Metabolic syndrome

Metabolic syndrome isn't a single condition but a cluster of risk factors that occur together and reinforce each other. According to the internationally harmonised definition (IDF/AHA 2009), it is present when at least three of five criteria are met: increased waist circumference (for Europe, according to the IDF, 94 cm or more in men and 80 cm or more in women), triglycerides of 150 mg/dL or more, low HDL cholesterol (below 40 mg/dL in men, below 50 in women), blood pressure of 130 mmHg or more systolic or 85 mmHg or more diastolic, and fasting blood sugar of 100 mg/dL or more. If you already take medication because of one of these values, that criterion counts as met too.

The common denominator is usually insulin resistance, driven by fat around the abdomen. This visceral fat is hormonally active: it releases inflammatory messengers and fatty acids, throwing the liver, blood vessels and pancreas out of balance. That's why waist circumference comes first in the definition – not BMI.

How common is it? Estimates for Germany suggest about one in four to one in five adults, becoming much more common with age. People with the syndrome have roughly twice the risk of heart attack and stroke and around five times the risk of type 2 diabetes.

The good news: all five criteria respond to the same measures. Losing 5 to 10% of your body weight, 150 minutes of exercise a week, strength training, less sugar and alcohol, more fibre and enough sleep often improve waist circumference, blood pressure, blood sugar and blood lipids all at once. In the US Diabetes Prevention Program, after three years of a lifestyle programme, almost four in ten participants no longer met the criteria – around twice as many as in the comparison group.

The syndrome is now also being seen in teenagers who are severely overweight. For them, it isn't diets that help but family routines: shared meals, fewer sugary drinks, daily exercise – and a check of their values at the paediatrician's.