Five criteria in simple terms
The wording from the manuals looks scary, although there are clear measurements behind them. The diagnosis is made if any three out of five points are present. The situation is also taken into account when the indicator is normal, but only because the person is already taking the drug: the prescribed treatment for blood pressure or lipids is counted as a corresponding criterion.
- Окружность талии: у мужчин от 94 см и выше, у женщин от 80 см и выше. Для населения азиатского региона нередко применяют более строгий порог для мужчин — от 90 см.
- Триглицериды натощак 1,7 ммоль/л и выше либо уже назначенное лечение по этому поводу.
- Липопротеины высокой плотности ниже 1,0 ммоль/л у мужчин и ниже 1,3 ммоль/л у женщин.
- Артериальное давление 130/85 мм рт. ст. и выше либо приём препаратов от гипертонии.
- Глюкоза натощак 5,6 ммоль/л и выше либо ранее установленное нарушение углеводного обмена.
It's worth noting how soft the rapids are here. Pressure 132/86 mm Hg. Art. in everyday life it is considered “almost normal”, and sugar 5.7 mmol/l is “at the upper limit”. In isolation, this is really not a cause for alarm. But three such “almost normal” indicators together describe a completely definite state of metabolism, and this is precisely the meaning of combining them into a syndrome: the sum is more dangerous than the parts.
Why is the waist more important than weight and BMI?
Body mass index is useful for statistics, but it does not describe a specific person well: it does not distinguish between muscle and fat and does not say anything about where exactly this fat is located. And for metabolism, location is more important than quantity. Subcutaneous fat on the thighs and buttocks is metabolically quite calm. Visceral fat—the fat that surrounds the organs inside the abdomen—behaves differently.
- Visceral adipose tissue actively secretes substances that support low-grade inflammation throughout the body.
- From it, fatty acids enter directly into the portal vein and liver, triggering fatty hepatosis and the growth of triglycerides
- It directly impairs tissue sensitivity to insulin
- It affects vascular tone and renal regulation, raising blood pressure
- It compresses the diaphragm and impairs breathing during sleep, increasing sleep apnea.
Hence the paradoxical but common situation: a person with normal weight and a normal body mass index, but with a protruding belly and thin limbs, can have the whole set of metabolic disorders, while a strong person with a lot of weight due to muscles can have none. That is why a measuring tape is more informative than scales, and the conversation “I have a normal weight” does not eliminate the need to measure your waist.
What's Happening Inside: Insulin Resistance
All five criteria are connected by one common mechanism - a decrease in tissue sensitivity to insulin. Insulin acts as a key that allows cells to access glucose. When the lock begins to give in less easily, the pancreas compensates by releasing more keys. For some time, the scheme works: blood sugar remains normal, but only at the cost of constantly increased insulin. It is during this period - sometimes many years before diabetes - that all other signs of the syndrome are formed.
- Избыток инсулина заставляет почки задерживать натрий и воду — растёт артериальное давление.
- Печень получает сигнал производить больше жиров — растут триглицериды и снижаются липопротеины высокой плотности.
- В печени накапливается жир — развивается жировой гепатоз, который дополнительно ухудшает чувствительность к инсулину.
- Повышенный инсулин мешает расщеплению жировой ткани, из-за чего похудеть становится объективно труднее.
- Со временем клетки поджелудочной железы истощаются, компенсация ломается, и уровень сахара начинает расти — сначала это предиабет, затем диабет.
Pay attention to the fourth point: it explains why people with metabolic syndrome really have a harder time losing weight than others, and why accusations of laziness are unfair here. It's not just a matter of motivation - hormonal levels at this moment work against weight loss. The good news is that the very first kilograms break this cycle: insulin sensitivity improves, and then it becomes easier.
