A case

study of
Metabolic
Syndrome

Jessica Wright

1
Table of Contents

Introduction. 1
Methods.. 5
Results. 5
Discussion 7
Sources.. 9
Appendices
Appendix A 11
Appendix B 13

1
Introduction
Metabolic syndrome (MetS) is not by definition a disease. It is a
collection of conditions that raise a persons risk for health problems such as
heart disease, stroke, and if not already diagnosed, diabetes. The syndrome
goes by many other names, including syndrome X, obesity syndrome, and
insulin resistance syndrome1. The definition of MetS is a somewhat
controversial subject as there is no standard. The ATP III (2001 National
Cholesterol Education Program Adult Treatment Panel) defined metabolic
syndrome as the presence of three or more of the following metabolic risk
factors: Increased abdominal obesity, high triglyceride levels, low blood
levels of HDL, high blood pressure, and finally an increased fasting glucose2.
The two other major definitions for metabolic syndrome are by the World
Health Organization (WHO) and the International Diabetes Federation (IDF).
The WHO definition is different because it lists insulin resistance as a
requirement to be diagnosed with MetS3. To be diagnosed by the WHO the
patient must have insulin resistance as well as two other criteria: low HDL
levels, increased triglycerides, high BMI or high blood pressure3. The WHO
also looks at a persons microalbuminuria levels. The IDF diagnosis includes
central obesity as well as two out of four conditions3. The IDFs conditions are
high blood pressure, low HDL levels, raised triglycerides, and an increased
fasting glucose3. The multiple definitions make diagnosing MetS somewhat
difficult4.

2
The conditions involved in metabolic syndrome are interrelated and
having one increases a persons risk for the others, as well as, more serious
health problems. Insulin plays a major role in the body and can be caused by
obesity5. The book by Gropper and Smith explains how the conditions are
interrelated in detail6. Insulin stimulates glucose uptake by the cell. It
stimulates the production of glycogen from glucose and inhibits
glycogenolysis6. In insulin resistance a persons blood glucose levels are
high, which leads to many diseases such as cardiovascular disease and type
II diabetes6. Insulin also contributes to the regulation of blood pressure. In
some forms of insulin resistance, a persons pancreas overproduces insulin to
control blood glucose. This rise damages the lining of a persons arteries and
cause inflammation6.
Inflammation is caused by white blood cells attaching to artery walls,
which are made more attractive by insulin6. The inflammation makes arteries
less pliable and this makes it easier for cholesterol plaques to form.
Cholesterol plaques narrow arteries and increase blood pressure6. There are
different types of cholesterol. LDL or low-density lipoprotein is known as the
bad cholesterol because it is the major carrier of cholesterol to tissues. HDL
is known as the good cholesterol it is made in the liver and circulates the
body picking up cholesterol from tissues and bringing it back to the liver6. A
major source of dietary fat is triglycerides. When a person has high blood
level triglycerides the fat stocks up in the arteries6. A diet high in saturated

3
and trans fatty acids increases a persons LDL cholesterol and triglycerides
and lowers their HDL6.
Metabolic syndrome can lead to diabetes, cardiovascular disease,
stroke and other complications. Diabetes can create long term damage in the
body. It has harmful effects on many organs and can even result in
amputation5. Uncontrolled diabetes can lead to foot ulcers7. If the ulcers are
left uncared for they can cause damage to the tissues and even the bone. If
it gets to that level amputation may be required7. Cardiovascular disease is
currently the leading cause of death in America. The term cardiovascular
disease covers a wide number of forms of disease related to the heart such
as heart failure, atrial fibrillation, atherosclerotic disease, and cardiac
arrest10.
There are certain factors that put a person more at risk to gain the
conditions associated with MetS. These risk factors are increased abdominal
obesity, inactive lifestyle, insulin resistance, family history of diabetes or
hypertension, increasing age, and women with history of polycystic ovarian
syndrome1. It is believed that the major cause behind metabolic syndrome is
abdominal obesity, as it creates other problems related to MetS2. People with
abdominal obesity can develop metabolic syndrome without previous insulin
resistance. It has been discovered that while MetS affects white men and
women almost equally, it does not do this with other races. The syndrome is
more common in Mexican American and African American women than in the

