Metabolic syndrome

What it is

Metabolic syndrome is a cluster of health conditions rather than one disease. Five of them run together in it: visceral obesity, hypertension, insulin resistance, high triglycerides and low HDL-cholesterol.

Causes and risk

Insulin resistance is what runs through the routes into it. Obesity is associated with early pubertal development mainly through obesity-related insulin resistance, and that resistance leads to increased insulin and leptin levels: centrally obesity causes increased secretion of leptin, and peripherally it causes insulin resistance with a compensatory hyperinsulinemia.

Premature adrenarche is one of the benign or nonprogressive pubertal variants, the premature maturation of the adrenal zona reticularis that gives elevated androgen levels and onset of pubarche before age 8 years in girls and age 9 years in boys, and it is associated with obesity, insulin resistance and the later development of PCOS and/or metabolic syndrome.

Pregnancy shows the same physiology moved one step further. Normal pregnancy carries increased insulin resistance with an increase in insulin secretion; in the diabetes of pregnancy the insulin resistance is worsened and the pancreatic B cell reserve falls, with a 40 to 80% fall in insulin sensitivity in late pregnancy. The baby of that pregnancy carries the risk on: childhood and adult obesity, type 2 diabetes in a third of offspring, the same diabetes in her own pregnancy, and metabolic syndrome. The mother's own risks are recurrence of that diabetes in a later pregnancy and development of type 2 diabetes, 60% in 5-15 yrs, with an annual incidence of 0.5-7.5% in various studies.