Metabolic Syndrome or Insulin Resistant - Literature review Example

RUNNING HEAD: Metabolic Syndrome Metabolic Syndrome of the Under the guidance of Introduction Cluster of risk factors like abdominal obesity, hyperglycemia, dyslipidemia and hypertension, which are associated with heart attack, is known as metabolic syndrome (IDF, 2005). Other names for this condition are Syndrome X, insulin resistance syndrome and dysmetabolic syndrome (Sutton and Raines, 2007). Globally, this syndrome is gaining more and more importance because of the increased risk of stroke and heart attack this condition is associated with. The global prevalence of metabolic syndrome is estimated to be 35% (Sutton and Raines, 2007). In the United States alone, there are about 55 million people suffering from metabolic syndrome (Sutton and Raines, 2007). Knowledge about metabolic syndrome will give scope for physicians and nurses to identify at-risk population at early stages and provide proper guidance and advice so that mortality and morbidity associated with this condition is decreased. Unfortunately, many health professionals are unaware of this crisis (Sutton and Raines, 2007). This article explores the literature pertaining to metabolic syndrome with respect to nursing. International standards definitions and research pertaining to the disease will be evaluated in the article. Metabolic syndrome As early as 1988, Reaven (cited in Grundy, Brewer and Cleeman et al, 2004) observed and reported that several risk factors like hypertension, hyperglycemia and dyslipidemia usually cluster together. Reaven named this clustering Syndrome X and proposed this condition to be a multiple risk factor for the development of cardiovascular disease. Most of the times, this condition is associated with insulin resistance. Current researchers use the term metabolic syndrome. Thus the primary outcome of metabolic syndrome is cardiovascular disease. Since most people with this syndrome have insulin resistance, there is also increased risk of development of diabetes mellitus type-2. Once diabetes is apparent clinically, the risk of cardiovascular disease rises sharply (Grundy, et al, 2004). Other outcomes of metabolic syndrome are fatty liver, polycystic ovarian disease, asthma, sleep disturbances, certain types of cancer and gall stones (Grundy, et al, 2004). Components of metabolic syndrome According to the Adult Treatment Panel III report (cited in Grundy, Brewer and Cleeman et al, 2004), there are basically six components which make up metabolic syndrome. They are abdominal obesity, hypertension, atherogenic dyslipidemia, insulin resistance with or without glucose intolerance, prothrombotic state and proinflammatory state. Abdominal obesity is strongly associated with metabolic syndrome when compared to other forms of obesity and clinically presents as raised waist circumference. Raised triglycerides and low HDL cholesterol levels constitute atherogenic dyslipidemia. Other forms of dyslipidemia which increase the risk of formation of atheromas are small LDL particles, raised apolipoproteinB, small LDL particles and increased remnant lipoproteins (Grundy, et al, 2004). Hypertension is common in both obese and insulin-resistant persons and thus including it in the metabolic syndrome becomes obvious. Majority of the persons with metabolic syndrome have insulin resistance and hence this syndrome is also known as insulin resistance syndrome. Proinflammatory state manifests as raised C-reactive protein levels and prothrombotic state manifests as increased fibrinogen levels and plasminogen activator inhibitor levels. Causes of insulin resistance There are many causes for development of insulin resistance. While the hereditary causes are the most common and include mutations of glucose transporter, insulin receptor and signallin proteins; certain acquired causes also contribute to insulin resistance which include glucose toxicity, physical inactivity, diet, medications, aging and increased free fatty acids (Olatunbosun and Dagogo-Jack, 2008). Pathophysiology of metabolic syndrome Insulin resistance diminishes the tissues ability to respond to insulin in the blood leading to decreased absorption of glucose by adipose tissue, muscle and liver cells. Thus, the levels of circulating blood glucose levels rise and the pancreas releases more insulin leading to hyperinsulinemia. However, since the tissues are resistant to insulin, the blood glucose levels continue to be elevated. The fat cells respond to insulin resistance by hydrolysis of stored triglycerides causing elevated free fatty acids in the plasma. The muscle and liver cells respond by not taking-up glucose causing raised blood glucose levels. Though it is unclear as to how high blood glucose levels cause hypertension, research has shown that development of insulin resistance predisposes to hypertension, elevated plasma triglyceride levels and low HDL-C levels. Besides contributing to insulin resistance, obesity leads to excess cytokines