4
men of the same races1. Testing for metabolic syndrome means testing for
the individual criteria. These tests include blood pressure, waist
circumference measurements, BMI or waist/hip ratio as well as some lab
tests3. Depending on the definition being used the tests are cholesterol,
fasting glucose, and microalbuminuria3.
Metabolic syndrome is often underdiagnosed, many people who have
the condition are unaware of it. There are a few possible reasons for the
underdiagnoses, one being the lack of standard definition4. There are at least
three different definitions for metabolic syndrome. It is hard to diagnose a
condition when a person meets the requirements for one definition and not
for the other. Another reason is that some doctors may not realize the
importance of the diagnosis4. Diagnosing MetS can guide cardiovascular
disease risk management. Also, the diagnosis make it easier to treat the risk
factors. When the doctor looks at the syndrome as a whole they may find
treatments that they had not considered before.
There are measures that a person can take to prevent metabolic
syndrome, such as, consuming an overall healthy diet with limited saturated
and trans fats as well as a lower sodium intake1. Maintaining a healthy
weight and quitting smoking have been associated with reducing the risk of
metabolic syndrome1. Taking medications to treat some of the related
symptoms could reduce a persons chance of gaining the others1. Overall,
the best prevention methods are a healthy diet and physical exercise.

5
Treatment involves lifestyle changes similar to prevention. Weight loss
is the ideal first recommendation as obesity is usually associated with all of
the risk factors2. This weight loss should be reached through a heart healthy
diet and physical activity1. With the diet and exercise changes the conditions
involved in metabolic should start to come under control8. However,
metabolic syndrome is a lifelong condition that does not simply go away1. A
person must keep a healthy diet and exercise to prevent further damage.
Metabolic syndrome is common among the middle aged and elderly.
One major cause of this is the decline in physical activity with age. Bianchi,
Rossi, Muscari, Magalotti, and Zoli found that limited physical activity was
directly related to the presence of metabolic syndrome in the elderly9.
Mobility is something that many elderly people struggle with and this is one
of the reasons MetS is so common in an older population. Many of the risk
factors related to metabolic syndrome become more common with an
increased age. It is this reason that it was hypothesized that the patient
would not only meet the requirements to be diagnosed with metabolic
syndrome by the ATP III definition but that they would exceed them. It was
expected that the patient would be severely obese and have already
struggled with diseases that come from metabolic syndrome such as heart
disease, diabetes, or stroke.
Methods

6
When selecting a case study the ATP III definition of metabolic
syndrome was used. It was assumed that the best place to find a person to
meet the qualifications was the Wood County Senior Center. At that location
a man was found who met several of the criteria of metabolic syndrome and
was willing to be interviewed. The patient gave their address and requested
that the interview be done there. The questions asked can be seen in
Appendix A.
Results
The patient interviewed was an 81 year old male who has had a
decline in his health in the past 24 years. He was diagnosed with diabetes at
age 59 and had struggled with blood sugar problems for many years before
that. The patient has had a pacemaker for the last 22 years and it has been
replaced three times. He has had four stints put in as well as a defibrillator.
Both of his knees have been replaced as well as his hip. Four years ago the
patients big toe on his right foot was amputated and six months after that
the rest of his foot was removed. The subject also has problems with high
cholesterol, low HDL, and high blood pressure. The patient weighs 279
pounds and is 5'10" this puts him at a BMI of 40 which is categorized as
obese class III. A man of his height has an ideal body weight of 166 lbs
10% (149.4-182.6). However, his amputation puts his adjusted ideal body
weight at 156.2 lbs 10% (140.6-171.8). This puts him at 198%-162.4% of
his adjusted ideal body weight. The patient consumed 1352 kcals on the day

