As many as 22 percent of American adults—some 47 million people—may have a sinister sounding disorder called syndrome X or "metabolic syndrome," which significantly increases a person’s risk of developing life threatening chronic diseases.

Equally unsettling, most of the 40 million plus Americans with metabolic syndrome have not been diagnosed with the condition. Given these numbers, says endocrinologist S. Sethu Reddy, M.D., the onus is on primary care physicians to identify individuals with the syndrome. "There aren’t enough cardiologists and endocrinologists around to look after these patients," says Dr. Reddy, chairman, department of endocrinology, diabetes and metabolism, Cleveland Clinic Foundation.

Cluster of risk factors
Metabolic syndrome is not a condition per se, like arthritis or high blood pressure; rather it refers to a cluster of risk factors that are associated with an increased risk of development of heart disease or diabetes. The syndrome is most common among populations in Western countries such as the United States, Canada, and Britain and appears to run in families. Metabolic syndrome also is known as insulin resistance syndrome and dysmetabolic syndrome. Prevalence of the syndrome increases with age, but it can easily develop in kids.

Guidelines for establishing a diagnosis of metabolic syndrome have been published by various medical bodies, but the criteria proposed largely overlap and include:

• abdominal or "central" obesity (waist size of greater than 40 inches in men, greater than 35 inches in women)
• high levels in the blood of triglycerides (fats) and LDL (bad) cholesterol
• low levels of HDL (good) cholesterol
• high blood pressure (greater than 130/85)
• high levels of glucose (as measured by a "fasting" glucose test)
• insulin resistance

Moderate changes yield significant results
Thorough assessment by a primary care physician would reveal the simultaneous existence of most of these risk factors, says Dr. Reddy. And once a physician determines that examination results strongly point to metabolic syndrome, basic steps can be taken to manage the situation.

For instance, moderate lifestyle changes can have a significant impact, says Dr. Reddy, particularly in persons who are overweight or who have diabetes or insulin resistance. In insulin resistance, cells do not respond to insulin and thus do not store sugar for energy use. This resistance to insulin causes the pancreas to increase the release of insulin, and this results in excessive insulin levels in the blood. The condition is associated with obesity, hypertension, and abnormal cholesterol levels.

The good news, says Dr. Reddy, is that when metabolic syndrome is diagnosed early in its development, it can be slowed, and in some cases, even reversed. And the best medication, he says, is a healthy dose of common sense. For instance, he says that studies have shown that small decreases in weight—even in persons considered obese—"can result in significant improvements in a number of parameters—dyslipidemia (high LDL, low HDL), high blood pressure, and high blood glucose levels. These are the key components of the metabolic syndrome criteria."

Dr. Reddy says that making strategic changes in diet—cutting out cookies, crackers, cakes, and other items full of refined carbohydrates—and taking up exercise can help significantly reduce the risk of developing diabetes (or help manage it in persons who have it) as well as reduce the risk of heart disease. For instance, he says that 150 minutes of exercise per week can help prevent development of diabetes. "It all comes down to lifestyle choices," says Dr. Reddy.

Look down for clues
Although Dr. Reddy recommends a visit to a physician for proper assessment, many people have a readily identifiable metabolic syndrome risk factor hanging on their bodies: fat. Indeed, metabolic syndrome is found primarily in people who are overweight or obese, the same group most likely to develop diabetes and insulin resistance. Central obesity in both men and women, particularly around the abdomen, suggests the presence of metabolic syndrome. "Any man with a waist greater than 40 inches, or a woman with a waist greater than 35 inches is considered to be at high risk for developing diabetes," says Dr. Reddy.

For persons with diabetes, high blood pressure, high cholesterol, coronary artery disease (some or all of these), treatment with medication is key, but drugs alone will not solve the problem, says Dr. Reddy. "While there are promising drugs currently being tested, there are no magic pills that will clear up any of these conditions," he says. "That’s why I stress the importance of lifestyle changes as the key to good health."

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional written health information, please contact the Health Information Center at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771 or visit www.clevelandclinic.org/health/. This document was last reviewed on: 4/1/2003