Metabolic Syndrome is a Myth

It's Medical Industry BULLSHIT!

OK fatties you just lost another excuse for why you are fat. The way to cure "Metabolic Syndrome" is the cease your gluttony! Either accept and embrace your gluttony or stop being a glutton.

The World Health Organization met again in 2009 to re-evaluate a consensus statement regarding metabolic syndrome after a decade of shifting meanings and research.  The conclusion was that “While [metabolic syndrome] may be considered useful as an educational concept, it has limited practical utility as a diagnostic or management tool.” [15]  Furthermore the WHO deemed that clinicians should not use this term as a clinical diagnosis and that further research regarding the syndrome would be an inappropriate use of resources.  Even more recently, the proginitor of it all—the Stanford physician that originally created the idea of Syndrome X—published a review article in December of 2010.  In it, he states that “despite the many publications…it is not clear that it is a diagnostic category worth continuing”[16].

What all of this means is that our patient from the case at the beginning does have metabolic syndrome.  Having metabolic syndrome may place this patient at a higher risk for cardiovascular disease and/or death.  It may not change the advice that she receives from her doctors regarding lifestyle changes or medical treatment; however it may appropriately target her for aggressive intervention.

In conclusion, Metabolic Syndrome has not proven to be as solid of a “disease” as it was once theorized.  It describes a set of pre-morbid conditions without a unifying underlying disease, making it fall shy of the official definition of a “syndrome”.[17] And it is important to understand that the international community does not view it as a valid diagnosis.  Although, physicians may still use the terminology as a way to describe a patient or a way to closely watch patients at higher risk for developing co-morbidities.  In this way, it may still prove to have clinical utility as a descriptor.

Dr. Vicky Jones is a 3rd year resident at NYU Langone Medical Center

Image courtesy of Wikimedia Commons

References

1. Reaven G.M.:  Banting lecture 1988. Role of insulin resistance in human disease.  Diabetes 37. (12): 1595-1607.1988.
2. Reaven GM. Role of insulin resistance in human disease (syndrome X): an expanded definition. Annu Rev Med. 1993;44:121-31.
3. Kaplan NM. The deadly quartet. Upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension. Arch Intern Med. 1989; 149:1514 –1520
4. “Obesity” Goldman: Cecil Medicine, 23rd ed. 2007.
5. Gallagher E G, LeRoith D, Karnieli E.  The Metabolic Syndrome – from insulin resistance to Obesity and Diabetes.   Endocrinol Metab Clin N Am 37 (2008) 559–579.
6. Grundy S, Cleeman J, Daniels S, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Circulation 2005;112(17):2735–-52.  http://circ.ahajournals.org/content/112/17/2735.full
7. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106:3143–3421. Circulation. 2002;106:3143–3421.
8. Trayhurn P, Wood IS. Adipokines: inflammation and the pleiotropic role of white adipose tissue. Br J Nutr. 2004;92:347–355.  http://journals.cambridge.org/download.php?file=%2FBJN%2FBJN92_03%2FS0007114504001795a.pdf&code=560b41b8c0825a15a8274c4fdfabca59
9. Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M, Taskinen MR, Groop L. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care. 2001;24:683– 689.
10. Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, Salonen JT. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA. 2002;288: 2709–2716.
11. Sattar N, Gaw A, Scherbakova O, Ford I, O’Reilly DS, Haffner SM, Isles C, Macfarlane PW, Packard CJ, Cobbe SM, Shepherd J. Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention Study. Circulation. 2003 Jul 29;108(4):414-9. Epub 2003 Jul 14.
12. McNeill AM, Rosamond WD, Girman CJ, Golden SH, Schmidt MI, East HE, Ballantyne CM, Heiss G. The metabolic syndrome and 11-year risk of incident cardiovascular disease in the atherosclerosis risk in communities study. Diabetes Care. 2005;28:385–390.
13. Solymoss BC, Bourassa MG, Lesperance J, Levesque S, Marcil M, Varga S, Campeau L. Incidence and clinical characteristics of the metabolic syndrome in patients with coronary artery disease. Coron Artery Dis. 2003;14:207–212.
14. Turhan H, Yasar AS, Basar N, Bicer A, Erbay AR, Yetkin E. High prevalence of metabolic syndrome among young women with premature coronary artery disease. Coron Artery Dis. 2005;16:37– 40.
15. Simmons RK, Alberti KG, Gale EA, Colagiuri S, Tuomilehto J, Qiao Q, Ramachandran A, Tajima N, Brajkovich Mirchov I, Ben-Nakhi A, Reaven G, Hama Sambo B, Mendis S, Roglic G. The metabolic syndrome: useful concept or clinical tool? Report of a WHO Expert Consultation. Diabetologia. 2010 Apr;53(4):600-5. Epub 2009 Dec 11.
16. Reaven GM. The metabolic syndrome: time to get off the merry-go-round? (Review) J Intern Med 2011; 269: 127–136.  http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2010.02325.x/abstract
17. “Syndrome.” Oxford English Dictionary. 2nd edition. 1989.
18. Ervin RB. Prevalence of Metabolic Syndrome Among Adults 20 Years of Age and Over, by Sex, Age, Race and Ethnicity, and Body Mass Index: United States, 2003–2006. National Health Statistics Reports. Number 13.  May 5, 2009. http://www.ncbi.nlm.nih.gov/pubmed/19634296