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Metabolic syndrome in Community Medicine
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Metabolic Syndrome
Prepared by Dr.Anees AlSaadiCommunity Medicine Residents
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• History and Definition.• Criteria of Diagnosis. • Epidemiology.• Risk Factors.• Complications • Etiology.• Group Exercise. • Prevention.
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Definition
Agr
eem
ent
on O
ne
crit
eria
His
tory
of
the
Dis
ease
s
Many Definitions.
Changing Diagnostic Criteria.
1988 Reaven
1998
WHO
1999 EGIR
2001 NCEP ATPIII
2005 AHA/NHLBI
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Definition
• Clustering of Risk Factors:– Impaired Glucose test.– Hyperinsulinemia.– High Triglycerides.– Low HDL.– HyperUricemia.– High PAI-1
Dr. Reaven “ Syndrome X” 1988
Coronary Heart Disease.DMII.Hypertension.
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Insulin Resistance.
BMI ≥ 30kg/m²
Hypertension 140/90mmHg
Microalbumineuria
• WHO 1998
Insulin Resistance Syndrome.
Excluding DMII. fasting Insulin.
Obesity By Waist Circumference.
Hypertension.
Dyslipidemia.
Coronary Heart Disease.
• European Group for the Study of Insulin Resistance 1999
Metabolic Syndrome.
• NCEP/ATPIII 2001• IDF/AHA/NHLBI
2005
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Definition
Metabolic Syndrome
Dyslipidemia
Diabetes Mellitus Hypertension
Central Obesity
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DefinitionCentral Obesity
Abdominal Waist Circumference
≥102 cm (40 in) in men
≥ 88 cm (35 in) in women
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DefinitionDyslipidemia
Serum Lipids• TG ≥ 150 mg/dl (1.7 mmol/L)
• HDL ˂ 40 mg/dl (1.03 mmol/L) in men
˂ 50 mg/dl (1.30 mmol/L) in women
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DefinitionDiabetes Mellitus
Fasting Glucose
≥ 100 mg/dl (5.6 mmol/L)
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DefinitionHypertension
Blood pressure
≥ 130 mm Hg systolic blood pressure.
≥ 85 mm Hg diastolic blood pressure.
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EpidemiologyInternational Burden
• U.S. prevalence adults (22% - 34.6%) [IDF 2006]• Sweden prevalence (24% m &19% f)[IDF 2007]• India prevalence of (19.52%) [ATPIII 2010]
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EpidemiologyRegional Burden
• Turkey 33.9% (28% m & 39.6% f) [ATP III/ 2007]• Iranian (34.7%m &37.4%f) [ ATPII, IDF/ 2007]• Tunisia (24.3%m, 45.5%f) [ ATPIII, IDF/2007]
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EpidemiologyRegional Burden
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EpidemiologyRegional Burden
• Jordan 37.4% (31.7% m & 41.0% f)[ATPIII/ 2007]
• Oman 21.0% [ATPIII/ 2003]
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Situation in Qatar
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EpidemiologySituation in Qatar
• Overall prevalence of among obese patients was 46.3%.
• The prevalence was higher in females (50%) than in males (42.4%).
• [IDF/ 2010]
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EpidemiologySituation in Qatar
• Overall prevalence 3.0% in children aged 6–12 years.
• The prevalence 9.5% in overweight and obese subjects.
• Increased TG frequent abnormality (28.4%) .
• Low HDL-C (19.4%) .
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Where Can You Find The Highest Metabolic
Syndrome ….?
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WHAT
ARE
THE
RISK FACTORS
FOR
METABOLIC SYNDROME?
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EpidemiologyRisk Factors
• Age.
• Gender.
• Race.
• More than 40% of individuals 60 years.
• Increasing prevalence among women.
• African American and Mexican American populations.
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5% Normal Weight.
60% Obese.
22% Overweight.
EpidemiologyRisk Factors
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EpidemiologyRisk Factors
• Low socioeconomic status.
• Lack of physical activity.
• High carbohydrate diet.
• No alcohol intake.
• Smoking.
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What are
the Complications of
Metabolic Syndrome?
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Complications
7 X DMII
2 X CVD
1.5 X Mortality
Metabolic Syndrome
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Complications
–Cognitive decline (elderly).– Fatty liver disease, –Polycystic ovary syndrome. –Obstructive sleep apnea.– Gout.–Chronic Kidney Disease.
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Etiology
Genetic Susceptibility
Environmental Factors
Metabolic Syndrome
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Prevention
Fighting
The Related
Risk Factors.
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Group Exercise
Outline
Prevention Program
For Obesity ….
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Pri
mar
y P
reve
ntio
n Promotion of Healthy Eating.
Promotion of Physical Activity
Healthy School Initiatives
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Sec
onda
ry P
reve
ntio
nScreening for
Obesity.
Management of Healthy life style
Medications/ Surgery
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Medications :
BMI ˃27 + comorbidity
OR
BMI ˃30
OR/and
If no weight loss after (3-6 months) of life style changes.
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Bariatric Surgery
BMI ˃35 + Co-morbidity.
BMI ˃ 40.
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References :• Study in Americans: • Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings
from the third National Health and Nutrition Examination Survey.J Am Med Assoc 2002;287(3):356–9.
• • Maggi S, Noale M, Gallina P, et al. Metabolic syndrome, diabetes, and cardiovascular disease in an
elderly Caucasian cohort: the Italian longitudinal study on aging. J Gerontol A Biol Sci Med Sci 2006;61(5):505–10.
• • Patel A, Huang KC, Janus ED, et al. Is a single definition of the metabolic syndrome appropriate? A
comparative study of the USA and Asia. Atherosclerosis 2006;184(1):225–32.• • Study in Sweden:• Halldina M, Rosella M, de Fairea U, et al. The metabolic syndrome: prevalence and association to
leisure-time and work-related physical activity in 60-year-old men and women. Nutr Metab Cardiovasc Dis 2007;17(5):349–57.
• • Study in Saudi Arabia:• Bahijri SM, Al Raddadi RM. The importance of local criteria in the diagnosis of metabolic syndrome
in Saudi Arabia. Saudi: Ther Adv Endocrinol Metab; 2013;4(2) 51–59. Available from: • http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632005/pdf/10.1177_2042018813483165.pdf
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References :
• Study in India:• Sawant A, Mankeshwar R, Shah S, Raghavan R, Dhongde G, Raje H, et al. Prevalence of
Metabolic Syndrome in Urban India. India: Hindawi Publishing Corporation; 2011. Available from:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114375/pdf/CHOL2011-920983.pdf
• • South Asian Countries:• P. Nestel, R. Lyu, P. L. Lip et al., “Metabolic syndrome: recent prevalence in East and
Southeast Asian populations,” Asia Pacific Journal of Clinical Nutrition, vol. 16, no. 2, pp. 362–367, 2007.
• • D. Eapen, G. L. Kalra, N. Merchant, A. Arora, and B. V. Khan, “Metabolic syndrome and
cardiovascular disease in South Asians,” Vascular Health and RiskManagement, vol. 5, pp. 731–743, 2009.
• • Jordan Study:• Yasein N, Masa'd D. Metabolic syndrome in family practice in Jordan: a study of high-risk
groups. Jordan: East Mediterr Health J; 2011 Dec;17(12):943-8.
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Thank You