Metabolic Syndrome

Overview?
Tests
Treatment
More Details

Tests
A doctor may suspect that a patient has metabolic syndrome if he has central/abdominal obesity and a sedentary lifestyle. In order to make a diagnosis of metabolic syndrome the criteria in the above table must be met therefore both laboratory and non-laboratory tests are important in establishing the diagnosis. Recommended laboratory tests include:

Laboratory Tests

Glucose. Usually a fasting glucose test is performed but, in some cases, a doctor may also order a post prandial glucose (after a meal) or a GTT (glucose tolerance test – several glucose tests that are taken before and at timed intervals after a glucose drink. The commonest form of the test involves a fasting level and another glucose level after 2 hours after the glucose drink). The goal of glucose testing is to determine whether a patient has an impaired response to glucose resulting in elevated blood glucose concentrations.
Lipid profile. Measures total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides. If the triglycerides are significantly elevated, a DLDL (direct measurement of the LDL) may need to be done.

There are other laboratory tests that are not recommended for diagnosing metabolic syndrome but that may requested by some doctors to provide additional information. They include:

C-peptide. A reliable indicator of endogenous (by the body itself) insulin production.
Urine albumin : creatinine ratio. An early indicator of kidney disease, this test is used to help monitor patients with diabetes and is recommended under the WHO criteria.
hs-CRP (highly sensitive C-reactive protein). A measure of low levels of inflammation that may be tested as part of an evaluation of cardiovascular risk. This test is not performed by many laboratories.
sdLDL. A measurement of the number of small dense low-density lipoprotein molecules a patient has. LDL varies in size, and the smaller denser molecules, which tend to form when elevated triglycerides and VLDL are present in the blood, are thought to be more aggressive in causing atherosclerosis. This test is not performed by many laboratories and is not requested frequently. Its ultimate clinical utility has yet to be determined. May be evaluated in a lipoprotein subfractionation test.
Insulin. The fasting insulin test is considered too variable to be clinically useful in diagnosing metabolic syndrome but, if measured, will usually be elevated in those affected.

Tests for which the clinical utility in diagnosing metabolic syndrome has not yet been established include plasminogen activator inhibitor-1 (PAI-1) and proinsulin.

Non-Laboratory Tests

Blood pressure. To check for hypertension
Weight and waist circumference. To document abdominal obesity
BMI (Body Mass Index). An alternate measure of obesity that is used by many doctors. It is calculated by taking: (Weight in pounds X 705) / (height in inches squared); for example: (150 pounds X 705) / (67 inches X 67 inches) = a BMI of 23.5. An adult with a BMI greater than 30kg/m2 is considered obese. This calculation does not, however, describe where the excess weight is on the body.