which exacerbate the syndrome (Sutton and Raines, 2007). Criteria for clinical diagnosis of metabolic syndrome As per Adult Treatment Panel III report (cited in Grundy, et al, 2004), a diagnosis of metabolic syndrome is made if minimum of 3 of these findings are found: waist circumference of atleast 102cm in men and 88cm in women, fasting triglyceride levels of atleast 150 mg per dl, blood pressure of atleast 130/85 mmHg, HDL-C levels of less than 40mg/dl in men and less than 50mg/dl in women, fasting glucose levels of atleast 110mg/dl. The definition by the World health Organization or WHO is slightly different. According to WHO (cited in Olatunbosun and Dagogo-Jack, 2008), a diagnosis of metabolic syndrome is established when the individual has type-2 diabetes mellitus, imapired glucose intolerance test, fasting glucose levels of 101-125 mg/dL and atleast two of these which are: hypertension, triglyceride levels of atleast 150 mg/dl, HDL-C levels of less than 35mg/dl for men and 39mg/dl for women, body mass index of atleast 30kg/m2 and urinary albumin excretion of atleast 20mcg/min or albumin-creatinine ratio of atleast 30 mg/g Therapeutic implications The Adult Treatment Panel III report (cited in Grundy, et al, 2004) has recommended to primarily target obesity to treat metabolic syndrome. This is because reduction in weight causes fall in serum cholesterol and triglyceride levels, raises serum HDL levels, lowers blood pressure and glucose and also contributes to reduction in insulin resistance. Current research has also demonstrated that weight reduction causes fall in proinflammatory factors too (Grundy et al, 2004). Weight reduction must be achieved both by diet control and physical activity. Whenever insulin resistance is evident, it should be targeted with weight reduction, physical activity, diet control and drugs like metformin and insulin sensitizers. Dyslipidemia must be managed with lipid lowering drugs like statins and fibrates. Hypertension must be brought to control with lifestyle therapies and antihypertensive agents. Prothrombotic state may be controlled using low-dose aspirin therapy. Role of nurses in metabolic syndrome Nurses play a critical role identifying risk factors, developing management strategies and in educating patients to prevent individual risk factors. They also have a role in preventing worsening of the already present risk factors. Through these actions, nurses reduce the morbidity and mortality associated with this global heath calamity (Sutton and Raines, 2007). To those who have developed the syndrome or are at risk of development of the syndrome, nurses must advise therapeutic lifestyle changes like weight reduction, increased physical activity, moderation of alcohol intake, restriction of dietary sodium intake and increased intake of low-fat dairy products, vegetables and fresh fruits. The aim of body mass index should be less than 25kg/m2. Physical activity should be regular and of moderate-intensity nature, for atleast 30 minutes, preferable everyday. Dietary intake of simple sugars and saturated fat should be restricted. Nurses can inculcate healthy lifestyle habits in individuals by the nature of their profession also by virtue of their intimacy with patients, caring attitude and sympathetic temperament. Future research Currently there is research going on to develop drugs to combat proinflammatory and prothrombotic states. Some research shows that lipid-lowering agents may reduce proinflammatory states (Grundy et al, 2004). Conclusion Metabolic syndrome is nothing but clustering of various risk factors like hyperglycemia, hypertension, dyslipidemia, abdominal obesity, proinflammatory state and prothrombotic state. This condition is now a global calamity and warrants aggressive identification and management by physicians and nurses. The main strategy to target this syndrome is by education and counseling about healthy lifestyle habits like weight reduction, moderate physical activity, low dietary intake of saturated fat and sodium and increased intake of fresh fruits and vegetables. References Grundy, S.M., Brewer, B., Cleeman, J.I., Smith, S.C.,and Lenfant, C. (2004). Definition of Metabolic Syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on Scientific Issues Related to Definition. Circulation, 109, 433- 438. Retrieved on August 8th, 2009 from http://circ.ahajournals.org/cgi/content/full/109/3/433 International Diabetes Federation or IDF. (2005). IDF Worldwide Definition of the Metabolic Syndrome. Retrieved on August 8th, 2009 from http://www.idf.org/metabolic_syndrome Olatunbosun, S.T. and Dagogo-Jack, S. (2008). Insulin Resistance: Differential Diagnoses & Workup. Emedicine from WebMD. Retrieved on August 8th, 2009 from http://emedicine.medscape.com/article/122501-diagnosis Sutton, D.H., and Raines, D.A. (2007). Identification and Management of Metabolic Syndrome: The Role of the APN. Medscape Pediatrics. Retrieved on August 8th, 2009 from http://www.medscape.com/viewarticle/562756 Read More