The Global Epidemic of the Metabolic Syndrome

Mohammad G Saklayen, Mohammad G Saklayen

Abstract

Metabolic syndrome, variously known also as syndrome X, insulin resistance, etc., is defined by WHO as a pathologic condition characterized by abdominal obesity, insulin resistance, hypertension, and hyperlipidemia. Though there is some variation in the definition by other health care organization, the differences are minor. With the successful conquest of communicable infectious diseases in most of the world, this new non-communicable disease (NCD) has become the major health hazard of modern world. Though it started in the Western world, with the spread of the Western lifestyle across the globe, it has become now a truly global problem. The prevalence of the metabolic syndrome is often more in the urban population of some developing countries than in its Western counterparts. The two basic forces spreading this malady are the increase in consumption of high calorie-low fiber fast food and the decrease in physical activity due to mechanized transportations and sedentary form of leisure time activities. The syndrome feeds into the spread of the diseases like type 2 diabetes, coronary diseases, stroke, and other disabilities. The total cost of the malady including the cost of health care and loss of potential economic activity is in trillions. The present trend is not sustainable unless a magic cure is found (unlikely) or concerted global/governmental/societal efforts are made to change the lifestyle that is promoting it. There are certainly some elements in the causation of the metabolic syndrome that cannot be changed but many are amenable for corrections and curtailments. For example, better urban planning to encourage active lifestyle, subsidizing consumption of whole grains and possible taxing high calorie snacks, restricting media advertisement of unhealthy food, etc. Revitalizing old fashion healthier lifestyle, promoting old-fashioned foods using healthy herbs rather than oil and sugar, and educating people about choosing healthy/wholesome food over junks are among the steps that can be considered.

Keywords: Abdominal obesity; Healthy herbs; Insulin resistance; Leisure time physical activity (LTPA); Metabolic syndrome; Obesity; Prediabetes; Waist-hip ratio.

