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Metabolic syndrome: Could you have it and not know it?

Author: Bronwen King - NZ registered nutritionist

First published: Sep 2011

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Nutritionist Bronwen King explains an increasingly common issue that many New Zealanders may not be aware they have.

Are you at risk of metabolic syndrome?

The International Diabetes Federation estimates that up to a quarter of the world’s adults have metabolic syndrome. Do you have any of the following? (Ask your doctor to confirm.) If you have more than three factors, you have metabolic syndrome.

a large waist measurement
high cholesterol
high blood pressure
high triglycerides
high fasting glucose

It is important to note that each of the factors listed above increases your risk of heart attack, stroke and type 2 diabetes – even if you do not have enough risk factors to be identified as having metabolic syndrome. The more factors you have, the more significant your risk.

What is metabolic syndrome?

Definitions vary slightly but metabolic syndrome, or syndrome X (another term for the same condition) means you have at least three of the factors that increase the risk of heart attacks, stroke and type 2 diabetes. These factors include:

Abdominal obesity (large waist circumference)

This means you carry fat around your middle and have an ‘apple’ shape. As a guide, a waist measurement greater than 88cm if you are female or 102cm if you are male will put you at increased risk. Abdominal obesity exists in most cases of metabolic syndrome, and is considered one of the reasons for higher levels amongst Maori and Pacific people than for New Zealand Europeans.

Elevated cholesterol levels

There are two types of cholesterol: HDL or ‘good’ cholesterol and LDL or ‘bad’ cholesterol. For good health we want higher HDL cholesterol and lower LDL cholesterol. When cholesterol is measured, health risk is assessed by a ratio of total cholesterol to HDL cholesterol. Ideally the ratio should be less than 4.0. A high ratio, low HDL and/or high LDL are all risk factors for metabolic syndrome.

High blood pressure

A blood pressure of 130/85 or higher (or being on medication to treat high blood pressure) is a risk factor. If only one of your two blood pressure numbers is high, this is still considered a risk factor for metabolic syndrome.

High triglycerides

Triglycerides are a type of fat found in the blood. A triglyceride level of greater than 1.7mmol/L (or being on medication to treat high triglycerides) is a risk factor.

Blood glucose

The HbA1c test provides an indication of blood glucose control. This is important to test for pre-diabetes or diabetes.

What is pre-diabetes?

Pre-diabetes is diagnosed when a person’s HbA1c levels are higher than normal but not yet high enough to be diagnosed as diabetes.

What your HbA1c levels mean

≥ 50 mmol/mol indicates probable diabetes (but does not confirm a diagnosis by itself)
41-49 mmol/mol suggests prediabetes/insulin resist
≤40 mmol/mol is normal

Your doctor may use words like ‘impaired glucose tolerance’ (IGT) or ‘impaired fasting glucose’ when explaining the results of a blood glucose test. These also mean you have pre-diabetes. When blood glucose rises (as after a meal), the body releases insulin to bring the level back to normal. Pre-diabetes happens when this mechanism is not working properly. Excess body fat is a major cause of this.

If you are overweight or have any of the factors associated with metabolic syndrome, it is wise to have regular blood tests to measure your fasting blood glucose. A rising fasting level is good reason to make lifestyle changes (see below).

Diabetes is a very debilitating disease that can lead to kidney failure, limb amputations and blindness – something well worth changing your habits to avoid!

Should you be concerned about metabolic syndrome and pre-diabetes?

The answer is yes: both are ‘diseases of modern living’ not conditions we catch like colds or flu. They are good indicators that your lifestyle choices around food and activity are affecting your health. Being overweight, lack of activity and excess consumption of sugar, white bread, cakes, muffins, fizzy drinks, pastries and other fatty foods are all choices that are driving the incidence of these modern day diseases to alarming levels. Even more alarming is the fact that we are now seeing signs of them in children. The good news is that changing lifestyle can reverse these conditions and help you return to good health. Early diagnosis is the key.

What can we do about it?

All the indicators of metabolic syndrome and pre-diabetes will improve with weight-loss. Making small changes to habits around eating and activity is the best way to achieve this. Your aim is to:

achieve and maintain a healthy body weight
keep blood glucose levels within the normal range
keep blood fats within an acceptable range
reduce your blood pressure if it is too high.

Increase activity

Choose activities that you enjoy.
Find a buddy to do it with.
Push yourself but not to the point where you give up. Compare yourself only with yourself and go as hard as you can, as far as you can, for as long as you can.

Remember, the body is meant to move. Moving it more increases mental well-being as well as physical health. Movement is preferable to anti-depressants for lifting our mood!

Make changes to how and what you eat

ALWAYS eat breakfast. Make sure it includes plenty of fibre (10g fibre is a good goal).

Stick to a regular eating pattern. Regular meals make it easier for healthy habits to be maintained. Three meals of similar size a day is a healthy pattern. People on shift work or with erratic schedules may need more smaller meals. Whatever you do, aim to stick to the same pattern each day.

Watch portion size – if you are overweight, try reducing your normal portions of meat and starchy foods (such as potato, rice, pasta) by 25 per cent and balance this with increased portions of salads or non-starchy vegetables (which should make up half of your plate).

Reduce your fat consumption:

avoid fried foods and keep takeaways to a minimum
choose lean meat, remove the skin from chicken and trim fat off bacon
replace butter and margarine with lower-fat spreads such as mashed avocado, hummus or extra-light cream cheese
replace cream, biscuits, cakes, muffins and pastry with healthier alternatives
get the fat you need from nuts, seeds, avocado, olives and plant oils (excluding coconut and palm oils). Watch quantity, however
include fish twice weekly to get essential omega-3 fats. This can come from canned fish.

Increase your fibre intake. Aim for 30g+ fibre each day. Get fibre from:

wholegrain breads – bread with 5g or more fibre per 100g
breakfast cereals – untoasted, with 7g or more fibre per 100g
vegetables – unpeeled if possible
raw fruit – unpeeled if possible. Canned fruit is OK provided it does not have added sugar
legumes such as lentils, kidney beans, baked beans, chickpeas
nuts and seeds.

Sample menu

Breakfast

high-fibre cereal such as Weet-Bix or porridge with trim milk and fresh fruit

Lunch

lean meat and salad wholegrain sandwich – butter or margarine replaced with a low-fat spread such as reduced-fat mayonnaise, hummus or extra-light cream cheese
low-fat yoghurt
piece of fruit