ABSTRACT
Metabolic syndrome is a clinical and physiological entity designating a constellation of clustering risk factors that explain a significant proportion of the cardiovascular disease risks not accounted for when considering risk factors such as blood cholesterol and smoking status. The syndrome includes abdominal, visceral obesity, insulin resistance, elevated serum fasting triglyceride and glucose, low circulating HDL cholesterol concentration, and elevated blood pressure. Available algorithms to identify at-risk patients characterized by metabolic syndrome consider a positive diagnosis in the presence of abdominal obesity and two additional features according to specific thresholds. Excess visceral adiposity likely represents a major determinant in the etiology of metabolic syndrome. This is accompanied by visceral adipocyte hypertrophy, a hallmark feature of dysfunctional adipose tissue, along with impaired adipogenesis, low triglyceride synthesis rates, and poor insulin inhibition of lipolysis, all of which contribute to postprandial fatty acid spillover, ectopic adipose tissue storage, and metabolic alterations. Prevention and treatment modalities for metabolic syndrome should primarily focus on lifestyle intervention and should monitor abdominal fat loss and metabolic syndrome feature improvements rather than weight loss alone.
