Metabolic Syndrome

  • Diagnosis
  • Monitoring
  • Background
  • Pediatrics
  • Lab Tests
  • References
  • Related Topics

Indications for Testing

  • High blood pressure
  • Overweight or obesity
  • Physical inactivity
  • Increased waist circumference
  • Abnormal results for one component of syndrome (triglycerides, HDL, plasma glucose)
  • Suspicion for metabolic syndrome due to other history (use of oral steroids, atypical antipsychotics, myocardial infarction, or stroke)

Criteria for Diagnosis

  • Several definitions for metabolic syndrome – 4 main areas of dysfunction
    • Increased visceral adipose
    • Dyslipidemia
    • High blood pressure
    • Derangements in glucose handling
  • National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria for diagnosis of metabolic syndrome (Grundy, 2005) – must meet ≥3 of the 5 criteria
    • Waist circumference
      • Men ≥40 inches, women ≥35 inches
      • Measure at the top of the iliac crest after inspiration
    • Triglyceride concentration – ≥150 mg/dL
    • High-density lipoprotein cholesterol (HDL-C) – men <40 mg/dL, women <50 mg/dL, or individual receiving pharmacologic therapy to treat cholesterol
    • Hypertension – blood pressure (BP) ≥130/85 or individual receiving pharmacologic therapy for hypertension
    • Fasting blood glucose – ≥100 mg/dL (American Diabetes Association [ADA] guidelines, 2014)

Laboratory Testing

  • Lipid panel
  • Glucose measurement
    • Fasting glucose
    • Glucose tolerance – may also use if criteria not met but suspicion for diabetes mellitus is moderate to high
    • Hemoglobin A1c (HbA1c) – not currently incorporated into diagnostic criteria

Metabolic syndrome is a cluster of metabolic changes thought to have a shared pathologic mechanism that is associated with an increased risk for developing cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM).

Epidemiology

  • Prevalence – ~23% in U.S. (Beltrán-Sánchez, 2013, using National Health and Nutrition Examination Survey [NHANES] data, 2009-2010)
  • Age
    • Incidence increases with age
      • Found in ≥50% of patients >60 years
    • Becoming more common during childhood (see Pediatrics section)
  • Sex – M:F, equal

Risk Factors

Pathophysiology

  • Insulin resistance thought to represent most of the underlying pathophysiology
    • Obesity and physical inactivity lead to insulin resistance
  • Proinflammatory and prothrombotic state with glucotoxicity and lipotoxicity contributes to metabolic and vascular abnormalities

Clinical Presentation

  • Central obesity (apple shape)
  • Hyperlipidemia
  • Hypertension
  • Complications
    • CVD
    • T2DM
    • Nonalcoholic fatty liver disease
    • Renal insufficiency
    • Peripheral vascular disease
    • Obstructive sleep apnea

Clinical Background

Epidemiology

  • Prevalence – 6.4% (Cook, 2007, using National Health and Nutrition Examination Survey [NHANES] data, 1999-2000)
  • Sex – M>F
  • Age – usually ≥12 years

Definition of Obesity in Children

  • Obesity in children (2-19 years) – called childhood overweight
  • Body mass index (BMI) ≥95 percentile for children of same age and sex (CDC, 2011, and American Academy of Pediatrics [AAP], 2003)

Clinical Presentation

Diagnosis

Indications for Testing

  • Suspicion based on criteria for diagnosis – hypertension, dyslipidemia, glucose intolerance, moderate to severe obesity

Criteria for Diagnosis

  • No consensus for pediatric criteria
    • Use adult diagnostic elements with pediatric cutoffs (see Diagnosis section for National Cholesterol Education Program Adult Treatment Panel III criteria)
  • Must meet 3 of 4 criteria
    • Triglyceride concentration – >110 mg/dL
    • High-density lipoprotein cholesterol (HDL-C) – ≤40 mg/dL
    • Blood pressure – 90% for age, gender, height
    • Fasting blood glucose – ≥100 mg/dL (American Diabetes Association [ADA] guidelines, 2014)

Laboratory Testing

  • Lipid panel
  • Fasting glucose
Tests generally appear in the order most useful for common clinical situations. Click on number for test-specific information in the ARUP Laboratory Test Directory.

Lipid Panel 0020421
Method: Quantitative Enzymatic

Glucose, Plasma or Serum 0020024
Method: Quantitative Enzymatic

Glucose Tolerance Test 0020542
Method: Quantitative Enzymatic

Limitations 

Emesis and conditions which delay stomach emptying may cause invalid results

Guidelines

American Academy of Pediatrics Committee on Nutrition. Policy Statement - Prevention of Pediatric Overweight and Obesity. American Academy of Pediatrics. Elk Grove Village, Illinois [Accessed: May 2017]

American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014; 37 Suppl 1: S81-90. PubMed

Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC, Spertus JA, Costa F, American Heart Association, National Heart, Lung, and Blood Institute. 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. PubMed

General References

Beltrán-Sánchez H, Harhay MO, Harhay MM, McElligott S. Prevalence and trends of metabolic syndrome in the adult U.S. population, 1999-2010. J Am Coll Cardiol. 2013; 62(8): 697-703. PubMed

Cook S, Auinger P, Li C, Ford ES. Metabolic syndrome rates in United States adolescents, from the National Health and Nutrition Examination Survey, 1999-2002. J Pediatr. 2008; 152(2): 165-70. PubMed

Cornier M, Dabelea D, Hernandez TL, Lindstrom RC, Steig AJ, Stob NR, Van Pelt RE, Wang H, Eckel RH. The metabolic syndrome. Endocr Rev. 2008; 29(7): 777-822. PubMed

Denys K, Cankurtaran M, Janssens W, Petrovic M. Metabolic syndrome in the elderly: an overview of the evidence. Acta Clin Belg. 2009; 64(1): 23-34. PubMed

Gardner M, Gardner DW, Sowers JR. The cardiometabolic syndrome in the adolescent. Pediatr Endocrinol Rev. 2008; 5 Suppl 4: 964-8. PubMed

Kassi E, Pervanidou P, Kaltsas G, Chrousos G. Metabolic syndrome: definitions and controversies. BMC Med. 2011; 9: 48. PubMed

Kursawe R, Santoro N. Metabolic syndrome in pediatrics. Adv Clin Chem. 2014; 65: 91-142. PubMed

Little RR, La'ulu SL, Hanson SE, Rohlfing CL, Schmidt RL. Effects of 49 Different Rare Hb Variants on HbA1c Measurement in Eight Methods. J Diabetes Sci Technol. 2015; 9(4): 849-56. PubMed

Olufadi R, Byrne CD. Clinical and laboratory diagnosis of the metabolic syndrome. J Clin Pathol. 2008; 61(6): 697-706. PubMed

Pi-Sunyer X. The metabolic syndrome: how to approach differing definitions. Med Clin North Am. 2007; 91(6): 1025-40, vii. PubMed

Medical Reviewers

Content Reviewed: 
May 2017

Last Update: July 2017