10 Metabolic Syndrome Symptoms
Metabolic syndrome is a condition caused by excessive and abnormal adipose (fat) deposition along with insulin resistance. It is a major risk factor for various conditions such as diabetes, coronary heart disease, and cancers.
Based on the guidelines from the American Heart Association (AHA) and National Heart, Lung, and Blood Institute (NHLBI), metabolic syndrome occurs when a patient meets 3 of the following 5 conditions: triglycerides 150 mg/dL (or on medication for hypertriglyceridemia); fasting blood glucose 100 mg/dL (or on medication for hyperglycemia); HDL-C < 40 mg/dL in men or < 50 mg/dL in women (or on medication for low levels of HDL-C); blood pressure 130/85 mmHg (or on medication for high blood pressure); and waist circumference 102 cm or 40 inches for men and 88 cm or 35 inches for women (in Asian Americans, these numbers decrease to 90 cm or 35 inches for men and 80cm or 32 inches in women.)
Management of metabolic syndrome includes lifestyle changes and weight loss. Studies have compared similar populations that are exposed to different diets and found that Westernized diets are associated with a higher likelihood of developing metabolic syndrome. Data from studies have suggested that those with metabolic syndrome have an increased risk of fatty liver disease, cancer, and stroke. Some additional studies that may be helpful include electrocardiography, ultrasonography, cardiac positron emission tomography (PET), and stress single-photon emission computed tomography (SPECT).
Symptom #1: Central Obesity
Central obesity refers to abdominal obesity. This means that there is excessive abdominal fat around the abdominal area to the extent where it has a negative impact on health. Central obesity has been associated with Alzheimer’s disease, cardiovascular disease, and diabetes. Visceral fat is located in the peritoneal cavity.
Central obesity is often associated with dyslipidemia and glucose intolerance. Some studies have suggested that excessive visceral adiposity (adipose tissue of the organs) is linked to decreased insulin sensitivity and dysregulation of lipids. Furthermore, fat located around the abdomen can produce excessive levels of molecules called cytokines, contributing to a generalized inflammatory state in the body.
Symptom #2: Hypertension
Arterial hypertension or high blood pressure occurs when the blood pressure in the arteries is constantly higher than normal. Even though a blood pressure of 130/85 is in the range of “prehypertension,” it’s enough to contribute to the diagnosis of metabolic syndrome. Hypertension is a major risk factor for stroke, atrial fibrillation, coronary artery disease, peripheral arterial disease, loss of vision, dementia, and chronic kidney disease.
Hypertension is often seen among those with a family history of hypertension and lifestyle choices such as smokers, use of birth control pills, excessive consumption of salt, alcohol consumption, and excess body weight.
Symptom #3: Hyperglycemia
Hyperglycemia is the situation where there is excessive glucose circulating in the bloodstream. It can be defined as having a blood sugar level of more than 100mg/dl. Metabolic syndrome is associated to insulin resistance resulting in hyperglycemia. Insulin resistance means that the cells of your tissues (i.e. muscles, fat, liver) can’t respond properly to insulin and are unable to use glucose from the blood for energy. As a response, the pancreas secretes more insulin, however, glucose levels continue to increase in the blood.
Some symptoms that patients may experience with hyperglycemia include polyuria (excessive urination volume), polyphagia (increased appetite), blurry vision, restlessness, fatigue, loss of weight, and poor wound healing.
Symptom #4: Hypertriglyceridemia
Hypertriglyceridemia refers to excessive amounts of triglyceride. These transport fatty acids through the blood after they are absorbed from food. Chronic high triglyceride levels can result in atherosclerosis, despite having normal cholesterol levels. Atherosclerosis refers to the build-up (plaques) of cholesterol, fats and other substances in the walls of blood vessels. These plaques may cause obstruction of blood flow or rupture, causing the acute occlusion of a vessel. Thus, hypertriglyceridemia is considered to be a major risk factor for cardiovascular disease. It also increases the risk of pancreatitis.
Hypertriglyceridemia may manifest with lesions such as xanthomas and xanthelasmas. These are usually present in severe dyslipidemia. A xanthoma is a deposition of yellowish cholesterol-rich material located anywhere on the body. Xanthelasmas are a subtype of xanthomas. They are depositions of cholesterol that appears to be yellowish under the skin, usually located around the eyelids. Patients who have hypertension, hyperglycemia, and hypertriglyceridemia should be evaluated for metabolic syndrome.