7
of the recall this is 52% of his needs (2578 kcal). He consumed 102.5 g of
protein which is 81-67% of his needs (126.55- 151.86 g). His carbohydrate
intake was 129 g, he did not list a specific restriction based on his diabetes.
His fat intake was 76g this was 88% of his estimated needs (86 g). His fluid
intake for the day was 1422 cc/day which is 37% of his estimated need of
3795.5 cc/.
The subject is on numerous medications to take care of his medical
conditions. The medicines he takes are: Nifedpine for angina, Coreg a betablocker, Pravachol for cholesterol, Lasix for fluid retention, Isoartan for
hypertension, Nitrostat for angina, Alendronate for bone health, Novolog
Flexpen as needed for diabetes, and Lantus as needed for diabetes. They
also take Iron and B-complex supplements as well as, tylenol extra strength
for pain. The patient attempts to follow a low sugar diet and takes his blood
sugar levels four times a day. He takes insulin in the morning upon waking
and then during the day as needed.
Due to short notice the subject was only able to provide a 24 hour diet
recall which can be seen in Appendix B. For breakfast he had two poached
eggs, a fat free blueberry yogurt and a black coffee. Sometime between
breakfast and lunch he drank some water. He then had lunch at the senior
center which included roast beef, scalloped potatoes, coleslaw, applesauce,
and coffee. He did not consume the dessert provided this day, although he
usually does. For dinner he had a McDonalds fish sandwich with tartar sauce

8
and no cheese. He consumed this at home with a side of veggie chips and a
diet Orange soda. On this day he did not have any snacks.

Discussion
With this specific patient the hypothesis was correct. Along with
metabolic syndrome he had developed diabetes and problems associated
with heart disease. As stated in the introduction the conditions had a domino
effect on the subject. He began with abdominal obesity and insulin resistance
that went uncontrolled. These two conditions then led to high blood pressure
and cholesterol build up. Together all of these conditions effected the
efficiency of his heart and blood vessels. Eventually, the patient required
surgeries and pacemakers to keep his heart running properly. The diabetes
led to circulation problems that resulted in foot ulcers. While the doctors
believed that cutting off a toe would prevent the spread, the foot ulcers
continued until the rest of his foot was removed.
Before his foot had been amputated the patient had been making no
efforts to control his diabetes. The doctors had not pushed a low sugar or low
fat diet until a few years ago. After he lost his foot he started a low sugar
diet and kept track of his blood sugar levels. His 24 hour recall did a show a
diet low in sugar, however, his intake was very low in overall calories. While
a lower amount of calories is healthy to a certain point, he needs to make

9
sure he is meeting his energy needs. There were ways he could have added
foods in his diet that increase calories and nutrients without adding much fat
or sugar. The patient had said that he cut out snacks to limit the opportunity
for sugar, he could use snacks as a chance to add vegetables and whole
grains to his diet. His fluid intake is an area of concern, he consumed half of
the recommended amount. It is clear that he could benefit from an
appointment with a dietitian, but his doctor has never recommended one.
Since his amputation the patients physical activity has decreased. One
of the main methods of treatment for metabolic syndrome is increasing
physical activity. The patient does what he feels he is able to do. This usually
includes using his cane more than his wheelchair. The subject also tries to
get out of the house as much as possible, which does increase his activity.
The small measures he is taking to be more active is more than likely making
a big difference. With somebody of his age and in his condition small steps
need to be taken.
The patient interviewed was an easy way to see the effect of
uncontrolled metabolic syndrome, and the importance of diagnosis. Doctors
treated each risk factor and symptom as it appeared in the patient. If they
had been looking at the whole picture they may have encouraged him to
take measures to prevent the spread of disease. Metabolic syndrome is a
serious condition, and its occurrence is increasing in America. More

10
awareness needs to be spread so people understand that having one risk
factor puts them at risk for so much more.