Prediabetes is reversible - that's the main thing
If you need to remember one fact from the whole topic, it is this one. Prediabetes is a condition in which sugar is higher than normal, but does not yet reach diabetes: fasting glucose is approximately 5.6–6.9 mmol/l or glycated hemoglobin is about 5.7–6.4%. This is not “incipient diabetes”, from which there is nowhere to escape, but a fork in the road. Large studies have shown that lifestyle changes at this stage reduce the likelihood of developing diabetes by about half - and this turned out to be more effective than drug prevention.
- The target weight loss is about 7% of the initial weight. For a person weighing 90 kg, this is approximately 6 kg, and not “minus thirty”
- About 150 minutes of moderate-intensity physical activity per week—essentially 30 minutes of brisk walking five times a week
- Even without weight loss, regular exercise alone improves insulin sensitivity
- The effect of each workout on tissue sensitivity lasts about a day or two, so regularity is more important than intensity
- Adding strength training twice a week improves results: muscles are the main consumer of glucose
- Sleep 7–8 hours: lack of sleep significantly impairs glucose tolerance after just a few nights
It is important to understand the word “reversible” correctly. It does not mean that after losing weight you can return to your previous lifestyle: the tendency does not disappear anywhere, and when habits are returned, the indicators return. It means something else - that a diagnosis of prediabetes is not a one-way ticket, and years, and sometimes decades, of living without diabetes are quite achievable. That is why finding a sugar level of 6.1 mmol/l during a medical examination is not a reason to give up, but the best moment to intervene.
Where to start: examination plan
Testing for suspected metabolic syndrome is inexpensive and quick—most of it can be done in one visit and one blood draw. Its meaning is not only to confirm the diagnosis, but also to search for those conditions that often go side by side and go unnoticed.
- Измерение окружности талии, роста, веса и артериального давления, желательно с домашним контролем давления в течение недели.
- Глюкоза натощак и гликированный гемоглобин; при пограничных значениях — тест с нагрузкой глюкозой.
- Липидограмма: общий холестерин, липопротеины низкой и высокой плотности, триглицериды.
- Печёночные ферменты и ультразвуковое исследование печени — жировой гепатоз при метаболическом синдроме встречается очень часто и обычно ничем себя не проявляет.
- Мочевая кислота, креатинин и анализ мочи на белок — почки и суставы страдают одними of первых.
- ТТГ для исключения гипотиреоза, у женщин с нарушением цикла — обследование на синдром поликистозных яичников.
- Оценка риска апноэ сна при храпе с остановками дыхания и дневной сонливости.
This last point deserves special attention because the connection works both ways. Sleep apnea worsens glucose metabolism and raises blood pressure, and excess weight worsens sleep apnea. While sleep remains interrupted and oxygen-free, attempts to normalize sugar and blood pressure often stall for no apparent reason, and recognition of apnea becomes the missing link that moves things forward.
What to do: practical steps
General calls to “eat right and exercise” are useless precisely because they don’t tell you where to start. It makes more sense to change one or two habits at a time, strengthening each one, than to try to rebuild your entire life from Monday and quit after three weeks.
- Remove liquid calories: sweet drinks, packaged juices, sugar in tea. This is the fastest and most noticeable change in triglycerides
- Replace some fast carbohydrates with protein and vegetables: satiety increases and sugar fluctuations decrease
- Shift the bulk of your meals to the first half of the day, don’t skip breakfast and don’t have one huge late dinner
- Walking as a basic load: start with the volume that is realistically feasible and increase gradually
- Strength training twice a week, even with your own bodyweight - muscles act as glucose storage
- Limit alcohol: it hits triglycerides and the liver more than is commonly thought
- Smoking cessation - in metabolic syndrome, smoking increases the already increased vascular risk
- Monitoring pressure at home and recording indicators: hypertension here is treated according to the usual rules and there is no need to wait until it happens
Medicines are not opposed to lifestyle, but complement it. In case of persistently high blood pressure, antihypertensive therapy is prescribed; in case of high risk, lipid-lowering drugs are prescribed; in case of severe disturbance of carbohydrate metabolism, the doctor may recommend drugs that improve insulin sensitivity. The mistake is not in taking medications, but in taking only them, leaving unchanged what created the problem.
