PRESENTATION

ON METABOLIC
SYNDROME

SUBMITTED TO
MRS. SHALY ULAHANNAN
ASSISTANT. PROFESSOR
HOLY FAMILY COLLEGE OF
NURSING

SUBMITTED BY
MRS. DANI THOMAS
1ST YEAR M.Sc NURSING
HOLY FAMILY COLLEGE OF NURSING

SUBMITTED ON 28/11/18
 INTRODUCTION

Metabolic syndrome is a cluster of conditions — increased blood pressure, high blood

sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels —
that occur together, increasing your risk of heart disease, stroke and diabetes.

Having just one of these conditions doesn't mean you have metabolic syndrome.
However, any of these conditions increase your risk of serious disease. Having more than one
of these might increase your risk even more.

If you have metabolic syndrome or any of its components, aggressive lifestyle

changes can delay or even prevent the development of serious health problems. When
changes in lifestyle alone do not control the conditions related to metabolic syndrome, your
health practitioner may prescribe medications to control blood pressure, cholesterol, and
other symptoms. Carefully following your practitioner's instructions can help prevent many
of the long term effects of metabolic syndrome. Every step counts and hard work and
attention to these areas will make a difference in your health!

DEFINITION
Metabolic syndrome, sometimes known by other names, is a clustering of at least three of
the five following medical conditions: central obesity, high blood pressure, high blood
sugar, high serum triglycerides, and low serum high-density lipoprotein (HDL).
OTHER NAMES
Cardiac metabolic syndrome
Syndrome x
Insulin resistance syndrome
Reavens syndrome
CHAOS
Beer belly syndrome

INCIDENCE
Approximately 20–25 percent of the world’s adult population has the cluster of risk factors
that is metabolic syndrome. In 2000, approximately 32% of U.S. adults had the metabolic
syndrome. In more recent years that figure has climbed to 34%.
CAUSES
The exact mechanisms of the complex pathways of metabolic syndrome are under
investigation. The pathophysiology is very complex and has been only partially elucidated.
Most patients are older, obese, sedentary, and have a degree of insulin resistance. Stress can
also be a contributing factor. The most important risk factors are diet (particularly sugar-
sweetened beverage consumption), genetics, aging, sedentary behavior or low physical
activity, disrupted chronobiology/sleep, mood disorders/psychotropic medication use, and
excessive alcohol use.
 Stress
Recent research indicates prolonged chronic stress can contribute to metabolic
syndrome by disrupting the hormonal balance of the hypothalamic-pituitary-adrenal
axis (HPA-axis). A dysfunctional HPA-axis causes high cortisol levels to circulate,
which results in raising glucose and insulin levels, which in turn cause insulin-
mediated effects on adipose tissue, ultimately promoting visceral adiposity, insulin
resistance, dyslipidemia and hypertension, with direct effects on the bone, causing
"low turnover" osteoporosis. HPA-axis dysfunction may explain the reported risk
indication of abdominal obesity to cardiovascular disease (CVD), type 2 diabetes
and stroke. Psychosocial stress is also linked to heart disease.

 Overweight-Central obesity
Central obesity is a key feature of the syndrome, being both a sign and a cause, in that
the increasing adiposity often reflected in high waist circumference may both result
from and contribute to insulin resistance. However, despite the importance of obesity,
patients who are of normal weight may also be insulin-resistant and have the
syndrome.

 Sedentary lifestyle
Physical inactivity is a predictor of CVD events and related mortality. Many
components of metabolic syndrome are associated with a sedentary lifestyle,
including increased adipose tissue (predominantly central); reduced HDL cholesterol;
and a trend toward increased triglycerides, blood pressure, and glucose in the
genetically susceptible. compared with individuals who watched
television or videos or used their computers for less than one hour daily, those who
carried out these behaviors for greater than four hours daily have a twofold
increased risk of metabolic syndrome.
 Aging
Metabolic syndrome affects 60% of the population older than age 50. With respect to
that demographic, the percentage of women having the syndrome is higher than that
of men. The age dependency of the syndrome's prevalence is seen in most populations
around the world.

