Metabolism is the totality of all metabolic processes in living organisms. A syndrome is the most characteristic combination of individual symptoms (signs) for a specific pathological condition or specific disease. Metabolic syndrome - interconnected metabolic, hormonal and clinical disorders, which are high-risk factors for the development of diseases of the cardiovascular system. The disorders are based on the primary immunity of cells to insulin and a compensatory systemic increase in it in the blood.
Urgency of the problem
Metabolic syndrome is called the new non-infectious pandemic of the 21st century that has embraced industrialized nations. For developing countries, it could turn into a demographic catastrophe. The prevalence of the syndrome is an average of 23%, and the number of patients is constantly increasing. According to forecasts, an increase of 50% is expected in the next 25 years.
In all patients with this disease, the risk of developing diabetes mellitus is 5–9 times higher. In recent years, there has been a wide spread of the syndrome (up to 30%) among men over 40. 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 - 2 times more often.
Etiology and pathogenesis
There is no consensus on the causes of metabolic disorders. The main factor is considered a person’s hereditary predisposition to insulin resistance (a reduced reaction 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.
- Primary or secondary male hypogonadism (insufficiency of the function of the gonads and a decrease in the synthesis of testosterone), accompanied by a deficiency of testosterone .
- Low physical activity (lack of exercise).
- Severe stressful conditions or psychoemotional disorders of a less intense nature, but prolonged and often recurring.
The last two factors of the list are given less importance.
There are various hypotheses for the pathogenesis of the disease. The essence of the most common theory of the mechanism of the development of the syndrome is a combination of causal and provoking factors, which determines the realization of a genetic predisposition to obesity and to tissue immunity to insulin. Because of this, a vicious circle of metabolic disorders is formed.
It is expressed in a reflex compensatory increase in pancreatic insulin secretion (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 glucose in blood plasma in violation of the splitting, its transformation into fats and deposition in fat depots. In addition, a high content of insulin in the blood inhibits the breakdown of fats and leads to their deposition, and severe obesity contributes to:
- an increase in the hormone leptin, which reduces the feeling of fullness and stimulates the sympathetic department of the central nervous system, and this helps to increase food intake and increase blood pressure;
- a decrease in 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 a true insulin deficiency and even greater obesity.
Diagnosis and clinical manifestations
The syndrome occurs with a predominance of disorders of a particular type of metabolism, but in the end it manifests itself:
- diabetes mellitus, not influenced by insulin;
- arterial hypertension ;
- violation of the ratio of lipids (fats) in the blood serum;
- atherosclerotic vascular disease;
- ischemic damage to the heart and brain.
Insufficient knowledge of the causes and mechanism of development of the metabolic syndrome gave rise to various classifications. For the convenience of its diagnosis in practice, the use of the following criteria is recommended:
- Abdominal obesity. 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 circumference of the waist. In men, it is normally less than 102 cm.
- Fasting blood glucose is more than 6.1 mmol / L. With its normal content and suspicion of a metabolic syndrome, an oral glucose resistance test is recommended. It consists in the patient taking 75 grams of glucose and in determining its concentration in blood plasma after 2 hours. In case of disease, this indicator exceeds 7.8 mmol / L.
- Indicators of systolic pressure exceed 130 and / or diastolic - 85 mm. Hg. st .; diagnosis of arterial hypertension in the past and its treatment.
- Low blood cholesterol high density lipoproteins - less than 1 mmol / l for men.
- Triglycerides exceed 1.7 mmol / L.
One of the main diagnostic problems is the lack of reliable clinical manifestations of metabolic disorders at the initial stages of the development of this pathology. In this case, a suspicion of its presence may arise if the results of the corresponding blood tests deviate from the norm.
Principles of therapy for metabolic syndrome
Treatment should be:
- Lifestyle changes.
- Therapy of hypogonadism.
- Correction of hypertension by a combination of drugs having a different mechanism of action.
- Correction of carbohydrate metabolism disorders by using biguanides (metformin) and glitazones (troglitazone, etc.), lipid metabolism - drugs of the statins group and fibroic acid derivatives.
Lifestyle changes are central to treatment. It includes:
- proper diet;
- restriction of meals containing fats and saturated fatty acids;
- increase in the proportion of fiber in the diet;
- performing systematic 30-minute physical activity of medium intensity.
In people suffering from metabolic syndrome for 3 years and following these rules for six months, the waist circumference decreases by 9%, body weight decreases by 11%, triglycerides by 24%, and low-density lipoprotein (LDL) cholesterol levels 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, it is recommended to add medication for obesity with drugs of various mechanisms of action (sibutramine, orlistat, etc.). BMI of 35 kg / m 2 and higher is an indication for surgical treatment with one of the methods:
- gastric bypass;
- bandage on the upper stomach;
- gastric resection 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 absorption of various food ingredients and to obtain a feeling of quick satiety.
Treatment of hypogonadism is carried out with a prolonged-release drug testosterone undecanoate (see hormonal drugs for men ). It has a positive effect in relation to all manifestations of metabolic disorders: it reduces the number of symptoms of androgen deficiency up to their elimination, helps to reduce insulin levels, and in 75% of sick men it leads to its normalization, affects the improvement of lipid metabolism.
Many researchers have discovered the presence of hypogonadism in all obese men (with a waist circumference of more than 102 cm), and also revealed a relationship between the degree of testosterone deficiency and manifestations of the metabolic syndrome, diabetes mellitus and arterial hypertension. Therefore, the determination of testosterone levels in the blood is mandatory for all men with metabolic syndrome. The elimination of testosterone deficiency and the correction of concomitant hormonal disorders are just as important components of treatment as the correction of body weight, hypertension, diabetes mellitus, and LDL cholesterol.