Dysmetabolic Syndrome

1
Dysmetabolic Syndrome

• Jim Mold, M.D., M.P.H.
• Department of Family and Preventive Medicine
• OUHSC OKC

2
NCEP (ATP III) Criteria (Adults)

• Waist circumference
• gt40 inches for men
• gt35 inches for women
• Triglycerides
• gt150 mg/dl
• HDL cholesterol (Any 3
  or more)
• lt40 mg/dl for men
• lt50 mg/dl for women
• Blood pressure
• gt130/85
• Fasting blood glucose
• gt110 mg/dl

3
WHO Criteria for Abdominal Obesity

• Waist to hip ratio gt0.9
• BMI gt 30 kg/m2
• Waist circumference gt 37 inches

4
Criteria (Children)

• Same principles but norms for waist circumference
  not yet established
• BMI curves are available
• http//www.cdc.gov/nchs/about/major/nhanes/growt
  hcharts/clinical_charts.htmClin201
• BP must also be age-adjusted

5
Prevalence

• 20 30 of adults in industrialized countries
  like the U.S.
• 5 of normal weight adults
• 22 of overweight adults (BMI 25-30)
• 60 of obese adults
• 16 of black men
• 37 of Hispanic women

6
Features

• Increased inflammatory markers (e.g. CRP,
  fibrinogen)
• Increased coagulation (e.g. platelet aggregation,
  inc. d-dimer, fibrinopeptide A)
• Oxidative stress (oxidized LDL-C, lipid
  peroxides)
• Endothelial dysfunction

7
Significance

• Twice the rate of CAD events
• Three times the rate of CV mortality
• Twice rate of CHF after MI
• Increased risk of fatty liver and NASH
• Increased risk of sleep apnea
• Increased risk of polycystic ovary syndrome
• Increased risk of dementia at earlier age
• 9 10 X risk of developing diabetes mellitus

8
Treatment

• Exercise both aerobic and strengthening
• Skeletal muscle is the most insulin sensitive
  tissue in the body
• More and greater use of muscle reduces insulin
  resistance
• Diet
• Weight loss
• Fruits, veggies, whole grains, monounsaturated
  fats (Medierranian diet)

9
Treatment

• Drugs
• Metformin
• Aspirin, Plavix
• Statins, niacin, fibrates
• ACEI
• Thiazolidinediones
• Alpha glucosidase inhibitors

10
Audit Results

• 30 different OKPRN practices
• 19 private practices
• 2 Native American clinics
• 1 Community Health Center
• 8 Residency Program clinics
• 40 charts per practice (total N1200)
• Randomly selected from among all patients over
• 6 years old seen during the week of April 4 8,
  2005

11
Demographics (Adults)

• Age N
• 19-40 246 23
• 41-64 480 45
• 65 342 32
• Gender
• Female 639 60
• Male 429 40
• Race (when recorded)
• White 454/622 58

12
Demographics (Children)

• Age N
• 6-18 131 100
• Gender
• Female 67 51
• Male 64 49
• Race (when recorded)
• White 44/68 52

13
Central Obesity (Documentation)

• Measure Adults Children
• Weight 96 (24-100) 96 (50-100)
• Height 74 (3-100) 83 (17-100)
• Waist Circ 1 (0-15) 0 (0-0)
• BMI
• At index visit
• Within 2 yrs
• Within 6 months

14
Lipids, BP, FBS, Smoking

• Measure Adults Children
• Lipid Panel 58 (14-91) 4 (90-25)
• BP 96 (88-100) 70 (0-100)
  
• FBS 69 (29-95) 11 (0-50)
• ______________________________________
• Smoking 82 (42-100) 91 (0-100)
• Within 2 years
• At index visit
• Within 2 years
• Ever

15
Patients Meeting Individual Criteria

• Measure Adults Children
• BMI 29 10
  (gt30)
• TG 45
  40
• HDL 44 25
• BP 49
  9 (gt130/80)
• FBS 30 0

16
Patients With gt3 Criteria

• Measure Adults Children
• Documented 58 4
• Abnormal 25 0

17
Proportion Treated

• Abnormality Adults
  Children
• Obesity
• Diet 28
  18
• Exercise 24
  18
• Lipids 54
  0
• BP 46
  38
• FBS 55
  0
• ______________________________________
• Smoking 27
  0