Talk:Metabolic syndrome

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I am very much inclined to move this article to metabolic syndrome, which seems to be accepted nomenclature (see J Clin Endocrinol Metab of June 2004). Any views or comments?? JFW | T@lk 10:47, 8 Jun 2004 (UTC)

Agree. Current nomenclature is metabolic syndrome. Maintain redirect, of course. Kd4ttc 02:37, 9 Jun 2004 (UTC)

note that on your section with regards to diagnostic criteria - you include six criteria , not five. i wasn't aware that an elevated CRP was one of the criteria. alex tan. 62.6.139.10 (talk · contribs)

You are completely right. I have no idea who inserted that. Thanks. JFW | T@lk 12:51, 31 October 2005 (UTC)

I agree with your observation on this .I also beleive that given the fact the patient with metabolic syndrome have high incidence of cardiovascular disease.It would be even prudent to call it cardiometabolic syndrome as some of the recent leading researched in this field having been doing.

I have not heard the term "cardiometabolic syndrome". It may not be notable enough to be mentioned in the article. JFW | T@lk 20:34, 14 February 2006 (UTC)

Heh. It was coined by Sanofi-Aventis to push rimonabant. I hear it in active use all the time now :-). JFW | T@lk 12:47, 12 May 2008 (UTC)

War is over

Apparently the AHA and ADA differed in how the metabolic syndrome should be addressed. They have now agreed on some things. Do we include this?[1]. JFW | T@lk 10:42, 21 August 2006 (UTC)

don't think the war is completely over - at the 2006 ADA conference, alberti and kahn were presenting arguments for the different diagnostic criteria for the syndrome (WHO/IDF vs ADA/EASD). there were also comments about whether it was necessary at all to have the metabolic syndrome label... identify CVS risk factors individually and treat accordingly.

Dysmetabolic syndrome

I don't understand why it is called "metabolic" syndrome when it really is a dysmetabolic syndrome. Everyone has a metabolic syndrome: well, everyone that's living that is. I know it is overwhelmingly standard to not use the dys- prefix, but are there any sources arguing my point that "metabolic syndrome" is misnamed? Practically every medical term I can think of relies on proper use of suffixes, prefixes, and root words (see List of medical roots) and this seems to go against that. Sloppy terminology, if you will. Cburnett 04:36, 7 December 2006 (UTC)

I don't have much experience at Wikipedia, but it seems to me that an encyclopedia should be DEscriptive, not PREscriptive. That is, Wikipedia should not tell the medical community what terminology SHOULD BE used, but should report using the terminology that IS used.Rocky143 05:17, 4 January 2007 (UTC)

I thought I made it pretty clear; I repeat:

...are there any sources arguing my point that "metabolic syndrome" is misnamed?

I am NOT saying wikipedia should dictate. I am stating that I think it's wrong and I am ASKING if any one knows of any sources regarding it being misnamed. If dysmetabolic syndrome can be sourced then WP is not dictating, it's reporting. Cburnett 05:50, 4 January 2007 (UTC)

mmol/L and mg/dL

Someone who knows how should supply mg/dL figures to supplement the mmol/L figures in this article.Rocky143 05:18, 4 January 2007 (UTC)

Metformin

The article about treatment is misleading, it says that the treatment of insulin resistance by Metformin is not FDA approved, but if you go to the article on Metformin it says that it is FDA approved. So which is it?

--> Metformin is approved for treatment of type 2 diabetes, not metabolic syndrome —Preceding unsigned comment added by 68.45.246.66 (talk) 12:53, 1 September 2007 (UTC)

I changed some stuff.

I removed the symptoms in the first section because they were duplicated in the diagnosis section. I also added the citation for Grundy. Rhetth 00:20, 14 July 2007 (UTC)

Elevated CRP and TNF-alpha

I have read in some sources that indeed these are elevated in metabolic syndrome. Can anyone with greater knowledge confirm this? Russthomas15 07:13, 14 November 2007 (UTC)

hsCRP is a marker not of metabolic syndrome but probably atherosclerotic burden. In a patient with MetS who also has a high CRP (and no evidence of infection or autoimmune disease) there is good reason to be a bit nervous.