Symptom #5: Chest Pain
Patients with metabolic syndrome are at increased risk for coronary heart disease and heart attacks (myocardial infarction). As described above, this condition is associated with the formation of plaques (atherosclerosis) in arteries that supply blood to the heart (coronary arteries). These can partially or completely decrease the amount of blood and oxygen that reaches the heart, causing chest pain (angina) or a heart attack. Angina is a symptom of coronary artery disease and an important cause of chest pain. The sensation may be sudden or recur over time. It can be described as dull, heavy, squeezing, or sharp. Some associated symptoms may include radiation of pain to the jaw, nausea, upper abdomen, arm, and shoulder. Patients may also experience cold sweats, shortness of breath, and dizziness.
Sudden and severe chest pain is almost always considered a medical emergency as it has potentially life-threatening causes. However, chest pain can be divided into cardiac or non-cardiac causes. Patients with metabolic syndrome may experience chest pain due to their higher risk of cardiovascular disease.
Symptom #6: Shortness of Breath
Dyspnea refers to shortness of breath or difficult breathing. It has been defined as a subjective experience where the affected individual experiences chest tightness, increased effort needed to breathe, and the feeling of not having enough air. It can be physiological during exercise or exertion but becomes pathological when it occurs due to underlying disease such as pneumonia, asthma, interstitial lung disease, heart failure, cardiac ischemia, and chronic obstructive pulmonary disease.
Patients with metabolic syndrome may experience shortness of breath. In many cases it can be a consequence of cardiovascular disease (i.e. acute coronary syndrome).
Symptom #7: Peripheral Neuropathy
Peripheral neuropathy occurs when the peripheral nerves are affected. Peripheral nerves refer to the nerves beyond the spinal cord and brain. When the peripheral nerves are affected, it can impair organ function, movement, gland function, and sensation. Some issues they may face are tremors, numbness, impairment of balance, weakness, tiredness, cramps, and abnormalities in gait. This depends on whether the neuropathy affects the sensory, motor, or autonomic nerves.
Some causes of peripheral neuropathy include vitamin deficiency, side effect of medications, diabetes, leprosy, injury, ischemia, immune system disease, and radiation therapy. Since high levels of glucose in the blood can cause peripheral neuropathy, it is a common symptom among patients with metabolic syndrome as they often have insulin resistance.
Symptom #8: Retinopathy
Retinopathy is a term describing damage to the retina in the eyes. Retinopathy can result in visual impairment and is often due to abnormal blood flow or retinal vascular disease. Retinopathy can be divided into proliferative and non-proliferative retinopathy.
Since individuals with metabolic syndrome have high blood pressure and high blood glucose levels, retinopathy is a common issue as the pressure and high glucose levels cause damage to the blood vessels in the eyes. Patients with metabolic syndrome may benefit from an annual eye examination to prevent retinopathy.
Symptom #9: Hirsutism
Hirsutism refers to the growth of hair (usually dark and coarse) in women following a male-like pattern, in areas where normally fine hair grows or no hair at all. These areas include above the lip and on the chin, abdomen, chest, and back. This abnormal hair growth is usually cause by an underlying endocrine imbalance, such as an increase in male hormone levels (androgens). Hirsutism is a symptom that can result in social difficulty and psychological distress. Previous records have shown that facial hirsutism has led to anxiety, depression, and avoidance of social situations.
Studies have found that there is an association between hirsutism and metabolic syndrome. It has been reported that the most common cause of hirsutism, polycystic ovary syndrome (PCOS), is associated to metabolic syndrome. However, hirsutism is often observed in patients with metabolic syndrome alone. This relationship is complex and not completely understood. Several studies have found that patients with metabolic syndrome and hirsutism had higher triglyceride levels and waist circumferences compared to those in control groups.
Symptom #10: Acanthosis Nigricans
Acanthosis nigricans is a term used to describe hyperpigmentation of the skin. The affected region of the skin is often brown to black in appearance with poorly defined margins and feels velvety. It usually occurs in skin folds such as the axilla, navel, groin, and neck. Acanthosis nigricans can be familial-related, malignancy-related, drug-related, obesity-related, or endocrine-related.
In metabolic syndrome patients, acanthosis nigricans can be attributed to insulin resistance that is often a part of metabolic syndrome. The higher insulin levels cause hyperpigmentation of the skin. While the hyperpigmentation can be lightened after treatment of the underlying condition, it may take months to years.
