A case report:
27-year-old female, a senior executive working for an IT major in the city has been complaining of fatigue for over 3 months. She has recently gained weight and has trouble sleeping. She also complains of numbness and burning sensation in her hands and feet for close to 3 months now. She has no past history of Diabetes or hypertension.
Height: 165cms, Weight: 82 Kgs. BMI: 32Kg/m2. BP: 156/90 mm Hg. Pulse: 88 bpm, regular. Systemic examination was unremarkable.
Lab Data are as follows:
- Total cholesterol: 230 mg/dL
- HDL: 28 mg/dL
- LDL: 152 mg/dL
- Triglycerides: 200 mg/dL
- Glucose (fasting): 120 mg/dL
- Thyroid stimulating hormone (TSH): 4.23mcIU/ml.
The patient was diagnosed with metabolic syndrome. The patient was counseled and explained that she has all the signs of metabolic syndrome and high risk for diabetes mellitus and hypertension. The patient was started on life style modification, diet modification. She has been advised to monitor her Blood pressures & Blood sugars on a regular basis and to review with the Physician after 2 months.
The condition has been escalating over the years due to marked shift and change in life style caused by urbanization, rapid economic growth, and dietary habits. Increasing prevalence of metabolic syndrome has been reported in urban children and young adults, particularly in young women. Adiposity is the most important correlate of metabolic syndrome. Diet rich in saturated, trans fatty acids & lack of Physical activity increase the deposition of intraabdominal fat & adiposity. Frequent night shifts, sleep disturbances result in hormonal imbalances that result in hyperinsulinemia and insulin resistance. The condition is associated with chronic low-grade inflammation and high levels of pro-coagulant factors that directly promote the development of Atherosclerotic cardiovascular diseases (ASCVD). Ex; Heart attacks, Stroke.
Metabolic syndrome rarely manifests clinically in the absence of obesity and physical inactivity.
Consequently, the key emphasis in management of the metabolic syndrome is to mitigate modifiable risk factors (i.e., obesity, physical inactivity, smoking, and atherogenic diet) through lifestyle changes. However, if the absolute risk is high drug therapy has to be considered.
Increasing physical activity assists in weight reduction has beneficial effects on metabolic risk factors, and reduces overall ASCVD risk. Current recommendations call for at least 30 minutes of moderate-intensity exercise (e.g., brisk walking) on most, and preferably all, days of the week.
For high-risk patients (e.g., those with recent acute coronary syndromes or recent revascularization), physical activity should be performed under medical supervision.
Beyond weight control and reduction of total calories, the diet should be low in saturated fats, transfats, cholesterol, sodium, and simple sugars. In addition, there should be ample intake of fruits, vegetables, and whole grains; fish intake should be encouraged, with recognition of concerns about the mercury content of some fish.
For patients, whose risk factors are not reduced adequately by lifestyle changes, pharmacologic interventions to control their blood pressure and lipid levels are indicated.