Conflict of interest statement

Conflict of Interest

The author declares no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

    1. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC, Jr, International Diabetes Federation Task Force on Epidemiology and Prevention, National Heart, Lung, and Blood Institute, American Heart Association, World Heart Federation, International Atherosclerosis Society, International Association for the Study of Obesity Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640–1645. doi: 10.1161/CIRCULATIONAHA.109.192644.
    1. National Center for Health Statistics, Division of Health Interview Statistics. Crude and age-adjusted percentage of civilian, noninstitutionalized adults with diagnosed diabetes, United States, 1980–2010. National Center for Chronic Disease Prevention and Health Promotion, Ed. Atlanta, GA, Centers for Disease Control and Prevention, Division of Diabetes Translation, 2012.
    1. Palaniappan LP, Wong EC, Shin JJ, et al. Asian Americans have greater prevalence of metabolic syndrome despite lower body mass index. In J Obe. 2017;35:393–400. doi: 10.1038/ijo.2010.152.
    1. Wang Y, Mi J, Shan X, et al. Is China facing an obesity epidemic and the consequences? The trends in obesity and chronic disease in China. Int J Obesity. 2007;31:177–188. doi: 10.1038/sj.ijo.0803354.
    1. 2015 Obesity collaborators GBD. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;
    1. Wildman RP, Muntner P, Reynolds K, et al. The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes among the US population (NHANES 1999–2004), 2008. Arch Int Med. 168:1617–24.
    1. Firmann M, Mayor V, Vidal PM, et al. The CoLaus study: a population based study to investigate the epidemiology and genetic determinants of cardiovascular risk factors and metabolic syndrome. BMC Cardiovasc Disord. 2008;8:6. doi: 10.1186/1471-2261-8-6.
    1. Ogurtsova K, Fernandes JD, Huang Y, et al. IDF Diabetes Atlas: global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes research and clinicalpractice. 2017;128:40–50. doi: 10.1016/j.diabres.2017.03.024.
    1. Delvari A, Forouanafar MH, Alikhani S et al. First nationwide study of the prevalence of the metabolic syndrome and optimal cutoff points of waist circumference in the Middle East.
    1. Yoneshiro T, Aita S, Matsushita M, et al. Recruited brown adipose tissue as an antiobesity agent in humans. J Clin Invest. 2013;123:3404–3408. doi: 10.1172/JCI67803.
    1. Adamczak M, Wiecek A. The adipose tissue as an endocrine organ. Semin Nephrol. 2013;33(1):2–13. doi: 10.1016/j.semnephrol.2012.12.008.
    1. Benrick A, Chanclon B, Micallef P, et al. Adiponectin protects against development of metabolic disturbances in a PCOS mouse model. Proc Natl Acad Sci U S A. 2017:E7187–96.
    1. Jing Y, Wu F, Li D et al. Metformin improves obesity associated inflammation by altering macrophage polarization. Mol cell Endocrinol 2017; epub PMID 28935544.
    1. Shan B, Wang X, Wu Y, Xu C, Xia Z, Dai J, Shao M, Zhao F, He S, Yang L, Zhang M, Nan F, Li J, Liu J, Liu J, Jia W, Qiu Y, Song B, Han JDJ, Rui L, Duan SZ, Liu Y. The metabolic ER stress sensor IRE1alpha suppresses alternative activation of macrophages and impairs energy expenditure in obesity. Nat immunolo. 2017;18(5):519–529. doi: 10.1038/ni.3709.
    1. Mosialou I, Shikel S, Liu JM, et al. MC4R-dependent suppression of appetite by bone -derived Lipocalin 2. Nature. 2017;543(7645):385–390. doi: 10.1038/nature21697.
    1. Miao Y, Warner M, Gustafsson JK. Liver X receptor beta—a new player in the regulatory network of thyroid hormone and browning of white fat. Adipocyte. 2016;5(2):238–242. doi: 10.1080/21623945.2016.1142634.
    1. Everard A, Belzer C, Geurts L. Crosstalk between Akkermansia muciniphila and intestinal epithelium controls diet-induced obesity. Proc Natl Acad Sci U S A. 2013;110:9066–9071. doi: 10.1073/pnas.1219451110.
    1. Plovier H, Everard A, Druart C, Depommier C, van Hul M, Geurts L, Chilloux J, Ottman N, Duparc T, Lichtenstein L, Myridakis A, Delzenne NM, Klievink J, Bhattacharjee A, van der Ark KC, Aalvink S, Martinez LO, Dumas ME, Maiter D, Loumaye A, Hermans MP, Thissen JP, Belzer C, de Vos WM, Cani PD. A purified membrane protein from A. muciniphila or pasteurized bacterium improves metabolism in obese and diabetic mice. Nat Med. 2017;23(1):107–113. doi: 10.1038/nm.4236.