TNFα is secreted by monocytes that have populated adipose tissue. It is a marker of obesity, again in patients who have other confounding conditions. It is not measured routinely and probably of limited clinical relevance. Interestingly, patients who receive infliximab (a TNF inhibitor) tend to get better glycaemic control when diabetic, suggesting that TNF does play a role in insulin resistance. JFW | T@lk 12:51, 12 May 2008 (UTC)

Added

This reference was left on the userpage:

Ford ES, Giles WH, Dietz WH: Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 287:356–359, 2002

It looks useful, but it had no content associated with it. JFW | T@lk 21:16, 16 January 2008 (UTC)

I put this reference back in with a link to the PubMed article. Dcwebb (talk) 16:09, 21 May 2008 (UTC)

Ouch

In the Cardiovascular Health Study, diagnosis of metabolic syndrome by either WHO or IDF criteria made little difference in mortality compared to simply diagnosing and treating hypertension and elevated fasting glucose (EFG). Food for thought, and probably part of a trend against the use of metabolic syndrome as a bona fide diagnosis. JFW | T@lk 12:45, 12 May 2008 (UTC)

Arch Intern Med 2008;168:969-978 JFW | T@lk 12:53, 12 May 2008 (UTC)

Simply new terminology?

Isn't this syndrome basically obesity, caused by the usual factors attributed to obesity, such as diet, lack of exercise, etc.? Everyone knows obesity greatly increases one's risks of things like cardiovascular disease and diabetes, the same things mentioned here. I live in Japan and it's commonly said when a person's waist goes beyond a certain number of centimetres, they have metabo (i.e. metabolic syndrome). I always thought this was a bit silly, thinking 'No, they're just getting fat.' Are the two not really one and the same--i.e. the same symptoms and risk factors? Just seems to me like this is a politically correct trend word. 122.102.237.156 (talk) 03:23, 17 May 2009 (UTC)

Diagnosis

There are currently two major definitions for metabolic syndrome provided by the International Diabetes Federation and the revised National Cholesterol Education Program, respectively. The revised NCEP and IDF definitions of metabolic syndrome are very similar and it can be expected that they will identify many of the same individuals as having metabolic syndrome. The two differences are that IDF state if BMI>30 kg/m³ central obesity can be assumed and waist circumference does not need to be measured, however this potenitally excludes any subject without increased waist circumference if BMI<30, while in the NCEP definition metabolic syndrome can be diagnosed based on other criteria and the IDF uses geography-specific cut points for waist circumference, while NCEP uses only one set of cut points for waist circumference regardless of geography. These two definitions are much closer to each other than the original NCEP and WHO definitions.

IDF

2006 :International Diabetes Federation

• Central obesity (defined as waist circumference** with ethnicity specific values)

plus any two of the following four factors following four factors:

• 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 FPG >5.6 mmol/L or 100 mg/dL, OGTT [2]is strongly recommended but is not necessary to define presence of the Syndrome

• • If BMI is >30kg/m², central obesity can be assumed and waist circumference does not need to be measured

Stress

Can we please have a vote on this. I believe that since the actual wiki article on Stress (biology) actually links stress with visceral fat and consequently imbalances in hormonal and metabolic symptoms leading to heart disease. The author Malcolm Kendrick simply states that this is a manifestation of Metabolic syndrome. This is not an unorthodox view.