 Diabetes mellitus type 2

The metabolic syndrome quintuples the risk of type 2 diabetes mellitus. Type 2
diabetes is considered a complication of metabolic syndrome. In people with impaired
glucose tolerance or impaired fasting glucose, presence of metabolic syndrome
doubles the risk of developing type 2 diabetes. It is likely that prediabetes and
metabolic syndrome denote the same disorder, defining it by the different sets of
biological markers.

The presence of metabolic syndrome is associated with a higher prevalence of CVD

than found in patients with type 2 diabetes syndrome. Hypoadiponectinemia (low
adiponectin –a protein hormone produced by adipose tissue involved in regulation of
glucose and breakdown of fatty acid,caused by genetic factors) has been shown to
increase insulin resistance, and is considered to be a risk factor for developing
metabolic syndrome.
Insulin resistance
Insulin resistance in which the cells are fail to response to normal quality of insulin
and there will be increase in sugar level outside the normal range and cause adverse
health effect

 Coronary heart disease

The approximate prevalence of the metabolic syndrome in patients with coronary
artery disease (CAD) is 50%, with a prevalence of 37% in patients with premature
coronary artery disease (age 45), particularly in women. With appropriate cardiac
rehabilitation and changes in lifestyle (e.g., nutrition, physical
activity, weight reduction, and, in some cases, drugs), the prevalence of the syndrome
can be reduced.

 Lipodystrophy (abnormal distribution of fat)

Lipodystrophic disorders in general are associated with metabolic syndrome. Both
genetic (e.g., Berardinelli-Seip congenital lipodystrophy, Dunnigan familial partial
 lipodystrophy) and acquired (e.g., HIV-related lipodystrophy in patients treated with
highly active antiretroviral therapy) forms of lipodystrophy may give rise to
severe insulin resistance and many of metabolic syndrome's components.

 Schizophrenia and psychiatric illness

In psychiatric patients sedentary life style is the main reason for metabolic
syndrome. In addition poor dietary habits, possible limited access to care and
antipsychotic drugs induced adverse affect also may results in metabolic syndrome

 Rheumatic disease
Psoriasis and psoriatic disease also contribute metabolic syndrome
Schizophrenia and other psychiatric disorders
Sedentary life style, poor dietary habits, limited access to health care activities and
psychotic drugs may results in metabolic syndrome
 Race.
In the United States, Mexican-Americans appear to be at the greatest risk of
developing metabolic syndrome.

 Other diseases.
Non alcoholic fatty liver disease or polycystic ovarian disease

PATHOPHYSIOLOGY
CLINICAL MANIFESTATIONS

Central obesity-it is a condition in which excessive abdominal fat around

the stomach and abdomen. This body shape is also known as apple shaped
opposite to pear shaped in which fat is deposited on hips and buttocks
DIAGNOSIS
History and physical examination
Enquire about the features of increased blood sugar like polyuria, polyphagia
and polydipsia
Social habits like smoking which also may precipiatate cardiovascular disease
Previous history of cardiovascular diseases eg. Hypertension
Family history also very important because genetics play an important role
Measurement of central obesity
Take height and weight of the patient and then assess the waist circumference
The INDEX F CENTRAL OBESITY IS
The ratio of weight circumference and height
In Indians for males 90cm is considered as normal and for female it is 80cm

According to the American Heart Association and the National Heart, Lung,
and Blood Institute, there are five risk factors that make up metabolic syndrome.

