Metabolic syndrome is a collection of cardiometabolic risk factors that includes obesity,
insulin resistance, hypertension, and dyslipidemia. (1) It is known and accepted that this cluster of risk factors is linked to increased risk of type 2 diabetes and cardiovascular disease. According to Saklayen (2), in his article ‘The Global Epidemic of the Metabolic Syndrome’, the global prevalence of people living with metabolic syndrome (in 2018) can be estimated to be about one-quarter of the world population or more than a billion people worldwide!
Diagnosis of Metabolic Syndrome is based on blood work and anthropometric (body) measurements, including:
fasting blood glucose levels (>7mmol/l)
waist circumference (>80cm in females and >94cm in males)
waist-to-hip ratio
blood pressure (>140/90)
lipid profile testing (Triglycerides <1.1mmol/l).
Hyperinsulinemia / insulin resistance as well as visceral adiposity can be attributed to all of these factors as well as contributing to chronic low-grade inflammation which can be measured on a highly sensitive- CRP test. (HS-CRP)
Metabolic Syndrome is associated with a poorer prognosis in health and wellness outcomes as it contributes to the inflammatory cascade during times of acute illness which can lead to an increase in the body’s natural immune response and increases inflammation affecting all organs and vessels in the body. Studies show that rising CRP levels increase the risk of hypertension, diabetes and cardiovascular disease (3). Particularly, during the early waves of the COVID-19 pandemic, those infected who were morbidly obese, prediabetic or had metabolic syndrome suffered from more severe disease and higher rates of mortality linked to reduced immune function, chronic inflammation, prothrombotic state, endothelial dysfunction and atherosclerosis as illustrated in the diagrams below (4).
According to Isomaa et al. in their study on Cardiovascular Morbidity and Mortality associated with Metabolic Syndrome, subjects with Metabolic Syndrome were at three times higher risk for coronary heart disease and stroke (5).
Further, in three separate studies conducted in Malaysia and the United States of America comparing population samples with and without Metabolic Syndrome, people with Metabolic Syndrome were shown to have a significantly higher risk of death from all-causes and cardiovascular disease when compared to those without Metabolic Syndrome. (6–8)
The researchers conclude that “it is thus imperative to prescribe individuals with Metabolic Syndrome, a lifestyle intervention along with pharmacological intervention to improve the individual components of Metabolic Syndrome and reduce this risk”(8).
A ketogenic diet or low carbohydrate diet can therefore be seen as a first-line treatment in reversing and improving the individual components of Metabolic Syndrome in this ‘at-risk’ population as it can assist in improving all the markers associated with metabolic syndrome (9).
References:
Roberts CK, Hevener AL, Barnard RJ. Metabolic syndrome and insulin resistance: Underlying causes and modification by exercise training. Compr Physiol. 2013;3(1):1–58.
Saklayen MG. The Global Epidemic of the Metabolic Syndrome. Vol. 20, Current Hypertension Reports. Current Medicine Group LLC 1; 2018.
Patel H, Patel VH. Inflammation and metabolic syndrome: An overview. Current Research in Nutrition and Food Science. 2015;3(3):263–8.
Dissanayake H. COVID-19 and metabolic syndrome. Vol. 37, Best Practice and Research: Clinical Endocrinology and Metabolism. Bailliere Tindall Ltd; 2023.
Isomaa B, Almgren P, Tuomi T, Forsén B, Lahti K, Nissén M, et al. Cardiovascular Morbidity and Mortality Associated With the Metabolic Syndrome. Diabetes Care [Internet]. 2001 Apr 1;24(4):683–9. Available from: https://doi.org/10.2337/diacare.24.4.683
Li W, Chen D, Peng Y, Lu Z, Kwan MP, Tse LA. Association Between Metabolic Syndrome and Mortality: Prospective Cohort Study. JMIR Public Health Surveill [Internet]. 2023 Sep 5;9:e44073. Available from: https://publichealth.jmir.org/2023/1/e44073
Malik S, Wong ND, Franklin SS, Kamath T V., L’Italien GJ, Pio JR, et al. Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation. 2004 Sep 7;110(10):1245–50.
Chee Cheong K, Lim KH, Ghazali SM, Teh CH, Cheah YK, Baharudin A, et al. Association of metabolic syndrome with risk of cardiovascular disease mortality and all-cause mortality among Malaysian adults: A retrospective cohort study. Vol. 11, BMJ Open. BMJ Publishing Group; 2021.
Volek JS, Feinman RD. Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction. Vol. 2, Nutrition and Metabolism. 2005. p. 1–17.