Sources
1. Explore metabolic syndrome. National heart, lung, and blood institute
[internet]. 2011 [cited 2015 Apr 1]. Available from:
http://www.nhlbi.nih.gov/health/health-topics/topics/ms
2. 2. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin
BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC, Spertus JA, Costa F.
Diagnosis and management of the metabolic syndrome: an american
heart association/national heart, lung, and blood institute scientific
statement. Circulation. 2005; 112; 2735-2752.
3. Prasanna Kumar KM. Metabolic syndrome. Int J diabetes dev ctries.
2011; 31(4): 185-187.

11
4. 4. Song SH, Hardisty CA. Diagnosing metabolic syndrome in type 2
diabetes: does it matter? QJM 2008 Mar 19; 487-491.
5. 5. American diabetes association. Diagnosis and classification of
diabetes mellitus. Diabetes care. 2009 Jan; 32(1):S62-67.
6. Gropper SS, Smith JL. Advanced nutrition and human metabolism. 6th
ed. California: Wadsworth, Cengage Learning; 2013.
7. Clayton W, Elasy TA. A review of the pathophysiology, classification,
and treatment of foot ulcers in diabetic patients. Clinical diabetes
2009; 27(2):52-58.
8. Han TS, Lean MEJ. Metabolic syndrome. Medicine 2015 Feb; 43(2): 8087.
9. Bianchi G, Rossi V, Muscari A, Magalotti D, Zoli M. Physical activity is
negatively associated with the metabolic syndrome in the elderly. QJM.
2008; 101:713-721
10. Yaffe K, editors. Chronic medical disease & cognitive aging: toward a
healthy body and brain. New York: Oxford; 2013.

12

Appendix A
1.
2.
3.
4.
5.

Age: 81 years old

Gender: male
Weight: 279 lbs
Height: 510
Complications/Conditions/Diseases:

13
Diabetes, Pacemaker (4th one in 22 years old), Four stints, Defibrillator,
Amputation of toe: 4 years ago and foot 3 and a half years ago, 2 knee
replacements, and a hip replacement
6. Lab values: N/A
7. Medications:
Nifedpine for angina
Coreg a beta- blocker
Pravachol for cholesterol
Lasix for fluid retention
Isoartan for hypertension
Nitrostat for angina
Alendronate for bone health
Novolog Flexpen as needed for diabetes
Lantus as needed for diabetes
Iron
B-complex
tylenol extra strength for pain
8. Special diet?
Low sugar diet
9. Other

14
Takes sugar 4 times a day
Takes insulin in morning and as needed
10.
24-hour recall
Breakfast: 2 poached eggs, 6oz Fat free blueberry yogurt, 8 oz. coffee
with no cream or sugar
Snack: 16 oz. water
Lunch: 6 oz. roast beef, .5 cup scalloped potatoes, .5 cup coleslaw, .5
cup applesauce, 8 oz. coffee with no cream or sugar
Dinner: Mcdonalds Fish sandwich, About 30 Veggie chips, Diet Orange
pop

Appendix B

Breakfast
Poached
eggs
Fat free
blueberry
Yogurt
Coffee
(black)
Snack
Water
Lunch

Amount

Calories

Fat

Protein

Carbohydra
te

2 eggs

142 kcal

25 g

13 g

1g

6 oz

162 kcal

7g

32 g

8 oz

2 kcal

Fluid

237 cc

16 oz
474 cc

15
Roast Beef
Scalloped
potatoes
Coleslaw
Applesauce
Coffee
(Black)
Dinner
McDonalds
Fish
sandwich
Veggie
Chips
Diet orange
pop
Total

6 oz
cup

266 kcal
91 kcal

12 g
1g

36 g
3g

cup
cup
8 oz

66 kcal
51 kcal
2 kcal

3g

1g

1
360 kcal
sandwic
h
About 30 210 kcal
chips
16 oz
1352
kcal

8g
9g
14 g
237 cc

17 g

14 g

38g

9g

1.5 g

27 g
474 cc

76 g

102.5 g

129 g

1422
cc/day