The metabolic syndrome represents a constellation of risk factors for atherosclerosis or hardening of the arteries, premature death, fatty infiltration of the liver, blood clot formation, obstructive sleep apnea and even Alzheimer’s Disease.

Variously known as syndrome x, the insulin resistance syndrome or the obesity syndrome, the metabolic syndrome includes an array of factors. To qualify for the diagnosis an individual must have at least 3 of 5 criteria. These include waist circumference of greater than 45 inches for men or at least 40 inches for women. Other traits include triglycerides in excess of 150 mg, good cholesterol or HDL of less than 50 mg for men or 40 mg for women, elevated blood pressure readings beyond 130/85 mm and/or type 2 diabetes or elevated blood glucose.

The excess fat must be about the waistline as opposed to the hips. Furthermore the unwanted adipose tissue must be within the abdominal cavity – so-called visceral fat rather than between the skin and abdominal wall – so-called subcutaneous fat. Due to its connection to the portal circulation the visceral fat feeds harmful metabolic byproducts directly to the liver.

Determining the exact location of fat deposits remains a challenge. Clinical examination fails to detect the precise origin. Identifying and quantifying visceral fat requires imaging tests. Appearances often belie the true nature of the fat. Asians, Indians and cigarette smokers often appear relatively lean but still harbor unhealthy accumulations of visceral adipose tissue.

Debate exists regarding whether metabolically healthy obesity exists. Most obese individuals ultimately deteriorate over time and eventually meet the criteria for the metabolic syndrome.

The precise metabolic defect underlying the metabolic syndrome remains undetermined. Recent research indicates dietary habits including a diet rich in simple carbohydrates may trigger an alteration in the intestinal microbiome. Adding fruit, vegetables, legumes and fiber may improve the bacterial mix of the intestine, stimulate secretion of protective mucus and generate production of health promoting short chain fatty acids.

With the epidemic of obesity in the country, estimates suggest the metabolic syndrome will soon overtake cigarettes as the primary cause of heart disease.