The Challenge of the Metabolic Syndrome

 

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Over the last 100 years, scientific innovation has led to a revolution in our understanding of the causes of chronic diseases and our ability to prevent and treat diseases [1] [2] [3]. This revolution has primarily improved the health aspect in industrialized countries. Parallel with globalization pronounced changes in the human environment, behavior, and lifestyle have resulted in escalating rates of both obesity and diabetes [4] [5]. The more prevalent sedentary lifestyle and the globalization of “fast” and overly rich nutrition promotes the development of risk factors for the Metabolic Syndrome and the development of diabetes [6]. The risk factors are well-known: obesity, visceral adiposity, physical inactivity, and unhealthy diet.

Today the Metabolic Syndrome is the largest epidemic in the western world and the disease with the highest impact on the western economy. The Metabolic Syndrome is currently undergoing vivid exiting debates by discussing it in the light of a mystery of medicine or a clinical paradigm. Recently, abnormalities in postprandial regulation in connection with the Metabolic Syndrome have become a hot topic in metabolic research [7]. In modern life with over-nutrition and diets rich in animal fat and protein, the postprandial phase lasts about 20 hours per day. There is now convincing evidence that the Metabolic Syndrome develops in conjunction with complex derangements in hormonal [8] [9] [10], behavioral [11] [12], and metabolic regulation [13] [14]. Central obesity has been labeled to be a precondition for the diagnosis of the Metabolic Syndrome by the IDF [15]. Visceral obesity together with insulin resistance and low grade inflammation seem to provide the foundation for the development of type 2 diabetes and atherosclerotic vascular disease. Excessive postprandial glucose and lipid excursion in the postprandial phase initiate a cascade of pro-atherogenic and pro-diabetic events. Incretins play a major role in postprandial hormonal and metabolic regulation [16]. Furthermore, food intake leads to a complex immune response which may activate low grade inflammation [17].

With the present issue of Hormone and Metabolic Research, we would like to add value to the current debate, following the discussions which particularly took place during the second International Symposia “The Metabolic Syndrome - a Postprandial Disease” in Dresden, Germany between October 6 to 8, 2006 and the 1st Symposia in 2005 [2]. We want to highlight different facets of the Metabolic Syndrome in this issue of the journal to continue the scientific discussion started at the Symposia. Even when the pathophysiology of the Metabolic Syndrome seems to be clear, this syndrome needs to be further elucidated. There is no doubt that it is useful to summarize the clinical spectrum under discussion in terms like Insulin Resistance Syndrome, Metabolic Vascular Syndrome [18], and Cardio Metabolic Syndrome. Existing discordance in the definition of the Metabolic Syndrome and different diagnostic [19] and treatment recommendations [20] complicate the development of effective preventive, diagnostic, or treatment strategies. The Metabolic Syndrome furthermore is discussed as a postprandial disease with concrete Metabolic Vascular Syndrome pathophysiology. At the symposia in 2006, the Metabolic Syndrome was presented as endocrine [21], nutritional [22], cardiovascular, metabolic [23], behavioral [24] and ethnicity driven disease [25], as well as in its preventive aspects. This fruitful discussion about the Metabolic Syndrome has just started calling for a clearer and global definition taking ethnic differences into account. The Metabolic Syndrome is becoming a global challenge. The most efficient way to manage the Metabolic Syndrome and its complications is to prevent it from developing [5]. Currently numerous prevention and disease management concepts exist worldwide which can be implemented into clinical practice [26]. Nevertheless, global strategies are still lacking but are needed to tackle inequalities in health between industrialized and developing world. A global health strategy has to take into account political, epidemiological, environmental, infrastructural, and genetic aspects [27] [28]. The aim is to accomplish the greatest benefit with available resources on a long-term perspective.

The Metabolic Syndrome is not a mystery - it is a clinical paradigm and global challenge - we have to address.

References

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Correspondence

Dr. med. P. E.H. Schwarz

Department of Medicine III

Carl Gustav Carus Medical School

Dresden University of Technology

Fetscherstrasse 74

01307 Dresden

Germany

Phone: +49/351/458 27 15

Fax: +49/351/458 73 19

Email: peter.schwarz@uniklinikum-dresden.de