Mechanism Underlying the Formation of a Cluster of Metabolic Syndrome

Author(s): Svetlana Igorevna Kseneva*, Elena Valentinovna Borodulina, Vladimir Vasilievich Udut, Vladimir Petrovich Fisenko

Journal Name: Endocrine, Metabolic & Immune Disorders - Drug Targets
(Formerly Current Drug Targets - Immune, Endocrine & Metabolic Disorders)

Volume 20 , Issue 4 , 2020

Become EABM
Become Reviewer

Graphical Abstract:


Abstract:

Background: The concept of metabolic syndrome (MetS) as a cluster of risk factors of type 2 diabetes and cardiovascular diseases has undergone some evolutionary transformations over the past years. Integrating the autonomic dysfunction into the pathogenesis of MetS creates the possibility of including a range of nosologies affecting treatment and clinical manifestations of pathologies belonging to MetS into the MetS cluster. The purpose of this work is to determine the involvement of autonomic dysfunction in the pathogenesis of associated pathological conditions in patients and MetS.

Methods: A cross-sectional study was conducted. The sample consisted of 158 patients with metabolic syndrome. The patients underwent a physical examination, including BMI; a blood chemistry test with the determination of the hormonal status (insulin, testosterone, dihydrotestosterone); a 24-hour monitoring of blood pressure (BP); an assessment of heart rate variability; studies showing the presence of gastric reflux (рН-measurement) or its damaging impact (endoscopy); men were tested with the IPSSQOL questionnaire and underwent transrectal ultrasound of the prostate and ultrasound of the bladder.

Results: It is revealed that because of MetS, the occurrence of cardiac autonomic neuropathy reaches 37.5%. Some features of gastroesophageal reflux disease in patients with MetS are shown. Regurgitation prevails in the structure of complaints. In case of fibrogastroduodenoscopy, an endoscopynegative form of the disease occurs in 38%. According to the data of daily pH-measurement, when DeMeester score is high, in the supine position, 25% of the time accounts for alkaline reflux (рН > 7). It is found out that young men experience the enlargement of prostate volume and size; according to the IPSS questionnaire, the scores correspond to the initial manifestations of hyperplastic diseases of the prostate gland due to insulin resistance and normal level of androgens.

Conclusion: The paper demonstrates that the autonomic dysfunction of the nervous system (on a par with insulin resistance) is the main link in the development of MetS. This provides the basis for including the mentioned states – cardiac autonomic neuropathy, lower urinary tract symptoms, and gastroesophageal reflux disease – into the MetS cluster.

Keywords: Metabolic syndrome, arterial hypertension, cardiac autonomic neuropathy, gastroesophageal reflux disease, lower urinary tract symptoms, autonomic dysfunction.

[1]
Saklayen, M.G. The global epidemic of the metabolic syndrome. Curr. Hypertens. Rep., 2018, 20(2), 12.
[http://dx.doi.org/10.1007/s11906-018-0812-z]
[2]
Amato, M.C. Visceral adiposity index: an indicator of adipose tissue dysfunction. Int. J. Endocrinol., 2014, 2014, 1-7.
[http://dx.doi.org/10.1155/2014/730827]
[3]
Singh, N. Scmhrd. Metabolic syndrome: Practice essentials, background, pathophysiology. J. Heart Stroke, 2018, 3(1), 1044.
[4]
Nolan, C.J. Insulin resistance and insulin hypersecretion in the metabolic syndrome and type 2 diabetes: Time for a conceptual framework shift. Diab. Vasc. Dis. Res., 2019, 16(2), 118-127.
[5]
Hohenester, S.C. Lifestyle intervention for morbid obesity: effects on liver steatosis, inflammation, and fibrosis. Am. J. Physiol. Gastrointest. Liver Physiol., 2018, 315(3), 329-338.
[6]
Ormazabal, V.; Nairm, S.; Elfeky, O.; Aguayo, C.; Salomon, C.; Zuñiga, F.A. Association between insulin resistance and the development of cardiovascular disease. Cardiovasc. Diabetol., 2018, 17(1), 122.
[7]
Könner, A.C.; Brüning, J.C. Selective insulin and leptin resistance in metabolic disorders. Cell Metab., 2012, 16(2), 144-152.
[http://dx.doi.org/10.1016/j.cmet.2012.07.004] [PMID: 22883229]
[8]
Cozma, A. Determining factors of arterial stiffness in subjects with metabolic syndrome. Metab. Syndr. Relat. Disord., 2018, 16(9), 490-496.
[9]
Ruud, J.; Steculorum, S.M.; Brüning, J.C. Neuronal control of peripheral insulin sensitivity and glucose metabolism. Nat. Commun., 2017, 8, 15259.
[http://dx.doi.org/10.1038/ncomms15259] [PMID: 28469281]
[10]
Moreira, M.C. Does the sympathetic nervous system contribute to the pathophysiology of metabolic syndrome? Front. Physiol., 2015, 6, 234.
[http://dx.doi.org/10.3389/fphys.2015.00234]
[11]
Pasquali, R. Metabolic syndrome in polycystic ovary syndrome. Front. Horm. Res., 2018, 49, 114-130.
[12]
Honma, M.; Sawada, S.; Ueno, Y.; Murakami, K.; Yamada, T.; Gao, J.; Kodama, S.; Izumi, T.; Takahashi, K.; Tsukita, S.; Uno, K.; Imai, J.; Kakazu, E.; Kondo, Y.; Mizuno, K.; Kawagishi, N.; Shimosegawa, T.; Katagiri, H. Selective insulin resistance with differential expressions of IRS-1 and IRS-2 in human NAFLD livers. Int. J. Obes. (Lond), 2018, 42, 1544-1555.
[13]
Cichos, K.H. Metabolic syndrome and hip fracture: Epidemiology and perioperative outcomes. Injury, 2018, 49(11), 2036-2041.
[14]
Vakil, N.; van Zanten, S.V.; Kahrilas, P.; Dent, J.; Jones, R. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am. J. Gastroenterol., 2006, 101(8), 1900-1920.
[http://dx.doi.org/10.1111/j.1572-0241.2006.00630.x] [PMID: 16928254]
[15]
Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation, 1996, 93(5), 1043-1065.
[http://dx.doi.org/10.1161/01.CIR.93.5.1043] [PMID: 8598068]
[16]
Kseneva, S.I.; Borodulina, E.V.; Trifonova, O.Y.; Udut, V.V. Cardiac Autonomic Drive during Arterial Hypertension and Metabolic Disturbances. Bull. Exp. Biol. Med., 2016, 161(2), 237-240.
[http://dx.doi.org/10.1007/s10517-016-3385-3] [PMID: 27383176]
[17]
McVary, K. Lower urinary tract symptoms and sexual dysfunction: epidemiology and pathophysiology. BJU Int., 2006, 97(Suppl. 2), 23-28.
[http://dx.doi.org/10.1111/j.1464-410X.2006.06102.x] [PMID: 16507050]
[18]
Budiyani, L. Insulin Resistance in Gastroesophageal Reflux Disease. Acta Med. Indones., 2018, 50(4), 336-342.


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 20
ISSUE: 4
Year: 2020
Page: [564 - 569]
Pages: 6
DOI: 10.2174/1871530319666191007115214
Price: $65

Article Metrics

PDF: 22
HTML: 2
EPUB: 1
PRC: 1