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Anju Lata answered on
May 08 2020
DYSMETABOLIC SYNDROME 12
PORTFOLIO ACTIVITY
ACUTE CARE NURSING
TOPIC: DYSMETABOLIC SYNDROME
ADELAIDE UNIVERSITY
INTRODUCTION
According to American Association of Clinical Endocrinologists, Dysmetabolic Syndrome (DMS) is an abnormal health condition in which a combination of risk factors for diabetes type 2 and cardiovascular issues takes place together (AACE 2017). The disease is mainly considered relevant due to four reasons: Firstly, it is extremely widespread in western countries. Secondly, it causes the majority of cardiovascular diseases. Thirdly, it is generally not identified easily by the patients and sometimes even undetected by the doctors. Fourthly, the life-threatening complexities of the disease can be reduced effectively through treatment.
The patients of dysmetabolic syndrome exhibit reduced survival rate due to elevated cardiovascular mortality (Khademvatan et al 2014). The problem generally develops as a result of interaction between many genes and supportive environment. Necessary changes in lifestyle like taking healthy diet, managing the blood pressure and weight, along with regular physical activity predominantly in women, can improve the situation and keep the disease under control.
The assignment presents a detailed definition of dysmetabolic syndrome according to various authentic sources. The study elaborates the pathophysiology, the role of inte
elated components in contributing to the severity of disease, and incidence and prevalence of disease in different countries of the world.
DEFINITION
According to American Association of Clinical Endocrinologists (AACE), a dysmetabolic syndrome is a group of metabolic i
egularities in glucose/insulin ratio of plasma, lipids, uric acid levels, imbalances in coagulation factors and physiology of blood vascular system (AACE 2017).
The Insulin resistance along with other several cardiovascular risk factors (obesity, hypertension, impaired glucose tolerance, impaired fi
inolysis, and dyslipidemia), is collectively known as Dysmetabolic Syndrome (Eschwege n.d.). It is also known as Syndrome X or the Metabolic Syndrome or Insulin Resistance Syndrome.
According to WHO 1998 report, “the patients of diabetes mellitus type-2 may develop dysmetabolic syndrome if they satisfy any two of the criteria among dyslipidemia, hypertension, microalbuminuria and obesity.”
The essential criteria for the diagnosis of Dysmetabolic Syndrome are the presence of reduced tolerance for glucose, diabetes type 2, insulin resistance and any two of the following issues:
Dyslipidemia; BP>140/90 mm Hg; Microalbuminuria; Obesity with BMI >30 kg/m2
Fig. Five recent definitions of dysmetabolic Syndrome (Source: Elvira 2012)
PATHOPHYSIOLOGY
Damage to the target organs takes place through different ways in dysmetabolic syndrome (Fogoros 2016). All the multiple diseases produce harmful effects in a collective manner. For instance, hypertension leads to left ventricle hypertrophy, renal disorders and degeneration of arteries. When the risks factors increase considerably, they cause microvascular disorders leading to hypertension and increased insulin resistance.
The dysmetabolic syndrome causes critical coronary heart disease, by elevating the thrombogenicity of blood by increasing the levels of adipokine and plasminogen activator-1 resulting into the dysfunction of endothelium. The disease elevates the stiffness of arteries thereby increasing the risks of cardiovascular problems.
Insulin resistance when combines with other components,causes deleterious changes in the lipid profile and vascular endothelium which ultimately leads to atherosclerosis (Eschwege 2003). When adipocytes are influenced by insulin resistance, it leads to reduced suppression of lipolysis and high levels of fatty acids damaging the walls of arteries and other blood vessels, ultimately leading to atherosclerosis. Lipid profiles of these patients are generally distinguished by the presence of micelles of LDL cholesterol with a low count of HDL cholesterol and hypertriglyceridemia. Moreover, the adipocytes consist of many things which decrease the insulin sensitivity considerably. All these derangements result into complicated issues where insulin resistance develops in large amount along with endothelial dysfunction and atherogenic lipid condition which further worsen the insulin resistance of the body. Such patients are always at four times increased risk of developing cardiovascular problems than the other normal people.
