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METABOLIC Syndrome: a Global Perspective

METABOLIC Syndrome: a Global Perspective

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METABOLIC Syndrome: a Global Perspective

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  1. METABOLIC Syndrome:a Global Perspective Charles Wang, PharmD Candidate

  2. Objectives • Defining Metabolic Syndrome (MetS) • Factors leading to Metabolic Syndrome • Metabolic Syndrome Around the World • Treatment • Test

  3. Definition • Metabolic Syndrome goes by many names • Metabolic syndrome X • Cardiometabolic syndrome • Syndrome X • Insulin resistance syndrome • Reaven’s syndrome (named after Gerald Reaven) • CHAOS (Australian)

  4. Definition • Metabolic Syndrome is a collection of medical disorders that when occur together, increase risk of cardiovascular disease and diabetes. • Incorrectly classified as First World Problem • Can occur in any nation, regardless of wealth • All starts with obesity • Main culprit is insulin resistance • On the rise

  5. Diagnosis • Depends on the organization • International Diabetes Federation • Central Obesity (determined by waist circumference) AND two of the following • Triglycerides > 150 mg/dL • HDL < 40 mg/dL in males <50 mg/dL in females • Systolic >130 or diastolic >85 mmHg • FPG > 100 mg/dL • If BMI > 30 kg/m^2 central obesity is assumed

  6. Diagnosis • World Health Organization • Diabetes Type 1 or 2, impaired glucose tolerance, impaired fasting glucose, or insulin resistance, AND two of the following • Blood Pressure ≥ 140/90 mmHg • Dyslipidemia: TG ≥ 1.695 mmol/L and HDL ≤ 0.9 mmol/L male, ≤ 1.0 mmol/L female • Central Obesity: waist:hip ratio > 0.9 in males, > 0.85 in females, or BMI > 30 kg/m^2 • Microalbuminuria: excretion ratio ≥ mcg/min or albumin:creatinine ration ≥ 30 mg/g

  7. Diagnosis • European Group for the Study of Insulin Resistance • Requires insulin resistance defined as the top 25% of the fasting insulin values among non-DM AND two or more of the following • Central obesity: waist circumference ≥ 94 cm in males and ≥ 80 cm in females • Dyslipidemia: TG ≥ 2.0 mmol/L and/or HDL < 1 • Hypertension: ≥ 140/90 mmHg • Fasting plasma glucose ≥ 6.1 mmol/L

  8. Diagnosis • National Cholesterol Education Program ATP III • At least 3 of the following • Central obesity: WC ≥ 40 inches in males ≥ 36 in female • Dyslipidemia: TG ≥ 150 mg/dl • HDL < 40 in males, < 50 in females • HTN: ≥ 130/85 mmHg • Fasting Plasma Glucose ≥ 110

  9. Definition • Diseases that encompass metabolic syndrome • Central Obesity • Insulin Resistance • Hypertension • Hyperlipidemia • Australian CHAOS • Coronary artery disease • Hypertension • Adult onset diabetes • Obesity • Stroke

  10. Central Obesity • Also known as the following • Abdominal obesity • Belly fat • It is high fat content in the abdominal areas • Excessive Visceral fat (organ fat) • Intra-abdominal fat • Located inside the peritoneal cavity • Packed in between internal organs

  11. Central Obesity

  12. Pathophysiology

  13. Insulin Resistance • Impaired fasting glucose >100 mg/dL • Impaired glucose tolerance • > 140 mg/dL for 120 minutes after ingestion of 75 grams of glucose • Elevated homeostatic model assessment of insulin resistance (HOMA-IR) • Quantifies insulin resistance and beta-cell function with formula

  14. Pathophysiology

  15. Dyslipidemia • Atherogenicdyslipidemia • High plasma TG • Low HDL cholesterol levels • Increase in small dense LDL

  16. Pathophysiology

  17. Hypertension • Most important single, modifiable risk factor for stroke and an important risk factor for atherosclerosis and ischemic heart disease • Disease caused by endothelial dysfunction • Fails to serve its normal physiological and protective mechanisms

  18. Pathophysiology

  19. Statistics • As countries “westernize/urbanize” • Theory is mankind evolved on limited nutrition and excess causes fat storage • Increased access to food • Decreased physical activity • Sedentary lifestyle • Diet high carbohydrates • Increases in obesity, dyslipidemia, hypertension, hyperglycemia/diabetes • No longer diseases of the wealthy

  20. Metabolic Syndrome Around the World • By 2025, three out of four people with diabetes will be living in third world countries. • United States • ~25% have metabolic syndrome as defined by the WHO • 50 million in 1990, 64 million in 2000 • India • Urbanization has caused an increase in hypertension in slums and increase risk of diabetes in females with normal BMI (18-25) • ~29% of the population have metabolic syndrome

  21. Metabolic Syndrome Around the World • China • Overweight 26.9% in men, 31.1% in women • 13.2% have metabolic syndrome • Higher in northern China than southern • Higher in urban residents vs rural • Growing rapidly due to aging population and urbanization

  22. Metabolic Syndrome Around the World • UK • Average BMI in 1970s was ~23 • Average BMI in 1990s was ~26

  23. Metabolic Syndrome Around the World

  24. Treatment • Lifestyle Changes • Lose weight • Exercise • Follow a heart healthy diet • Stop smoking • Pharmacological Interventions • Take your meds as prescribed