“Metabolic disease” is a broad term that can refer to many different conditions. When we evaluate cardiometabolic risk, one useful framework is metabolic syndrome.Metabolic syndrome is not a single disease. It is a cluster of common findings that tend to occurtogether and are associated with a higher risk of developing type 2 diabetes, cardiovascular disease and stroke. A person meets the traditional definition of metabolic syndrome when three or more of the
following five findings are present:
1. Abdominal obesity — commonly defined as a waist circumference greater than 40 inches in
men or 35 inches in women.
2. Elevated blood pressure — 130/85 mmHg or higher, or treatment for high blood pressure.
3. Elevated fasting triglycerides — 150 mg/dL or higher, or treatment for elevated triglycerides.
4. Low HDL cholesterol — less than 40 mg/dL in men or less than 50 mg/dL in women, or
treatment for this lipid abnormality.
5. Elevated fasting glucose — 100 mg/dL or higher, or treatment for elevated blood glucose.
Why do these seemingly different findings tend to occur together?
Two important factors are insulin resistance and excess visceral adipose tissue—the fat storedaround our internal organs. These can contribute to abnormalities in blood sugar regulation,
triglycerides, blood pressure and other aspects of metabolic health.
Looking Beyond the Five Criteria
It is useful to think of metabolic health as a continuum rather than an on/off switch. You do not suddenly become metabolically unhealthy when you develop your third risk factor, nor does having fewer than three necessarily mean your metabolic health is optimal. Waist circumference is a useful marker of abdominal fat, but it does not tell the whole story.
Body-composition testing such as DEXA can provide additional information about fat distribution, lean mass and, with appropriate technology, visceral adipose tissue. This can help us refine your overall cardiometabolic risk assessment.The goal is not simply to determine whether you technically “have metabolic syndrome.” The goal is to understand where you are on the spectrum of cardiometabolic health and whether your risk is moving in the right direction.
The Good News
Many of these risk factors are highly modifiable. Improving dietary quality, increasing regular physical activity, building and maintaining muscle, improving cardiorespiratory fitness, reducing excess body fat when appropriate, and getting
adequate sleep can substantially improve metabolic health. For some people, lifestyle changes alone may not be enough. Depending on the underlying problem and an individual's overall risk, medications for obesity, diabetes, blood pressure or
abnormal lipids may also play an important role. The earlier these changes are identified and addressed, the greater the opportunity to prevent metabolic dysfunction from progressing into diabetes, cardiovascular disease and other chronic conditions.
Written and Medically Reviewed by Dr. Tobin Dennis