    1. Kopec AK, Abrahams SR, Thornton S, Palumbo JS, Mullins ES, Divanovic S, Weiler H, Owens AP, III, Mackman N, Goss A, van Ryn J, Luyendyk JP, Flick MJ. Thrombin promotes diet-induced obesity through fibrin-driven inflammation. J Clin Inves. 2017;127(8):3152–3166. doi: 10.1172/JCI92744.
    1. Villa CR, Chen J, Wen B, Sacco SM, Taibi A, Ward WE, Comelli EM. Maternal vitamin D beneficially programs metabolic, gut and bone health of mouse male offspring in an obesogenic environment. In J obes. 2016;40(12):1875–1883. doi: 10.1038/ijo.2016.177.
    1. Cox RL. Rationally designed PPARdelta-specific agonists and therapeutic potential for metabolic syndrome. Proc Natl Acad Sci USA. 2017;114:3284–3285. doi: 10.1073/pnas.1702084114.
    1. Stout MB, Justice JN, Nicklas BJ, et al. Physiological aging: links among adipose tissue dysfunction, diabetes and frailty. Physiology. 2017;32(1):9–19. doi: 10.1152/physiol.00012.2016.
    1. Locke AE, Kahali B, Berndt SI, et al. Genetic studies of body mass index yield new insights for obesity biology. Nature. 2015;518(7538):197–206. doi: 10.1038/nature14177.
    1. Ferguson-Smith AC, Patti ME. You are what your dad ate. Cell Metab. 2011;13(2):115–117. doi: 10.1016/j.cmet.2011.01.011.
    1. Heijjmans BT, Tobi EW, Stein AD, et al. Persistent epigenetic differences associated with prenatal exposure to famine in humans. Proc Natl Acad Sci U S A. 2008;105(44):17046–17049. doi: 10.1073/pnas.0806560105.
    1. Bird SR, Hawley JA. Update on the effects of physical activity on insulin sensitivity in humans. BMJ Open Sport Exerc Med. 2017;2:2000143. doi: 10.1136/bmjsem-2016-000143.
    1. Hofmann T, Elbelt U, Stengel A. Irisin as a muscle-derived hormone stimulates thermogenesis-a critical update. Peptide. 2014;54:89–100. doi: 10.1016/j.peptides.2014.01.016.
    1. Yang Q, Cogswell ME, Flanders WD, Hong Y, Zhang Z, Loustalot F, Gillespie C, Merritt R, Hu FB. Trends in cardiovascular health metrics and association with all cause and CVD mortality among US adults. JAMA. 2012;307(12):1273–1283. doi: 10.1001/jama.2012.339.
    1. National Diabetes Statistics Report 2017 CDC publication.
    1. Okla M, Kim J, Koehler K, et al. Dietary factors promoting brown and beige fat development and thermogenesis. Adv Nutr. 2017:473–83.
    1. Ono K, et al. Intragastric administration of capsiate, a transient receptor potential channel agonist, triggers thermogenic sympathetic response. J Appl Physiol. 2011;10:789–798. doi: 10.1152/japplphysiol.00128.2010.
    1. Yoneshiro T, Aita S, Kawai Y, et al. Nonpungent capsaicin analogs (capsinoids) increase energy expenditure through the activation of brown adipose tissue in humans. Am J Clin Nutr. 2012;95:845–850. doi: 10.3945/ajcn.111.018606.
    1. Cheng CW, Villani V, Buono R, et al. Fasting mimicking diet promotes Ngn3-driven beta-cell regeneration to reverse diabetes. Cell. 2017;168:775–788. doi: 10.1016/j.cell.2017.01.040.
    1. Liu P, Ji Y, Yuen T, et al. Blocking FSH induces thermogenic adipose tissue and reduces body fat. Nature. 2017;546(7656):107–112. doi: 10.1038/nature22342.
    1. Borgeson E, Johnson AMF, Lee YS, et al. Lipoxin A4 attenuates obesity-induced adipose inflammation and associated liver and kidney disease. Cell Metab. 2015;22:1–13. doi: 10.1016/j.cmet.2015.05.003.
    1. Orchard TJ, Temprosa M, Goldberg R, et al. The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the diabetes prevention program. Ann Intern Med. 2005;142:611–619. doi: 10.7326/0003-4819-142-8-200504190-00009.
    1. Ruderman NB, Carling D, Prentki M, et al. AMPK, insulin resistance and the metabolic syndrome. J Clin Invest. 2013;123:2764–2772. doi: 10.1172/JCI67227.
    1. Wu H, Esteve E, Tremaroli V, Khan MT, Caesar R, Mannerås-Holm L, Ståhlman M, Olsson LM, Serino M, Planas-Fèlix M, Xifra G, Mercader JM, Torrents D, Burcelin R, Ricart W, Perkins R, Fernàndez-Real JM, Bäckhed F. Metformin alters the gut microbiome of individual with treatment-naïve type 2 diabetes contributing to the therapeutics effects of the drug. Nat Med. 2017;23(7):850–858. doi: 10.1038/nm.4345.
    1. Zhao Y, Sedighi R, Wang P, Chen H, Zhu Y, Sang S. Carnosic acid as a major bioactive component in rosemary extract ameliorates high-fat diet induced obesity and metabolic syndrome. J Agric Food Chem. 2015;63(19):4843–4852. doi: 10.1021/acs.jafc.5b01246.
    1. Jain SG, Puri S,Misra A etal. Effect of oral cinnamon intervention on metabolic profile and body composition of Asian Indians with metabolic syndrome: a randomized double-blind control trial. Lipids Health Dis 2017: 16:113–116, 1, DOI: 10.1186/s12944-017-0504-8.
