**2. Defining the metabolic syndrome (MetSy)**

Metabolic syndrome (MetSy) presents as a group of interrelated factors that increases the risk of acquiring cardiovascular disease (CVD) such as coronary heart disease (CHD), arterial atherosclerotic vascular disease and type-2 diabetes mellitus (T2DM), which was described as "Syndrome X" by Reaven in 1988. "Syndrome X" was characterized by impaired glucose tolerance (IGT), hyperinsulinemia, elevated triglycerides (TG), and reduced high-density lipoprotein cholesterol (HDLc) [8]. To date, several definitions of MetSy have been proposed by various international organizations and expert groups by incorporating its different components. These include definitions by the National Cholesterol Education Program Adult Treatment Panel III (NCEP:ATPIII), American Association of Clinical Endocrinology (AACE), International Diabetes Federation (IDF), American Heart Association (AHA) in collaboration with National Heart, Lung and Blood Institute (NHLBI), and World Health Organization (WHO) [9]. A summary of these definitions is presented in **Tables 1** and **2**.

In an effort to provide more consistency in both clinical care and research of patients with MetSy, these various international organizations and expert groups published a consensus joint statement in 2009 on uniform diagnostic criteria, The Harmonized Definition of Metabolic Syndrome [10]. The Harmonized Definition of Metabolic Syndrome (MetSy) includes the presence of 3 of the 5 risk factors, these being enlarged waist circumference (WC) with population-specific and country-specific criteria (WC > 102 cm in men and WC > 88 cm in women), serum triglycerides ≥150 mg/dL or 1.69 mol/l, high density lipoprotein (HDL-c) < 40 mg/dL or 1.03 mmol/l in men and < 50 mg/dL or 1.29 mmol/l in women, systolic blood pressure ≥ 130 mm Hg or diastolic blood pressure ≥ 85 mm Hg, as well as fasting glucose ≥100 mg/dL or 5.6 mmol/l. Also included are patients taking medication to manage hypertriglyceridemia, low highdensity lipoproteins (HDL-c), hypertension and hyperglycaemia.

MetSy predicts that the development of type 2 diabetes mellitus (T2DM) leads, in addition, to increased cardiovascular morbidity [9]. Thus, the main components of MetSy are: dyslipidaemia, characterized by elevated triglycerides and low High-Density Lipoproteins (HDL cholesterol), elevated blood pressure (BP), hyperglycaemia, abdominal obesity and/or insulin resistance (IR). Metabolic syndrome is not a disease per se, but a combination of metabolic abnormalities which can present in different ways in accordance with the various components that constitute the syndrome.

**193**

**Table 1.**

*Metabolic Syndrome in Reproductive Health: Urgent Call for Screening*

• Waist circumference > 102 cm in men and > 88 cm in women;

National Cholesterol Education Program Adult Treatment Panel III (NCEP:ATPIII): Any three or more of the

American Association of Clinical Endocrinology (AACE): Impaired glucose tolerance plus two or more of the

• TG ≥ 150 mg/dl (1.69 mmol/l) and/or HDL-cholesterol <40 mg/dl (1.03 mmol/l) in men and < 50 mg/

International Diabetes Federation (IDF): Central obesity (defined by waist circumference with ethnicity-

American Heart Association in collaboration with National Heart, Lung and Blood Institute (AHA/NHLBI):

• Fasting glucose ≥100 mg/dl (5.56 mmol/l). TG: Triglyceride; HDL: High density lipoprotein; BP: blood

and/or the

• HDL-cholesterol <40 mg/dl (1.03 mmol/l) in men and < 50 mg/dl (1.29 mmol/l) in women;

• HDL-cholesterol <40 mg/dl (1.03 mmol/l) in men and < 50 mg/dl (1.29 mmol/l) in women;

specific values#, but can be assumed if BMI > 30 kg/m2), plus two of the following:

• Waist circumference ≥ 102 cm in men, and ≥ 88 cm or greater in women;

• HDL-cholesterol <40 mg/dl (1.03 mmol/l) in men and < 50 mg/dl (1.29 mmol/l) in women;