For men: 40 inches or larger

Large Waist Size For women: 35 inches or larger

Either
Cholesterol: High Triglycerides 150 mg/dL or higher
or
Using a cholesterol medicine

Either
Cholesterol: Low Good Cholesterol (HDL) For men: Less than 40 mg/dL
For women: Less than 50 mg/dL
or
Using a cholesterol medicine

High Blood Pressure Either

Having blood pressure of 130/85mm Hg or
greater
or
Using a high blood pressure medicine

Blood Sugar: High Fasting Glucose Level 100 mg/dL or higher

To be diagnosed with metabolic syndrome, you would have at least three of these risk
factors.
Other tests include
HbA1C- it provides information regarding three months average plasma glucose concentraion

Uric acid- in metabolic syndrome due to insulin resistance body is not able to use the
reserved source of glucose that results in excessive protein breakdown and elevated uric acid
level
Liver function test- liver function test shows abnormality due to fatty liver
Thyroid function test- it is determine the precipitating factor that contribute to metabolic
syndrome
Ultrasonography-helps to identify fatty liver
ECG –to diagnose cardiovascular disoreders, that also seen in metabolic syndrome
SPECT- To identify the complication ie cancer
Polysomonography-to detect sleep apnoea, afeature of metabolic syndrome
COMPLICATIONS
Cardiovascular-atrial fibrillation, heart failure and aortic stenosis
Stoke
Obstructive sleep apnoea
Cance
Psoriasis
Decreased neurocognitive performance
Psychological problems like anger, depression and hostility
MANAGEMENT OF METABOLIC SYNDROME

ABCDE is the approach for metabolic syndrome

MANAGEMENT
Medications
Generally, the individual disorders that compose the metabolic syndrome are treated
separately. Diuretics and ACE inhibitors may be used to treat hypertension. Various
cholesterol drugs may be used if LDL cholesterol, triglycerides, and/or HDL cholesterol is
abnormal.
To lower LDL
1. HMCG-COA reductase and a ctalyzers that that act by different mechanism, either it
will reduce cholesterol by catalysing the step in cholesterol formation or reduce the
synthesis of cholesterol it self and increase the HDL level
HMCG-COA reductase-atorvastatin
HMCG-COA catalyzers-rosuvastatin
Fibric acid derivatives
Lower triglyceride approximately 40% and increase HDL up to 20% eg. Triglide
To manage hypertension
Diuretics-it can be loop, potassium sparing or thiazide diuretics, it can be alone or in
combination. It will excrete the water retain in the boady thus reduce hypertension
Loopdiuretics-furozemide
Potassium sparing diuretic-amloride
Thiazide diuretics-hydrochlorothiazide
ACE inhibitors-angiotensin converting enzyme inhibitors-prevents the conversion of
angiotensin1-angiotensin11, which is a potent vasoconstrictor eg.captopril
Betablockers –which will block the beta receptors thus promote vasodilation-eg.
Metoprolol
Beta blockers, alpha agonist-these drugs has vasodilator activity and are alpha 2
agonist which stimulate alpha 2 receptors and reduce sympathetic activity
egmethyldopa
Aldosterone agonist-compete with aldosterone receptors and thus reduce the activity
of aldosterone which has a role in sodium and water retentioneg. inspra
Alpha agonist –stimulate alpha 2 receptors and reduce sympathetic stimulation
Calcium channel blockers-prevents the influx of calciumeg.verapamil
Others-reserpine- peripherally acting , used for mild hypertension and as a adjuant
therapy
Diadetes mellitus
 Insulin resistance
Lipase inhibitors inhibit nutrient absorption results in weight loss and absorption of ADEK
Insulin sensitizing drug
Thiazolidinedione-increase the sensitivity to insulin and thus enhance uptake of glucose by
ske;letal muscle and fat adipose tissue
Immunosuppresants
Glucocorticoids-used for the treatment of immune insulin resistance due to auto insulin
antibody. Eg. Prednisolone
Insulin-large dose is needed to overcome insulin resistance

Diet
Dietary carbohydrate restriction reduces blood glucose levels, contributes to weight loss, and
reduces the use of several medications that may be prescribed for metabolic syndrome.
Preferred diet involves low fat , variety of fruits and vegetables and whole grain products
Eat a nutritious diet that could control blood glucose level
Food that should be avoided
Refined sugars
Products of white flour
Potatoes
Poly saturated and trans fat, alcohol , sodium and processed food
Foods should be included
Greens
Vegetables
Moderate amount of fat
Whole grain
Fat free diary products
Lean protiens
Dietary principals
Never skip meal
Eat breakfast within one hour of getting up and then eat something every 3 hr to keep your
metabolism going nd stomach full
If you stop eating , your metabolism shut down, decreasing energy requirments and cause
long term weight gain. Try stop eating 2hr bfore bed time
Avoid fruit juices, which are rich in calorie
Eat CHO when you are active ie morning and during day
Excercis
Daily exercise is helpful keep the body weight in normal limits and avoids insulin resistance