    1. Lee J, Liu J, Feng X, et al. Withaferin A is a leptin sensitizer with strong antidiabetic properties in mice. Nat Med. 2016;22:1023–1036. doi: 10.1038/nm.4145.
    1. Choudhary D, Bhattacharyya S, Joshi K. Body weight management in adults under chronic stress through treatment with Ashwagandha root extract: a double blind randomized, placebo controlled trial. J Evid based complementary altern med. 2017;22:96–106. doi: 10.1177/2156587216641830.
    1. Consolim-Colombo FM, Sangaleti CT, Costa FO, et al. Galantamine alleviates inflammation and insulin resistance in patients with metabolic syndrome in a randomized trial. JCI Insight. 2017;20:93340. doi: 10.1172/jci.insight.93340.
    1. Liu J, Lee J, Hernandez MAS, et al. Treatment of obesity with Celastrol. Cell. 2015;161:999–1011. doi: 10.1016/j.cell.2015.05.011.
    1. Rosa DD, Grzeskowiak LM, Ferreira CL, et al. Kefir reduces insulin resistance and inflammatory cytokine expression in an animal model of metabolic syndrome. Food Func. 2016;10:3390–3394. doi: 10.1039/C6FO00339G.
    1. Primeau V, Coderre L, Karelis AD, et al. Characterizing the profile of obese patients who are metabolically healthy. Int J obesity. 2011;35:971–981. doi: 10.1038/ijo.2010.216.
    1. Cheong KC, Ghazali SM, Hock LK, Subenthiran S, Huey TC, Kuay LK, Mustapha FI, Yusoff AF, Mustafa AN. The discriminative ability of waist circumference, body mass index and waist-to-hip ratio in identifying metabolic syndrome: variations by age, sex and race. Diabetes Metab Syndr. 2015;9(2):74–78. doi: 10.1016/j.dsx.2015.02.006.
    1. • Yamaoka K, Tango T. Effects of lifestyle intervention on metabolic syndrome: a systemic meta-analysis. BMC Med 2012; The relative proportion of patients with resolved MetS was around 2 times greater in the intervention group than the control group. Mean decrease in fasting blood sugar, triglycerides, waist circumference were 11.5 mg/dl, 12.0 mg/dl and 2.7 cm. Systolic and diastolic BP decreased by 6.4 and 3.3 mmHg. There was nonsignificant increase in HDL of 1.3 mg/dl.
    1. Damsgaard CT, Biltoft-Jensen A, Tetens I, et al. Whole-grain intake, reflected by dietary records and biomarkers, is inversely associated with circulating insulin and other cardiometabolic markers in 8-11-year-old children. J Nutr. 2017;147:816–824. doi: 10.3945/jn.116.244624.
    1. Fletcher JM, Frisvold DE, Tefft N. Non-linear effects of soda taxes on consumption and weight outcomes. Health Econ. 2015;24(5):566–583. doi: 10.1002/hec.3045.
    1. Bray GA, Nielsen SJ, Popkin BM. Consumption of high fructose corn syrup in beverages may play a role in the epidemic of obesity. Am J Clin Nutr. 2004;79:537–543. doi: 10.1093/ajcn/79.4.537.
    1. Coleman KJ, Huang YC, Koebrick C, et al. Metabolic syndrome is less likely to resolve in Hispanics and non-Hispanic blacks after bariatric surgery. Ann Surg. 2014;259:279–285. doi: 10.1097/SLA.0000000000000258.
    1. Peeters A, Backholder K. How to influence the obesity landscape using health policies. Int J Obesity. 2017;41(6):835–839. doi: 10.1038/ijo.2017.24.
    1. Barres R and Zierath JR. The role of diet and exercise in the transgenerational epigenetic landscape of T2DM. Nature reviews Endocrinology. 2016: 12:441–451. The review discusses the current understanding how life style factors affect the epigenetic landscape in MetS and diabetes.
    1. • Newcomer JW. Metabolic considerations in the use of antipsychotic medications: a review of recent evidence. J Clin psychiatry. While many clinicians noticed the weight gain and increased incidence of diabetes with use of second generation antipsychotic drugs like Clonazapine, Olanzapine, CATIE (Clinical antipsychotic trails of intervention efficacy) and other studies confirmed that use of these drugs are associated with substantial weight gain and associated metabolic disturbances.
    1. Emmerson PJ, Wang F, Du Y, et al. The metabolic effects of GDF15 are mediated by the orphan receptor GFRAL. Nat Med. 2017;23(10):1215–1219. doi: 10.1038/nm.4393.
    1. Cimino I, Coll AP, Yeo HS. GDF15 and energy balance: homing in on a mechanism. Nat Med. 2017;23:1119–1120. doi: 10.1038/nm.4414.
    1. Salas-salvado J, Bullo M, Estruch R, et al. Prevention of diabetes with Mediterranean diet—a subgroup analysis of a randomized diet. Ann Intern Med. 2014;160:1–10. doi: 10.7326/M13-1725.

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