Metabolic syndrome insulin resistance

PPARy White adipose tissue, atherosclerotic lesions Insulin-sensitizing and glucoselowering re-directs TG from non-adipose tissues and visceral adipose depots for storage in subcutaneous adipose tissue slowed progression of atherosclerosis Fatty acids, eico-sanoids Th iazolid i ned iones pioglitazone (Actos ), rosiglita-zone (Avandia ) Type 2 diabetes, (insulin resistance, metabolic syndrome)... 

S. Reynisdottir, K. Ellerfeldt, H. Wahrenberg, H. Lithell, and P. Arner, Multiple lipolysis defects in the insulin resistance (metabolic) syndrome, J. ain. Invest., 1994, 93, 2590-2599. 

Patients with metabolic syndrome are twice as likely to develop type 2 diabetes and four times more likely to develop CHD.3,11 These individuals are usually insulin resistant, obese, have hypertension, are in a prothrombotic state, and have atherogenic dyslipidemia characterized by low HDL cholesterol and elevated triglycerides, and an increased proportion of their LDL particles are small and dense.3... 

Insulin resistance has been associated with a number of other cardiovascular risks, including abdominal obesity, hypertension, dyslipidemia, hypercoagulation, and hyperinsulinemia. The clustering of these risk factors has been termed metabolic syndrome. It is estimated that 50% of the United States population older than 60 years of age have metabolic syndrome. The most widely used criteria to define metabolic syndrome were established by the National Cholesterol Education Program Adult Treatment Panel III Guidelines (summarized in Table 40-2). 

Differential diagnoses include diabetes mellitus and metabolic syndrome because patients with these conditions share several similar characteristics with Cushing s syndrome patients (e.g., obesity, hypertension, hyperlipidemia, hyperglycemia, and insulin resistance). In women, the presentations of hirsutism, menstrual abnormalities, and insulin resistance are similar to those of polycystic ovary syndrome. Cushing s syndrome can be differentiated from these conditions by identifying the classic signs and symptoms of truncal obesity, "moon faces" with facial plethora, a "buffalo hump" and supraclavicular fat pads, red-purple skin striae, and proximal muscle weakness. 

ATP III recognizes the metabolic syndrome as a secondary target of risk reduction after LDL-C has been addressed. This syndrome is characterized by abdominal obesity, atherogenic dyslipidemia (elevated triglycerides, small LDL particles, low HDL cholesterol), increased blood pressure, insulin resistance (with or without glucose intolerance), and prothrom-botic and proinflammatory states. If the metabolic syndrome is present, the patient is considered to have a CHD risk equivalent. 

Because of the polyfactorial nature of disease states, such as obesity, type 2 diabetes, and Metabolic Syndrome, it is expected that drugs targeting the lipid synthesis and metabolism pathways will be used in the context of combination therapy [7]. Pre-clinical and clinical results to date indicate that pronounced efficacy could be achieved toward the management of associated lipid levels and insulin resistance, and thus, investigation in these areas provides significant promise. 

Defects in glucose uptake into muscle cells are characteristic of insulin resistance in type 2 diabetes and the metabolic syndrome. This phenomenon is likely to be due to reduced activity of a transporter that operates by what mechanism ... 

Fluasterone is a stable adrenocortical steroid, a 16a-fluoro analogue of prasteron [dehydroepiandrosterone (DHEA)j. It is currently developed (phase II) for the treatment of metabolic syndrome (i.e. insulin resistance). Electrophilic... 

Dermatitis. Inflammation of the skin. Diabetes mellitus. A chronic syndrome of impaired carbohydrate, protein, and fat metabolism owing to insufficient secretion of insulin or to target tissue insulin resistance. Diabetes. A general term referring to disorders characterized by excessive urine excretion (polyuria), as in diabetes mellitus and diabetes insipidus. 

Abdominal obesity is associated with a threatening combination of metabolic abnormalities that includes glucose intolerance, insulin resistance, hyperinsulinemia, dyslipidemia (low HDL and elevated VLDL), and hypertension. This clustering of metabolic abnormalities has been referred to as syndrome X, the insulin resistance syndrome, or the metabolic syndrome. Individuals with this syndrome liave a significantly increased risk for developing diabetes mellitus and cardiovascular disorders. For example, men with the syndrome are three to four times more likely to die of cardiovascular disease. 

Disorders associated with syndrome X (insulin resistance syndrome, metabolic syndrome)... 

It is by no means impossible that the overall effect of oral contraceptives on the arterial system is exercised through a complex of different mechanisms. In this respect it is worth recalling the insulin resistance syndrome or metabolic syndrome, which comprises a set... 

The use of metformin in polycystic ovarian syndrome, which is often accompanied by insulin resistance or other aspects of the metabolic syndrome, has been systematically reviewed (101). Metformin was therapeutically less effective than weight loss. Adverse effects were nausea, vomiting, and gastrointestinal disturbances. 

Dyslipidemia is a common accompaniment of the lipodystrophy syndrome observed in HIV-infected patients. This syndrome presents as a combination of peripheral lipoatrophy and the metabolic syndrome (central adiposity, insulin resistance, and dyslipidemia). The term lipodystrophy syndrome was first used in two case reports to describe a clinical picture of subcutaneous fat wasting in the face and limbs of HIV infected patients treated with indinavir, reminiscent of the rare congenital lipodystrophy syndromes (138,139). In addition, benign symmetric lipomatoses on the trunk and neck were described. A systematic study of this syndrome in the Australian HIV cohort showed co-existence of peripheral lipoatrophy with abdominal visceral obesity, dyslipidemia, and insulin resistance in HIV-infected patients with or without treatment with protease inhibitors (140). 

While the association between dairy food intake and obesity is less clear, observational studies have indicated that dairy food consumption may be protective against the development of metabolic syndrome and type 2 diabetes. Pereira et al. (2002) reported an inverse relationship between dairy product consumption and insulin resistance syndrome in a prospective study of 3157 young adults (18-30 years) with 10 years of follow-up. Further, Mennen et al. (2000) reported that more than four servings of dairy products per day was associated with a nonsignificant inverse association with the metabolic syndrome in women, while a significant association in men was found. 

Riserus, U., Amer, P., Brismar, K., and Vessby, B. (2002). Treatment with dietary transl0cisl2 conjugated linoleic acid causes isomer-specific insulin resistance in obese men with the metabolic syndrome. Diabetes Care 25,1516-1521. 

Finally, insulin resistance is present in disease states other than type 2 diabetes mellitus. Patients with conditions such as hypertension, obesity, and certain hyperlipidemias are also found to have decreased tissue sensitivity to circulating insulin.19,72 As discussed in Chapter 21, a combination of these abnormalities is often described as metabolic syndrome, or syndrome X.127,128 Metabolic syndrome occurs when insulin resistance, high blood pressure, abdominal... 

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