Surgical management
Bariatric surgery (weight loss surgery) includes a variety of procedures performed on people
who have obesity. Weight loss is achieved by reducing the size of the stomach with a gastric
band or through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic
diversion with duodenal switch) or by resecting and re-routing the small intestine to a small
stomach pouch (gastric bypass surgery).

1. Adjustable gastric band

The restriction of the stomach also can be created using a silicone band, which can be
adjusted by addition or removal of saline through a port placed just under the skin. This
operation can be performed laparoscopically, and is commonly referred to as a "lap band".
Weight loss is predominantly due to the restriction of nutrient intake that is created by the
small gastric pouch and the narrow outlet. It is considered one of the safest procedures
performed today

2. Sleeve gastrectomy

Sleeve gastrectomy, or gastric sleeve, is a surgical weight-loss procedure in which

the stomach is reduced to about 15% of its original size, by surgical removal of a large
portion of the stomach, following the major curve. The open edges are then attached together
(typically with surgical staples, sutures, or both) to leave the stomach shaped more like a
tube, or a sleeve, with a banana shape. The procedure permanently reduces the size of the
stomach. The procedure is performed laparoscopically and is not reversible

3. Gastric bypass surgery

A common form of gastric bypass surgery is the Roux-en-Y gastric bypass, designed to
reduce the amount of food a person is able to eat by cutting away a part of the stomach.
Gastric bypass is a permanent procedure that helps patients by changing how the stomach and
small intestine handle the food that is eaten to achieve and maintain weight loss goals After
the surgery, the stomach will be smaller. A patient will feel full with less food.
 4. Sleeve gastrectomy with duodenal switch

A variation of the biliopancreatic diversion includes a duodenal switch. The part of

the stomach along its greater curve is resected. The stomach is "tubulized" with a residual
volume of about 150 ml. This volume reduction provides the food intake restriction
component of this operation. This type of gastric resection is anatomically and functionally
irreversible. The stomach is then disconnected from the duodenum and connected to the distal
part of the small intestine. The duodenum and the upper part of the small intestine are
reattached to the rest at about 75–100 cm from the colon.

LIFESTYLE AND HOME REMEDIES

A lifelong commitment to a healthy lifestyle is usually required to prevent serious health
problems, such as diabetes and heart disease. This includes:
  Being physically active. Doctors recommend getting 30 or more minutes of moderate-
intensity exercise, such as brisk walking, daily. Look for ways to increase activity, such
as walking instead of driving and using stairs instead of elevators when possible.
 Losing weight. Weight loss and maintaining a healthy weight can reduce insulin
resistance and blood pressure and decrease your risk of diabetes.
 Eating healthfully. The Dietary Approaches to Stop Hypertension (DASH) diet and the
Mediterranean diet, like many healthy-eating plans, limit unhealthy fats and emphasize
fruits, vegetables, fish and whole grains. Both dietary approaches have been found to
offer important health benefits — in addition to weight loss — for people who have
components of metabolic syndrome.
 Stopping smoking. Smoking cigarettes worsens the health consequences of metabolic
syndrome. Talk to your doctor if you need help quitting.
 Managing stress. Physical activity, meditation, yoga and other programs can help you
handle stress and improve your emotional and physical health.

PATIENT TEACHING
 Routinely monitor body weight (especially central obesity).
 Monitor blood glucose, lipoproteins and blood pressure.
 Treat individual risk factors (hyperlipidemia, high blood pressure and high blood
glucose) according to established guidelines.
 Carefully choose high blood pressure drugs because different drugs have different
effects on insulin sensitivity.

