Metabolic Syndrome Severity Score
What is metabolic syndrome? Metabolic syndrome is a term used to describe a combination of increased abdominal obesity, increased blood pressure, increased blood sugar, increased blood triglyceride levels, and decreased circulating HDL (“good”) cholesterol.
The metabolic syndrome is diagnosed when a person has three or more of the following five factors.1
What Causes Metabolic Syndrome?
Metabolic syndrome occurs in response to a process known as insulin resistance. To understand insulin resistance let’s start by looking at how things are designed to work.
Normally, insulin from your pancreas works in liver cells, muscle cells and fat cells to regulate glucose and energy metabolism.
How insulin works in liver cells, muscle cells, and fat cells
How common is metabolic syndrome?
Approximately 34% of the U.S. population has metabolic syndrome, and about 85% of individuals with type 2 diabetes have metabolic syndrome.2
Metabolic syndrome is present in approximately 9% of people with normal body weight, 22% of those who are overweight and 60% of those considered obese.3 Adults who continue to gain five or more pounds per year raise their risk of developing metabolic syndrome by up to 45%.4
The prevalence of metabolic syndrome increases with age, and about 50% of people over 60 are affected.5
In the U.S., Hispanic Americans have the highest prevalence of metabolic syndrome.2
## Metabolic syndrome risk for heart attack, stroke, and type 2 diabetes
Heart attack and stroke risk increases with the number of metabolic syndrome factors present. Compared to those with no metabolic syndrome factors, heart attack and stroke are increased 4-fold for men and 6-fold for women who have 3 or more factors.6
Likewise, diabetes risk increases with the number of metabolic syndrome factors present. Compared to those with no metabolic syndrome factors, risk of developing diabetes is 24-fold higher for men and 30-fold higher for women who have 3 or more factors.6
## Do individuals with the same number of metabolic syndrome factors have the same risk?
Actually, NO.
Counting the number of factors is not the same as knowing the actual measured value for a factor. For example, let’s compare a person with fasting blood sugar of 100 and someone with a fasting blood sugar of 200. Both people meet criteria for having a metabolic syndrome factor (fasting blood sugar > 100). However, the higher the measured value, the greater the individual risk.
The Metabolic Syndrome Severity Score overcomes this problem.
Metabolic Syndrome Severity Score
The Metabolic Syndrome Severity Score is a gender and ethnicity weighted combination of individual metabolic syndrome factors that ranges from 1% (least severe) to 100% (most severe).
Data from multiple landmark studies, including the Atherosclerosis Risk in Communities Study7,8, Jackson Heart Study7, and the National Diabetes Prevention Program (DPP)9, show a significant relationship between higher Metabolic Syndrome Severity Scores and risk for heart attack, stroke, and diabetes
Additionally, lifestyle interventions that improved metabolic syndrome severity were significantly predictive of decreased risk and may help in tracking earlier responses to treatment and in motivating patients.9
This is consistent with studies that show diet and exercise interventions which result in decreasing weight, decreasing central adiposity, and improving insulin resistance translate into decreased risk for cardiovascular events and decreased development of diabetes.10,11
Diabetes Prevention Program (DPP) and ongoing DPP Outcomes Study (DPPOS)
What to Remember
Metabolic Syndrome is a precursor to risk for developing type 2 diabetes and cardiovascular disease.
Metabolic syndrome is typically measured with 5 categorical factors, but those are insensitive to magnitude.
The Metabolic Syndrome Severity Score is a significantly more granular representation of individual risk for metabolic syndrome.
Want to know your Metabolic Syndrome Severity Score along with the rest of your risk for developing diabetes, heart attack, or stroke? Order your own Cardiometabolic Risk Assessment today!
References
Kassi E, Pervanidou P, Kaltsas G, Chrousos G. Metabolic syndrome: definitions and controversies. BMC Med 2011;9:48-.
Moore JX, Chaudhary N, Akinyemiju T. Metabolic Syndrome Prevalence by Race/Ethnicity and Sex in the United States, National Health and Nutrition Examination Survey, 1988-2012. Prev Chronic Dis 2017;14:E24-E.
Lau DCW, Yan H, Dhillon B. Metabolic syndrome: a marker of patients at high cardiovascular risk. Can J Cardiol 2006;22 Suppl B:85B-90B.
Marc J. Genetic Succeptibility to Metabolic Syndrome. EJIFCC 2007;18:7-14.
Aguilar M, Bhuket T, Torres S, Liu B, Wong RJ. Prevalence of the Metabolic Syndrome in the United States, 2003-2012. JAMA 2015;313:1973-4.
Wilson PWF, D’Agostino RB, Parise H, Sullivan L, Meigs JB. Metabolic Syndrome as a Precursor of Cardiovascular Disease and Type 2 Diabetes Mellitus. Circulation 2005;112:3066-72.
Gurka MJ, Golden SH, Musani SK, et al. Independent associations between a metabolic syndrome severity score and future diabetes by sex and race: the Atherosclerosis Risk In Communities Study and Jackson Heart Study. Diabetologia 2017;60:1261-70.
Gurka MJ, Guo Y, Filipp SL, DeBoer MD. Metabolic syndrome severity is significantly associated with future coronary heart disease in Type 2 diabetes. Cardiovasc Diabetol 2018;17:17.
DeBoer MD, Filipp SL, Gurka MJ. Use of a Metabolic Syndrome Severity Z Score to Track Risk During Treatment of Prediabetes: An Analysis of the Diabetes Prevention Program. Diabetes Care 2018;41:2421-30.
Lanier JB, Bury DC, Richardson SW. Diet and Physical Activity for Cardiovascular Disease Prevention. Am Fam Physician 2016;93:919-24.
Kitabchi AE, Temprosa M, Knowler WC, et al. Role of insulin secretion and sensitivity in the evolution of type 2 diabetes in the diabetes prevention program: effects of lifestyle intervention and metformin. Diabetes 2005;54:2404-14.