Metabolic Syndrome

The term Metabolic Syndrome is used when people start to put on weight especially around their waists (increased abdominal girth) , develop high blood pressure (hypertension), and also have a problem regulating their blood glucose levels and their blood fats levels (the so called triglycerides and cholesterol). The incidence of this in the general population is 20-25% which makes it a significant disorder. The fear about this is that it increases your risk of developing diabetes or getting a heart attack or stroke.

The metabolic syndrome has also been termed Syndrome X and Insulin Resistance.

There are varied definitions of Metabolic Syndrome. I have includeded 2 from the International Diabetes Federation and The World Health Organisation.

The IDF reached a expert consensus in 2006. it defined the Metabolic Syndrome as consisting of:

Central obesity (defined as waist circumference# with ethnicity specific values) was an essential criteria to the diagnosis. AND

  • Raised triglycerides: > 150 mg/dL (1.7 mmol/L), or specific treatment for this lipid abnormality.
  • Reduced HDL cholesterol: < 40 mg/dL (1.03 mmol/L) in males, < 50 mg/dL (1.29 mmol/L) in females, or specific treatment for this lipid abnormality
  • Raised blood pressure: systolic BP > 130 or diastolic BP >85 mm Hg, or treatment of previously diagnosed hypertension.
  • Raised fasting plasma glucose :(FPG)>100 mg/dL (5.6 mmol/L), or previously diagnosed type 2 diabetes.
  • If BMI (body mass index - kg/m2) is >30 kg/m, central obesity can be assumed and waist circumference does not need to be measured.

The World Health Organization criteria (1999) require the presence of one of diabetes mellitus, impaired glucose tolerance, impaired fasting glucose or insulin resistance, AND two of the following:

  • Blood pressure: = 140/90 mmHg
  • Dyslipidemia: triglycerides (TG): = 1.695 mmol/L and high-density lipoprotein cholesterol (HDL-C) = 0.9 mmol/L (male), = 1.0 mmol/L (female)
  • Central obesity: waist:hip ratio > 0.90 (male); > 0.85 (female), or body mass index > 30 kg/m2
  • Microalbuminuria: urinary albumin excretion ratio = 20 g/min or albumin:creatinine ratio = 30 mg/g

Whether you acribe to the IDF or WHO criteria, there is a high incidence of Metabolic Syndrome amongst people with Schizophrenia, as high as 32%. This is thought to be due to their sedentary lifestyle, poor dietary habits, effects of antipsychotic medication and possibly reduced acces to care. Some of these can be directly ascribed to the schizophrenia illness such as disorganisation and negative symptoms such as loss of motivation and loss of initiative. Certain medications such as olanzapine and clozapine are especially likely to weight gain. However sometimes they do not cause weight gain even in large doses. There are different individual responses to medication.

Prevention is the best way to treat anything. These recommendations extend to everyone who reads this.

A change in lifestyle is important. This means increasing physical activity. Aim to walk everyday. Buy a bicycle. Walk instead of using the car or public transport. Some studies have shown the benefits of regular walking to outweigh that of going to sweat it out in the gym. A 30 minute BRISK walk should be enough. But this does not mean that you should not go to the gym if you enjoy that. Taking up a sport, joining a club, might be more enjoyable and increase your social contacts at the same time. Your local health centre/hospital might have a fitness instructor or occupational therapist that can direct you or include you in sporting activities.

Following a sensible healthy, reduced calory diet is also essential. This does not mean that you must starve yourself by skipping meals and living on carrot sticks and lettuce leaves. You must still eat correctly proportioned meals.

Most importantly you must avoid or drastically reduce your consumption of fast food which is high calory low nutrional value food. Again talk to the dietician attached to your hospital for more advice on following a healthy diet.

If these measure fail to improve the disorder, then drug treatment might be needed to control the hypertension, diabetes and blood lipid problems (raised cholesterol).

A change in the antipsychotic medication might also be indicated if lifestyle and dietary changes do not result in weight loss.

Unfortunately all attempts to treat the Metabolic Syndrome through lifestyle and dietary changes can be difficult and extremely frustrating for family and loved ones to accept. The major factor often in this are the core symptoms of the schizophrenia illness. The disorganisation can be combatted in instances where there is a lot of social support through the provision of proper food. The negative symptoms of avolition which is the loss of motivation and loss of initiative to do things is a major factor to overcome, but which is not impossible.

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