Metabolic syndrome concise

Metabolic Syndrome

Insulin resistance syndrome
Syndrome X
 

• Obesity, a chronic disease that is increasing in prevalence in adults, adolescents, and children, is now considered to be a global epidemic.
• Obesity, particularly abdominal obesity, is associated with resistance to the effects of insulin on peripheral glucose and fatty acid utilization, often leading to type 2 diabetes mellitus.

Insulin resistance, the associated hyperinsulinemia and hyperglycemia, and adipocyte cytokines (adipokines) may also lead to vascular endothelial dysfunction, an abnormal lipid profile, hypertension, and vascular inflammation, all of which promote the development of atherosclerotic cardiovascular disease (CVD) [1-4].

For adipokines, refer to pathogenesis of DM2:

Adipokines, factors released from adipocytes, stimulate inflammatory activity which correlates with insulin resistance .

The incidence of type 2 diabetes has been correlated with increased levels of markers of inflammation, including C reactive protein, IL-6, plasminogen activator inhibitor-1 (PAI-1), and white cell count .

1-Adiponectin: An adipocyte-derived cytokine,

reduces levels of blood free fatty acids

and has been associated with improved lipid profiles,

better glycemic control,

and reduced inflammation in diabetic patients.

2-Tumor necrosis factor-alpha:

Studies in genetically obese animals suggest that increased release of TNF-alpha (TNFa) from adipocytes may play a major role in the impairment in insulin action .

The applicability of these findings to humans is uncertain.

Some studies found a strong correlation between the degree of obesity, hyperinsulinemia, and TNFa mRNA in adipose tissue.

3- Plasminogen activator inhibitor 1, an inhibitor of fibrinolysis, is another protein related to adipocytes.

4- Resitin:

In diet-induced or genetic obesity in mice, adipocytes secrete a signaling molecule named resistin. Administration of resistin decreases while neutralization of resistin increases insulin-mediated glucose uptake by adipocytes

Thus, resistin may be a hormone that links obesity to diabetes.

5- Retinol-binding protein 4 (RBP4), another protein released from adipocytes.

• Correlates with the degree of insulin resistance in patients with obesity, impaired glucose tolerance, or type 2 diabetes, as well as in non-obese subjects with a strong family history of type 2 diabetes.