiovascular system. Disorders are based on the primary immunity of cells to insulin and its compensatory systemic increase in blood.
The urgency of the problem
Metabolic syndrome is called the new non-infectious pandemic of the XXI century, which has covered industrialized countries. For developing countries, it can turn into a demographic catastrophe. The prevalence of the syndrome averages 23%, and the number of patients is constantly increasing. In accordance with the forecasts, in the nearest 25 years their increase by 50% is expected.
In all patients with this disease, the risk of diabetes is increased by a factor of 5 to 9. In recent years, there has been a widespread syndrome (up to 30%) among men over 40 years old. In this group, 4 times more often than in the general population, there is a violation of the blood supply to the heart muscle with a fatal outcome, and mortality from vascular disorders of the brain is 2 times more often.
Etiology and pathogenesis
There is no consensus on the causes of metabolic disorders. The main factor is considered a hereditary predisposition of a person to insulin resistance (reduced response of peripheral tissues to insulin) and obesity, which are realized mainly under the influence of:
- Overeating, especially accompanied by the consumption of foods with excess fat content.
- Primary or secondary male hypogonadism (insufficiency of the function of the sex glands and a decrease in testosterone synthesis), accompanied by a deficiency of testosterone .
- Low physical activity (physical inactivity).
- Severe stress states or psycho-emotional disorders of a less intense nature, but long and often recurring.
The last two factors of the list are given less importance.
There are various hypotheses of the pathogenesis of the disease. The essence of the most common theory of the mechanism of the development of the syndrome lies in the combination of causal and provoking factors, which determines the implementation of the genetic susceptibility to obesity and tissue insulin resistance. Because of this, a vicious circle of metabolic disorders is formed.
It is expressed in a reflex compensatory increase in the secretion of pancreatic insulin (beta cells) and in an increase in its concentration in the blood. An increased amount of insulin initially leads to a decrease in the sensitivity of the corresponding receptors to it, and then to a complete blockade of the latter. As a result, there is an increase in the glucose content in the blood plasma in violation of splitting, its transformation into fats and deposition in the fat depot. In addition, a high content of insulin in the blood inhibits the breakdown of fats and leads to their deposition, and pronounced obesity contributes to:
- an increase in the hormone leptin, which reduces the feeling of satiety and stimulates the sympathetic part of the central nervous system, and this contributes to an increase in food intake and high blood pressure;
- reduction of testosterone synthesis and the development of secondary hypogonadism.
The lack of sensitivity to insulin creates a situation of its relative deficiency, which, in turn, is a reflex stimulus for additional (even greater) synthesis of the hormone by beta cells and its secretion into the blood. Constant functioning completely depletes them and becomes the cause of the development of an already true insulin deficiency and even greater obesity.
Diagnosis and clinical manifestations
The syndrome proceeds with a predominance of violations of a particular type of metabolism, but in the end it manifests itself:
- diabetes, not influenced by insulin;
- arterial hypertension ;
- violation of the ratio of lipids (fats) in the serum;
- atherosclerotic vascular disease;
- ischemic damage to the heart and brain.
The lack of knowledge of the causes and mechanisms of the development of the metabolic syndrome has given rise to various classifications. In order to make it easier to diagnose in practice, it is recommended to use the following criteria:
- Obesity abdominal type. It is the most dangerous and is characterized not only by a significant increase in the thickness of the subcutaneous tissue of the anterior abdominal wall, but also by a large accumulation of intra-abdominal fat enveloping the abdominal organs. This indicator is determined by the waist circumference. In men, it is normally less than 102 cm.
- Fasting glucose in the blood - more than 6.1 mmol / l. With its normal content and suspected metabolic syndrome, an oral glucose resistance test is recommended. It consists in the patient receiving 75 grams of glucose and in determining its concentration in the blood plasma after 2 hours. With the disease, this indicator exceeds 7.8 mmol / l.
- Systolic pressure exceeds 130 or / and diastolic - 85 mm. Hg v .; diagnosis of hypertension in the past and its treatment.
- Reduced blood levels of high-density lipoprotein cholesterol - less than 1 mmol / l for men.
- Triglycerides exceed 1.7 mmol / L.
One of the main problems of diagnosis is the absence of reliable clinical manifestations of metabolic disorders in the initial stages of development of this pathology. In this case, a suspicion of its presence may occur if the results of the relevant blood tests deviate from the normal.
Principles of Therapy for Metabolic Syndrome
Treatment should be:
- Lifestyle changes.
- Therapy of hypogonadism.
- Correction of arterial hypertension by a combination of drugs with different mechanisms of action.
- Correction of disorders of carbohydrate metabolism by the use of biguanides (metformin) and glitazones (troglitazone, etc.), lipid metabolism - preparations of the group of statins and fibric acid derivatives.
Lifestyle change is central to treatment. It includes:
- correct diet;
- restriction of the use of dishes containing fats and saturated fatty acids;
- an increase in the proportion of fiber in the diet;
- performing systematic 30-minute physical exertion of medium intensity.
In persons suffering from metabolic syndrome for 3 years and following these rules within six months, waist circumference decreases by 9%, body weight decreases by 11%, triglycerides by 24%, low-density lipoprotein cholesterol (LDL) decreases by 13%, and insulin sensitivity is increased by 15%.
Body mass index correction
With a body mass index (BMI) of more than 27 kg / m 2 , the addition of drug treatment for obesity with drugs of different mechanisms of action (sibutramine, orlistat, etc.) is recommended. A BMI of 35 kg / m 2 and above is an indication for surgical treatment by one of the methods:
- the imposition of a bandage on the upper sections of the stomach;
- resection of the stomach with the formation of the "sleeve";
- gastrectomy with reconstruction of the small intestine.
With the help of surgical treatment, conditions are created to reduce the absorbability of various food ingredients and to obtain a feeling of rapid satiation.
Treatment of hypogonadism is carried out by the drug of a prolonged action testosterone undecanoate (see hormonal preparations for men ). It has a positive effect on all manifestations of metabolic disorders: reduces the number of symptoms of androgen deficiency and eliminates them, helps to reduce insulin levels, and in 75% of sick men leads to its normalization, affects the improvement of lipid metabolism.
Many researchers have discovered the presence of hypogonadism in all men with obesity (with a waist circumference of more than 102 cm), and also revealed a link between the degree of testosterone deficiency and manifestations of metabolic syndrome, diabetes mellitus and arterial hypertension. Therefore, the determination of blood testosterone levels is mandatory for all men with metabolic syndrome. Elimination of testosterone deficiency and correction of hormonal disorders accompanying it are equally important components of treatment as correction of body weight, hypertension, diabetes mellitus, and LDL cholesterol.