Quote from Stress (biology)wiki article:

Studies of female monkeys at Wake Forest University (2009) discovered that individuals suffering from higher stress have higher levels of visceral fat in their bodies. This suggests a possible cause-and-effect link between the two, wherein stress promotes the accumulation of visceral fat, which in turn causes hormonal and metabolic changes that contribute to heart disease and other health problems. 122.107.141.196 (talk) 02:21, 9 December 2009 (UTC)

What's wrong with you guys? Will no one debate me? Here are further links connecting stress with Metabolic syndrome: http://stress.about.com/od/stresshealth/a/jobstress.htm http://www.docguide.com/news/content.nsf/news/8525697700573E1885256C7800219682

This one is an actual scientific study. If you don't like Malcolm Kendrick as a reference, then try this one: http://www.bmj.com/cgi/content/abstract/332/7540/521

It states:

Objectives To investigate the association between stress at work and the metabolic syndrome

Conclusions Stress at work is an important risk factor for the metabolic syndrome. The study provides evidence for the biological plausibility of the link between psychosocial stressors from everyday life and heart disease 122.107.141.196 (talk) 17:56, 9 December 2009 (UTC)

A couple of things. First, this is not a vote. Secondly, I will not respond to rants like "What's wrong with you guys?" Thirdly, please have a quick glance at WP:MEDRS, which will provide a backdrop to almost everything I am about to explain.

Malcolm Kendrick is not mainstream. Anyone who writes a book for the popular press called "The Great Cholesterol Con" is not mainstream and clearly is not pretending to be. We cannot therefore treat his work as mainstream, however much you believe that he is mainstream, because his actions speak louder than your words.

If you want to say more about stress and metabolic syndrome, or the hypothalamic-pituitary-adrenal axis and metabolic syndrome, be my guest. But please stick to sources as outlines in MEDRS. Basically, sources need to be from peer-reviewed publications and be so-called "secondary sources" (reviews, meta-analyses etc). Anything less will not do, especially in a heavily researched topic such as metabolic syndrome. JFW | T@lk 20:38, 14 December 2009 (UTC)

Firstly, it seemed that no one wanted to engage me in a discussion so I provoked a response which seems to have now worked. Secondly, I have read Kendrick's book and you have not. The first 3/4 of his book is based on the debunking of the Lipid hypothesis which I knew was not a mainstream view. However, the final 1/4 of his book deals with the idea that stress is the underlying cause of Metabolic syndrome which results in obesity and heart disease. I was subsequently able to find many research papers that backed up this idea. However, I was not aware that on Wiki even though an author may have a verified thesis, if he himself is not a reputable person, then he cannot be used as a source.

In this case then I propose the following: that stress be included in the article with citations from reputable research papers. My proposed edit is as follows:

Stress

Recent research indicates that prolonged stress can be an underlying cause of Metabolic syndrome by upsetting the hormonal balance of the Hypothalamic-pituitary-adrenal axis (HPA-axis).[3] A dysfunctional HPA-axis causes high cortisol levels to circulate which results in raising glucose and insulin levels which cause insulin-mediated effects on adipose tissue, ultimately promoting visceral adiposity, insulin resistance, dyslipidemia and hypertension (metabolic syndrome X) and direct effects on the bone, causing “low turnover” osteoporosis.[4] Cortisol in the presence of relatively high insulin concentrations can promote the deposition of energy and lead to obesity.[5] HPA-axis dysfunction may explain the reported risk indication of abdominal obesity to Cardiovascular disease, type 2 diabetes and stroke.[6] Psychosocial stress is also linked to heart disease.[7][8]122.107.141.196 (talk) 01:24, 15 December 2009 (UTC)

You're quite right that I have not read Kendrick's book, but if the material on stress and metabolic syndrome is verifiable elsewhere, then we'd be better off using those sources. Now if you could put the references in citation templates I can't see why it cannot be included. JFW | T@lk 22:12, 16 December 2009 (UTC)

It was a struggle, but I think it was worth the fight to have Stress added. There seems to be enough evidence that stress is the underlying cause of Metabolic syndrome which results in all the degenerative diseases seen with it. It is a pity that Malcolm Kendrick's book cannot be acknowledged in some way because it truly is a brilliant book. It very well explains how Stress, Metabolic syndrome and heart disease are all tied together. It remains to be seen whether his debunking of the Lipid hypothesis will stand. He does provide a very good case that the cholesterol theory is in error. By adding to this article new important information, it represents the best of what Wiki and an obscure IP editor can achieve (such as myself) with the inspired writings of Dr Kendrick.122.107.141.196 (talk) 08:57, 18 December 2009 (UTC)