COMPLICATIONS
Having metabolic syndrome can increase your risk of developing:
 Diabetes. If you don't make lifestyle changes to control your excess weight,
which can lead to insulin resistance, your glucose levels will continue to
increase. You then might develop diabetes.
 Cardiovascular disease. High cholesterol and high blood pressure can
contribute to the buildup of plaques in your arteries. These plaques can narrow
and harden your arteries, which can lead to a heart attack or stroke
EVIDENCE BASED PRACTICE
1. Impact of non-apnea sleep disorders on diabetic control
and metabolic outcome - A population-based cohort study.
Hung YC1, Lin YC2, Hsieh HM3, Huang CJ4, Chiu HC5.

There has been a growing recognition that obstructive sleep apnea (OSA) could increase the
propensity for type 2 diabetes the metabolic syndrome

2. Risk factors and metabolic abnormality of patients with non-alcoholic

fatty liver disease: Either non-obese or obese Chinese population.
Lee SW1, Lee TY2, Yang SS2, Tung CF2, Yeh HZ2, Chang CS2

Non-obese NAFLD subjects displayed a higher proportion of metabolic abnormality

NURSING MANAGEMENT OF PATIENT WITH METABOLIC

SYNDROME
NURSING DIAGNOSIS
Deficient knowledge regarding the disease process and prevention as evidenced by patient
statement
GOAL
Patient will get adequate knowledge regarding the disease process and prevention
INTERVENTION
 Assess the knowledge level of the patient to obtain the baseline data
 Explain the criteria’s that defining metabolic syndrome for better understanding
 Warn about individual risk factors like hypertension, high blood pressure and
hyperlipidaemia to take preventive measures
 Advise to check weight daily because trucal obesity indicating metabolic syndrome
 Prepare a diet plan that include don’t’s and do’s that helps to guide the patient in
choosing food

NURSING DIAGNOSIS
Risk for unstable blood glucose level due to insulin resistance
GOAL
Patient will remain free from risk of unstable blood sugar level
INTERVENTION
 Collect the diabetic details from the patient to obtain baseline data
  Ask the patient to follow a strict diabetic diet that helps to maintain the blood sugar
level
 Advise the need to adhere to strict insulin therapy to control the sugar leve
 Educate the need of daily exercise that helps burn out the excess sugar
 Advise to check blood sugar level frequently, helps to modify the treatment according
to sugar level

NURSING DIAGNOSIS
Imbalanced nutrition more than body related to abnormal fat deposition as evidenced by
truncal obesity
GOAL
Patient will maintain normal nutritional status
INTERVENTION
 Assess the BMI of the patient to obtain baseline data
 Advise the patient to plan and follow a diet that low in calories, helps to reduce
weight
 Teach the patient the need of being active to to burn out excess fat
 Provide information regarding surgical management available to manage obesity that
help them to make choices

NURSING DIAGNOSIS
Risk for impaired cardiac tissue perfusion
GOAL
Patient will remain free from risk of impaired cardiac tissue perfusion
INTERVENTION
 Plan an extensive teaching schedule regarding cardiac risk of metabolic syndrome for
better understanding
 Educate the diet plan especially DASH diet that prevents atherosclerotic changes
 Advise to exercise regularly to reduce weight by burning up of fat
 Advise to seek medical help whenever there is cardiac symptoms to prevent
complications

CONCLUSION
Metabolic syndrome is not a disease in itself. Instead, it's a group of risk factors -- high blood
pressure, high blood sugar, unhealthy cholesterol levels, and abdominal fat. Obviously, having
any one of these risk factors isn't good. But when they're combined, they set the stage for serious
problems. These risk factors double your risk of blood vessel and heart disease, which can lead
to heart attacks and strokes. They increase your risk of diabetes by five times. The good news is
that metabolic syndrome can be controlled, largely with changes to your lifestyle.

BIBILIOGRAPHY
 en.wikipedia.org/wiki/Metabolic_syndrome
 www.heart.org/en/health-topics/metabolic-syndrome
 www.webmd.com/
 draxe.com/metabolic-syndromeheart/metabolic-syndrome/metabolic

 www.medicinenet.com/metabolic_syndrome/article.htm