Metabolic syndrome

Diagnostic Criteria — Harmonized Definition IDF/AHA/NHLBI (2009)

• Definition: 3 of the following 5 criteria:
• 1 — Abdominal obesity (waist circumference): man ≥ 102 cm + woman ≥ 88 cm (North American thresholds) + or man ≥ 94 cm + woman ≥ 80 cm (European thresholds + IDF - recommended for populations in South Asia + East Asia + Sub-Saharan Africa + Latin America) → waist circumference is measured at umbilicus + end of exhalation + standing patient
• 2 — High triglycerides: ≥ 1.7 mmol/L (≥ 150 mg/dL) + or specific hypolipidemic treatment for this anomaly
• 3 — Low HDL cholesterol: man < 1.0 mmol/L< 40 mg/dL) + female < 1.3 mmol/L< 50 mg/dL) + or specific treatment for this anomaly
• 4 — High Blood Pressure systolic ≥ 130 mmHg + or diastolic ≥ 85 mmHg + or antihypertensive treatment
• 5 — Elevated fasting blood glucose: ≥ 5.6 mmol/L (≥ 100 mg/dL) + or antidiabetic treatment + or known type 2 diabetes

Pathophysiology — central vicious cycle

• Visceral adipose tissue (VAT): visceral (not subcutaneous) abdominal adiposity is the centerpiece of SM + visceral adipocytes are metabolically very active → massively release free fatty acids (FFA) to the portal vein → liver directly exposed to FFA → increased hepatic gluconeogenesis + steatosis + increased VLDL → hypertriglyceridemia + small dense LDL (atherogenic) + lowered HDL
• Insulin resistance FFAs + TAV cytokines (TNF-α + IL-6) inhibit intracellular insulin signaling (IRS-1/PI3K pathway) → resistant muscle + liver + adipose tissue → compensatory hyperinsulinemia → pancreas exerts increased secretion → β-cell exhaustion in the long term → type 2 diabetes
• Chronic low-grade vascular inflammation : Slightly elevated CRP (1-3 mg/L - high sensitivity) + fibrinogen + PAI-1 (plasminogen inhibitor) + prothrombotic state → accelerated atherosclerosis
• RAAS activation: visceral adipose tissue produces angiotensinogen → hypertension + sodium reabsorption + aggravation of insulin resistance

Complications and associated risks

Treatment — Lifestyle-Centered Approach

• Weight loss (central treatment) : 5-10 % reduction in body weight → improvement in all SM components + reduced insulin resistance + decreased TG + increased HDL + lowered BP + normalized blood glucose + low-calorie diet (500-1,000 kcal/day deficit) + Mediterranean or DASH diet + nutritional follow-up + weight goal: long-term maintenance takes priority over rapid initial loss
• Physical activity : 150-300 min/week of moderate-intensity aerobic activity (brisk walking + cycling + swimming) + muscular resistance 2-3 ×/week → reduction in insulin resistance + lipid improvement + reduction in BP + independently of weight loss (physical activity improves insulin sensitivity even without weight loss)
• Treatment of Hypertension if BP ≥ 130/80 mmHg + ACE inhibitor or ARB II = first choice (renal protection + hepatoprotection + reduced insulin resistance) + or calcino antagonists + avoid beta-blockers in 1st line (worsening of insulin resistance + dyslipidemia)
• Dyslipidemia Treatment: statins if cardiovascular risk is high (LDL-C ≥ 3.4 mmol/L or Framingham risk score ≥ 15 %) → atorvastatin + rosuvastatin + fibrates if triglycerides are very high (> 5.6 mmol/L — risk of pancreatitis) + or high-dose omega-3 (Vascepa® — ethyl icosapentaenoate — if TG 1.5–5.6 mmol/L with high CV risk)
• Hyperglycemia treatment: if prediabetes → metformin (especially if BMI ≥ 35 + or history of gestational diabetes) + if type 2 diabetes → metformin in 1st line + SGLT2 (empagliflozin + dapagliflozin) and/or GLP-1 (semaglutide + liraglutide) = 2nd line + additional beneficial effects on weight + BP + TG + liver (MASLD) + cardiovascular and renal protection
• GLP-1 and double/triple agonists (cross-sectional treatment of DM) : sémaglutide (Ozempic® + Wegovy®) + tirzepatide (Mounjaro®) → weight loss 15-22 % of body weight + reduction of all SM components + reduction of MASLD + major cardiovascular protection (SELECT + SURMOUNT-MMO) → SM transforming agents in 2024
• Bariatric surgery: if BMI ≥ 35 with comorbidities (DM + diabetes + hypertension + apnea) + or BMI ≥ 40 → resolution of DM in 80-90 % + remission of type 2 diabetes in 50-80 % + reduction in cardiovascular mortality demonstrated

Consult at Clinique Omicron

Clinique Omicron's nurse practitioners (NPs) and physicians screen for metabolic syndrome using waist circumference, fasting blood glucose, lipid panel, and blood pressure. They calculate global cardiovascular risk (Framingham + SCORE), initiate lifestyle modifications, metformin for prediabetes, statins for high CV risk, SGLT2 inhibitors or GLP-1 agonists for type 2 diabetes, and appropriate antihypertensives (ACE inhibitors/ARBs). They refer patients to nutritionists, kinesiologists, or for bariatric surgery based on their profile and provide annual follow-up of metabolic syndrome components. Consultations are available at multiple service locations across Quebec and via telemedicine. To book an appointment, visit cliniqueomicron.ca.

The content of this page is for informational purposes only and does not substitute medical advice. Metabolic syndrome is a high cardiovascular and metabolic risk factor requiring comprehensive integrated management—lifestyle modifications as a priority, followed by targeted drug therapy for each component if goals are not met. Waist circumference should be measured at each annual consultation.