The disease is characterized by insulin resistance which is also a major cause of diabetes milletus 2. The body develops resistance to the normal metabolic functioning of insulin and hence it starts to make more amount of insulin to keep the blood glucose levels normal. However, the pancreas cannot produce such increased levels of insulin for a prolonged period of time. When the level of insulin decreases effectively, the body develops diabetes. To prevent the diabetes, the body requires very large amount of insulin, such a condition may worsen the complications of the problem manifold. The patient may develop excessive weight gain, giving rise to menstrual and ovarian problems in women.
Endothelial dysfunction is also one of the most important factors related to atherosclerosis in the disease of DMS.
INTER-RELATED COMPONENTS OF DYSMETABOLIC SYNDROME
The disease recombines the group of inte
elated health conditions which worsen the effect of each other and stimulate each other, further advancing in development of type 2 diabetes and atherosclerosis (Fogoros 2016).
It is evident that the Dysmetabolic Syndrome is also associated with the conditions of Stein Leventhal syndrome and Polycystic Ovarian Syndrome (PCIS) in adolescents and women (University of Medical Science 2014). These problems also have similar symptoms as that of dysmetabolic syndrome, in addition to increased male hormone levels, menstruation problems, issues related to ovaries functioning and growth of excessive hair on the body.
The condition is also induced by genetic inheritance. Both males and females are equally susceptible to the disease. The people who have family history of diabetes milletus 2 or that of dysmetabolic syndrome in their parents are generally at higher risk of developing it.
Fig. Components of Dysmetabolic Syndrome (Source: Fogoros 2016)
Each component of dysmetabolic syndrome, works to enhance the risks of getting more and more diseases. For example an increased waist circumference or high fat in the abdominal area, makes the patient more susceptible to develop cardiovascular problems and diabetes. The hypertension may result into cardiac a
est or a heart stroke. High level of LDL glucose and low levels of HDL elevates the severity of cardiovascular problems. Moreover the insulin resistance can significantly contribute in development of diabetes.
Diabetes is always associated with increased chances of heart problems, blindness and kidney dysfunction. In more complex form, the conditions may lead to limb amputation because of gangrene.
All the components of DMS are extremely interconnected and it is impossible to treat any of the symptoms separately (Spellman & Chemitiganti 2010). Insulin resistance acts as a primary mediator of DMS, although it may not induce obesity. The condition of obesity increases the chances of the person to become insulin resistant. The pancreas when secret excessive insulin, does not require to be treated with drugs but only requires physical activity and healthy diet. The combined effect of insulin resistance and excessive generation of insulin increases the risks of cardio vascular complications.
There is found a direct relation between visceral fat and the circumference of waist. The insulin resistance of visceral fat is associated with hyperglycemia, hypertension, dislipidemia and inflammation representing a cluster of problems in DMS.
The fat cells of the abdomen and visceral area discharge the inflammatory cytokines which induce elevated insulin resistance of skeletal muscles in the body (Elvira 2012). The abdominal and visceral fat results in inflammatory responses, while the subcutaneous fat is not harmful to larger extent. The accumulation of abdominal fat generates detrimental and dangerous levels of cytokines (such as plasminogen activator inhibitor, and tumor necrosis factor) and when combines with insulin resistance, may lead to cluster of components like increased VLDL, increased levels of plasma triglycerides, reduced HDL and elevated LDL etc.
The main etiological factors contributing to the incidence of DMS are Central Obesity, systemic inflammation, proinflammatory and prothrombotic conditions, in addition to atherogenic dyslipidemia. Around 40% differences in body fat accumulation are a result of genetic factors. In case of abdominal fat, the genetic contribution is around 60% in ladies > 55 years of age (Spellman & Chemitiganti 2010). If the parents have been diabetic, there are high chances that the children will have greater waist-hip ratio than the people without any history of diabetes in parents. Moreover, the inheritance of high blood pressure is 40-50% and the increased insulin resistance is generally linked to hypertension. The HDL cholesterol and microalbuminuria is also influenced by heredity, which is a very dangerous sign of increased risk of heart problems. The research also proves the great degree of association between microalbuminuria and the insulin resistance. It shows that many metabolic issues related to dysmetabolic syndrome are inherited through the genetic pathway, however, there is no evidence of inheritance of complete syndrome through the generations. The effectiveness of these factors includes both environmental and genetic components working together.
