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http://dx.doi.org/10.5223/pghn.2020.23.3.189

Novel Insights into the Pathogenesis and Management of the Metabolic Syndrome  

Wang, Helen H. (Department of Medicine and Genetics, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Einstein-Mount Sinai Diabetes Research Center, Albert Einstein College of Medicine)
Lee, Dong Ki (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine)
Liu, Min (Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine)
Portincasa, Piero (Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari Medical School)
Wang, David Q.H. (Department of Medicine and Genetics, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Einstein-Mount Sinai Diabetes Research Center, Albert Einstein College of Medicine)
Publication Information
Pediatric Gastroenterology, Hepatology & Nutrition / v.23, no.3, 2020 , pp. 189-230 More about this Journal
Abstract
The metabolic syndrome, by definition, is not a disease but is a clustering of individual metabolic risk factors including abdominal obesity, hyperglycemia, hypertriglyceridemia, hypertension, and low high-density lipoprotein cholesterol levels. These risk factors could dramatically increase the prevalence of type 2 diabetes and cardiovascular disease. The reported prevalence of the metabolic syndrome varies, greatly depending on the definition used, gender, age, socioeconomic status, and the ethnic background of study cohorts. Clinical and epidemiological studies have clearly demonstrated that the metabolic syndrome starts with central obesity. Because the prevalence of obesity has doubly increased worldwide over the past 30 years, the prevalence of the metabolic syndrome has markedly boosted in parallel. Therefore, obesity has been recognized as the leading cause for the metabolic syndrome since it is strongly associated with all metabolic risk factors. High prevalence of the metabolic syndrome is not unique to the USA and Europe and it is also increasing in most Asian countries. Insulin resistance has elucidated most, if not all, of the pathophysiology of the metabolic syndrome because it contributes to hyperglycemia. Furthermore, a major contributor to the development of insulin resistance is an overabundance of circulating fatty acids. Plasma fatty acids are derived mainly from the triglycerides stored in adipose tissues, which are released through the action of the cyclic AMP-dependent enzyme, hormone sensitive lipase. This review summarizes the latest concepts in the definition, pathogenesis, pathophysiology, and diagnosis of the metabolic syndrome, as well as its preventive measures and therapeutic strategies in children and adolescents.
Keywords
Obesity; Diabetes; Insulin resistance; Dyslipidemia; Hyperglycemia;
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