The Metabolic Syndrome and Inflammation

Abstract

The metabolic syndrome (MS) is a clustering of cardiovascular risk factors, with insulin resistance as a major feature. This syndrome has been variously defined, but generally consists of 3 or more of the following components: hyperglycemia, hypertension, hypertriglyceridemia, low HDL, and increased abdominal circumference and/or BMI at >30 kg/m(2). The WHO criteria require the presence of insulin resistance to make the diagnosis. The current review focuses particularly on the association of the MS and the proinflammatory state as well as treatment options to prevent the development of coronary heart disease (CHD). Chronic inflammation is frequently associated with the MS. Inflammatory markers that have been associated with MS include hs-CRP, TNF-alpha, fibrinogen, and IL-6, among others. The link between inflammation and the MS is not fully understood. One postulated mechanism is that these cytokines are released into the circulation by adipose tissue, stimulating hepatic CRP production. The prothrombotic molecule PAI-1 is also increased in the MS. Adiponectin, produced exclusively by adipocytes, is decreased in obesity. The association of these proinflammatory and prothrombotic markers with the MS is discussed in detail. The general goals of treatment of the MS are prevention of CHD events and diabetes if not already present. The approach to treatment of those with the MS should include lifestyle changes, including weight loss and exercise as well as appropriate pharmacological therapies. Certain medications, which may be used in persons with MS, have been shown to have beneficial effects on clinical outcome and/or anti-inflammatory effects.

Acute Pancreatitis in Obesity: Adipokines and Dietary Fish Oil

“…Obesity leads to fatty infiltration and organ dysfunction in many visceral organs, including the pancreas [3][4][5][6]. Obese humans are considered to be in a relative chronic inflammatory state [32]. Obesity has long been considered a major contributor in the development of several diseases with an inflammatory component, such as osteoarthritis, atherosclerosis, and inflammatory bowel disease [4,33,34].…”

“…Adipokines play a major role in carrying out the local and systemic effect of adipose tissue [13]. Adipokines modulate metabolism and the course of an inflammatory process [32]. Leptin was discovered in 1994 and is the most widely studied adipokine [3].…”

“…Adiponectin is the most abundant adipokine, and its circulating concentration paradoxically decreases with the progression of obesity [15,16]. Several studies have shown that adiponectin has a favorable protective antiinflammatory profile [32]. Modulating the adipokine milieu in obesity has been shown to attenuate the inflammatory process and slow disease progression associated with obesity [35].…”

Role of Oxidative Stress and Associated Alteration in Enzyme Activities in Obesity Comorbidities

“…5 Chronic increase in circulating free fatty acids often results in 'lipotoxicity', which is characterized by ectopic fat deposition in various organs as muscle and liver contributing to insulin resistance. 61,62 Moreover, hyperlipidemia is accompanied increased steroid hormones synthesis. For example, glucocorticoids increase the differentiation of visceral adipocytes) relative to subcutaneous, peripheral adipocytes, while decreasing adipocyte proliferation, causing hypertrophy of visceral adipocytes, and contributing to insulin resistance and hypertension.…”

Does Adiponectin Upregulation Attenuate the Severity of Acute Pancreatitis in Obesity?

“…[14][15][16] The status of the adipokine milieu associated with obesity contributes to the generalized proinflammatory state observed in obesity. 17 We have recently developed a murine model of acute pancreatitis in the setting of obesity. In this murine model, similar to the human situation, congenitally obese mice develop more severe pancreatitis than lean wild-type animals.…”