Metabolic Syndrome

Metabolic syndrome is not a single disease but a constellation of findings that travel together and amplify each other. The diagnostic criteria require three of five: central obesity (waist >102 cm men / 88 cm women), elevated triglycerides (≥150 mg/dL), low HDL (<40 men / 50 women), elevated blood pressure (≥130/85), and elevated fasting glucose (≥100 mg/dL). About one in three U.S. adults meets the criteria. The shared root is insulin resistance — peripheral tissues stop responding normally to insulin, the pancreas compensates with hyperinsulinaemia, and the metabolic picture cascades from there.

• Fasting glucose ≥100 mg/dL — one of the five criteria.
• Triglycerides ≥150 mg/dL — another.
• HDL cholesterol below 40 (men) / 50 (women) — another.
• HbA1c — typically rising even when fasting glucose is borderline; identifies progression risk.
• ALT — often elevated due to coexisting NAFLD.
• Uric acid, fasting insulin, hsCRP — supportive evidence of the underlying physiology.

Metabolic syndrome itself is asymptomatic — it's caught by routine screening before the downstream diseases (diabetes, heart disease, fatty liver) become symptomatic. Associated features may include:

• Visible central obesity
• Skin tags, acanthosis nigricans (velvety dark patches)
• Easy fatigue, especially after meals
• Polycystic ovary syndrome in women