The metabolic syndrome: Review of current concepts

The metabolic syndrome incorporates into a single entity, insulin resistance and its associated cluster of related cardiovascular metabolic risk factors including type 2 diabetes mellitus, essential hypertension, dyslipidamia and central obesity. Various hypotheses (thrifty genotype/phenotype, limbic-hypothalamic and altered homeostatic mechanisms) have been used to explain the interaction between genetic, intrauterine and environmental factors, leading to this enigmatic concept. Current interest addresses the roles of fat-derived adiponectin, inflammatory markers (C-reactive protein, leucocytes, interleukin and tumour necrosis factor), endothelial dysfunction and disordered haemostasis (plasminogen activator inhibitor-1 and fibrinogen). Angiotensin II, endothelin-1 and increased salt sensitivity contribute to the development of hypertension in metabolic syndrome. The main significance of the syndrome is the heightened risk of cardiovascular morbidity and mortality arising from increased atherogenic potential. Therapeutic interventions are multidimensional in approach, and aimed at enhancing insulin sensitivity and ameliorating the consequences of insulin resistance. Promotion of African native lifestyle characterised by high degree of physical activity and fibre diet is and appropriate tool for primary prevention of metabolic syndrome.