The Acute Nursing Care of DMS requires holistic approach as Dysmetabolic Syndrome may rapidly turn into severe lifelong chronic complications, leading to death. It requires the management of hypercholesterolemia, hypertension, increased glucose level, hypertriglyceridemia and obesity (American Nurses Association 2014). The disease can be controlled through Primary prevention or by Secondary prevention methods (Elvira 2012). The Primary prevention includes adopting healthy and active life, stopping the smoking and drinking habits, taking balanced calories, and physical activities. The secondary prevention is suggested to the patients who are unable to
ing necessary changes in their lifestyle. They are recommended for medical treatment, along with possible lifestyle improvements. The medicines may involve Angiotensin Enzyme inhibitors, medicines to treat diabetes, obesity-reducing treatments, and anti-inflammatory drug treatments.
INCIDENCE OF DISEASE IN WORLD
According to Organisation for Economic Cooperation and Development, Australia is among top 5 countries in the world having highest number of obese people in all age groups (Sugar Research Advisory Services n.d.). Therefore, we can expect that the Australian population would also be affected disproportionately with Metabolic Syndrome.
The disease is prevalent in the adult population of developed countries (Fogoros 2016). Its frequency of inception increases with age. According to a research in the US, the frequency of disease in adults of 20-29 years of age is just 7% while in people with age group 60-69 years the disease is found in 43% of frequency (AACE 2017). The disease also spreads with the extent of obesity in children and adolescents. It is found in the research that 20-25% of obese adolescents and children also suffer from the symptoms of insulin resistance, which is a prominent component of the dysmetabolic syndrome and may result into diabetes type 2.
In US, where around 2/3rd population is obese, more than ¼ of the population exhibits the affective symptoms of the disease. According to a survey analysis of year 2000, the prevalence of disease has increased significantly from 27% in 1994 to 32% in 2000, in US (Lovre & Mauvais 2015). However, the reports of 2010 data by National Health and Nutrition Examination Survey assert that the prevalence of disease has reduced to 24% in males and 22% in females.
The Dysmetabolic Syndrome is a highly dangerous globally recognized problem. About 1/4th of the European population is affected with the disease(AACE 2017). It is also observed as a prevailing disorder in many other countries like Latin America, and many developing countries like Japan, Korea, and China. In East Asian countries, the problem is around 8-13% in males and 2-18% in females (Lovre & Mauvais 2015). Among ethnic groups, in the US, the most affected ethnic communities are African American mainly the women due to increased diabetes, obesity and hypertension in these sections (Ford et al 2016). The disease is more prevalent in females than males and leads to many post delivery and post-menopause complications.
CONCLUSION
Dysmetabolic Syndrome is a complex cluster of many problems that affect the patient collectively weakening his overall body metabolism. The disease is characterized by increased insulin resistance, diabetes and many cardiovascular issues which adversely affect the health of the patient. Among the demographics, the females are more readily affected by the problem due to their sedentary lifestyle and obesity. The management of disease involves adaptive changes in the routine and transforming the lifestyle from sedentary mode to activeness. Regular exercise and balanced diet along with treatment which aims to treat multiple symptoms of the disease can control the problem effectively. However there is vigorous need of more research and inventions to find out effective medicines for this syndrome to prevent the occu
ence at the root level.
With many opinions and debates, DMS offers a
oad scope of research in future to determine more careful methods for prevention of risk beyond the conventional methods.
Jean Pie
e Despres attributes the Dysmetabolic syndrome as a work in progress. He emphasizes on redefining the syndrome as a cluster of metabolic abnormalities linked to insulin resistance and visceral body fat accumulation (Despres 2008). He says it will clarify a lot of confusion over the topic.
It is a metabolic and multifaceted abnormality which includes the issues related to approximately 10 other medical specialties. These elements of cardio-metabolic risks must be consolidated and quantified to find out effective management of this disease in future. The disease is so complex that appropriate research over the topic will invite the significant contributions from experts of many disciplines like practitioners, cardiologists, neurologists, geneticists, pediatricians, lipidologists, nutritionists, diabetologists, and endocrinologists. Committed and sincere team efforts can only lead to monitoring and improving the multiple abnormalities related to this cluster of disease.
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