Women & metabolic syndrome.

Measured your waist lately? If not, you should. Whether you're overweight or not, if your waist is more than 34 inches around, you may be looking at the tip of the proverbial iceberg when it comes to health problems. That's because a large waist is one sign of metabolic syndrome.

Metabolic syndrome is not pre-diabetes, insulin resistance or glucose intolerance. It's not even a disease. Rather, it's a cluster of risk factors associated with obesity. Identifying the syndrome is important because, like that tip of the iceberg, it represents a very serious, yet hidden, danger to your health. (13) You have metabolic syndrome if you have any three of the following five risk factors:

* A waist circumference more than 34 inches (more than 40 inches in men)

* A fasting blood glucose level of 110 mg/dL or higher (considered a marker for insulin resistance), or if you are taking medication for high glucose levels

* Triglycerides at or above 150 mg/dL

* An HDL-cholesterol level below 50 mg/dL (at or below 40 mg/dL in men), or if you are on medication to increase HDL 

* A blood pressure level at or above 130 mm Hg systolic (the top number) or 85 mm Hg diastolic (the bottom number) or you are taking medication for high blood pressure.

An estimated 24 percent of Americans over age 20 and 44 percent of Americans over 50, have metabolic syndrome. (14,15)

Why should you care? Because metabolic syndrome significantly increases your risk of developing atherosclerosis, a buildup of plaque in your coronary arteries that contributes to heart disease, stroke and peripheral vascular disease. You're also up to 3.5 times more likely to die from coronary heart disease if you have metabolic syndrome than someone who doesn't have it. (14)

And while it's not a direct cause of diabetes, metabolic syndrome is a strong predictor of the disease. It's very rare to have diabetes without also having metabolic syndrome. Even more important, the two together push your risk of heart disease up by 50 percent compared to having diabetes without metabolic syndrome. (15)

So how do you find out if you have metabolic syndrome? Ask your doctor to evaluate you on the five markers listed above. This is particularly important if you have polycystic ovarian syndrome (PCOS), a hormonal condition that often affects fertility, since women with the condition are 11 times more likely to have metabolic syndrome than those without. (16)

As for treatment, your best option is to lose weight and exercise. These are the only two approaches that can improve every one of the five markers. (17) One large study found metabolic syndrome completely disappeared in 30 percent of participants who rode a stationary bike three times a week (starting at 30 minutes a session and working their way up to 50 minutes) for 20 weeks. (18) Otherwise, your doctor will need to address each marker separately with medication--and who wants to take three or four pills for something they could improve on their own?

So what do you do? "You make better choices," says David Katz, MD, associate professor of public health at Yale University School of Medicine and the author of several consumer books on nutrition and weight loss. That means foods closer to nature that don't have long ingredient lists.

References

1 Centers for Disease Control and Prevention. Body Mass Index: About BMI for Adults. Available at: http://www.cdc.gov/nccdphp/dnpa/bmi/adult_BMI/about_adult_BMI.htm. Accessed Sep 14, 2006.

2 Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006 Apr;295(13):1549-55.

3 Muennig P, Lubetkin E, Jia H, Franks P. Gender and the burden of disease attributable to obesity. Am J Public Health. 2006 Sep;96(9):1662-8.

4 Palinkas LA, Wingard DL, Barrett-Connor E. Depressive symptoms in overweight and obese older adults: a test of the "jolly fat" hypothesis. J Psychosom Res. 1996 Jan;40(1):59-66.

5 Puhl RM, Brownell KD. Psychosocial origins of obesity stigma: toward changing a powerful and pervasive bias. Obes Rev. 2003 Nov;4(4):213-27.

6 Kuczmarski RJ, Flegal KM, Campbell SM, Johnson CL. Increasing prevalence of overweight among US adults. The National Health and Nutrition Examination Surveys, 1960 to 1991. JAMA. 1994 Jul 20;272(3):205-11.

7 Overweight and obesity. World Health Organization. Available at: http://www.who.int/dietphysicalactivity/publications/facts/obesity/en/. Accessed Sep 30, 2006.

8 Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA. 2005 Jan 5;293(1):43-53.

9 Saarni SE, Rissanen A, Sarna S, Koskenvuo M, Kaprio J. Weight cycling of athletes and subsequent weight gain in middle age. Int J Obes (Lond). 2006 Mar 28.

10 Field AE, Manson JE, Taylor CB, Willett WC, Colditz GA. Association of weight change, weight control practices, and weight cycling among women in the Nurses' Health Study II. Int J Obes Relat Metab Disord. 2004 Sep;28(9):1134-42.

11 Bacon L, Stern JS, Van Loan MD, Keim NL. Size acceptance and intuitive eating improve health for obese, female chronic dieters. J Am Diet Assoc. 2005 Jun;105(6):929-36.

12 National Women's Health Resource Center, Second Annual Women Talk survey, conducted by Harris Interactive. Aug 2006.

13 Grundy SM. A constellation of complications: the metabolic syndrome. Clin Cornerstone. 2005;7(2-3):36-45. Review.

14 Fonseca VA. The metabolic syndrome, hyperlipidemia, and insulin resistance. Clin Cornerstone. 2005;7(2-3):61-72. Review.

15 Alexander CM, Landsman PB, Teutsch SM, Haffner SM; Third National Health and Nutrition Examination Survey (NHANES III); National Cholesterol Education Program (NCEP). NCEP-defined metabolic syndrome, diabetes, and prevalence of coronary heart disease among NHANES III participants age 50 years and older. Diabetes. 2003 May;52(5):1210-4.

16 Dokras A, Bochner M, Hollinrake E, et al. Screening women with polycystic ovary syndrome for metabolic syndrome. Obstet Gynecol. 2005 Jul;106(1):131-7.

17 Orchard TJ, Temprosa M, Goldberg R, et al. Diabetes Prevention Program Research Group. The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial. Ann Intern Med. 2005 Apr 19;142(8):611-9.

18 Katzmarzyk PT, Leon AS, Wilmore JH, et al. Targeting the metabolic syndrome with exercise: evidence from the HERITAGE Family Study. Med Sci Sports Exerc. 2003 Oct;35(10):1703-9.