**3. Pathophysiological development of metabolic syndrome**

• Antihypertensive and/or high blood pressure (systolic or diastolic ≥140 ≥ 90 mm/Hg) • Plasma triglycerides ≥150 mg/dl ˂HDL cholesterol 39 mg/dl (in women)˃BMI 30 kg/m2

• Urinary albumin excretion rate ≥ 20 g/min or albumin creatinine ratio ≥ 30 mg/g

Many different factors such as genetics, lifestyle (diet and physical activity), obesity and insulin resistance have been hypothesized to play a role in the development of MetSy [8, 11, 12]. Visceral adiposity as a result of a high caloric intake has been demonstrated to be a primary trigger and a major causative factor for the pathogenesis in MetSy [13–15]. A metanalysis conducted by Ryckman et al. [16]

*DOI: http://dx.doi.org/10.5772/intechopen.95971*

• Fasting glucose ≥100 mg/dl (5.56 mmol/l).

• TG ≥ 150 mg/dl (1.69 mmol/l);

dl (1.29 mmol/l) in women;

• TG ≥ 150 mg/dl (1.69 mmol/l);

• Fasting glucose ≥100 mg/dl (5.56 mmol/l).

pressure: BMI: body mass index #See **Table 2**.1.

• Insulin resistance defined euglycemic hyperinsulinemic

• BP ≥ 130/85 mmHg;

• BMI ≥ 25 kg/m2;

• BP ≥ 130/85 mmHg.

• BP ≥ 130/85 mmHg;

Any three of the following:

• BP ≥ 130/85 mmHg;

Type 2 Diabetes

• Impaired fasting glucose • Impaired Glucose Tolerance

More any two of the following:

waist/hip ˃ 0.85 (in women)

*Metabolic syndrome definitions [9].*

• TG ≥ 150 mg/dl (1.69 mmol/l);

WHO clinical criteria for defining MetS: • Resistance to insulin by one of the following:

following:

following:

National Cholesterol Education Program Adult Treatment Panel III (NCEP:ATPIII): Any three or more of the following:


*Lifestyle and Epidemiology - The Double Burden of Poverty and Cardiovascular Diseases...*

impact on reproductive health in both the male and females population [7].

Metabolic syndrome (MetSy) presents as a group of interrelated factors that increases the risk of acquiring cardiovascular disease (CVD) such as coronary heart disease (CHD), arterial atherosclerotic vascular disease and type-2 diabetes mellitus (T2DM), which was described as "Syndrome X" by Reaven in 1988. "Syndrome X" was characterized by impaired glucose tolerance (IGT), hyperinsulinemia, elevated triglycerides (TG), and reduced high-density lipoprotein cholesterol (HDLc) [8]. To date, several definitions of MetSy have been proposed by various international organizations and expert groups by incorporating its different components. These include definitions by the National Cholesterol Education Program Adult Treatment Panel III (NCEP:ATPIII), American Association of Clinical Endocrinology (AACE), International Diabetes Federation (IDF), American Heart Association (AHA) in collaboration with National Heart, Lung and Blood Institute (NHLBI), and World Health Organization (WHO) [9]. A summary of these definitions is presented in

In an effort to provide more consistency in both clinical care and research of patients with MetSy, these various international organizations and expert groups published a consensus joint statement in 2009 on uniform diagnostic criteria, The Harmonized Definition of Metabolic Syndrome [10]. The Harmonized Definition of Metabolic Syndrome (MetSy) includes the presence of 3 of the 5 risk factors, these being enlarged waist circumference (WC) with population-specific and country-specific criteria (WC > 102 cm in men and WC > 88 cm in women), serum triglycerides ≥150 mg/dL or 1.69 mol/l, high density lipoprotein (HDL-c) < 40 mg/dL or 1.03 mmol/l in men and < 50 mg/dL or 1.29 mmol/l in women, systolic blood pressure ≥ 130 mm Hg or diastolic blood pressure ≥ 85 mm Hg, as well as fasting glucose ≥100 mg/dL or 5.6 mmol/l. Also included are patients taking medication to manage hypertriglyceridemia, low high-

MetSy predicts that the development of type 2 diabetes mellitus (T2DM) leads, in addition, to increased cardiovascular morbidity [9]. Thus, the main components of MetSy are: dyslipidaemia, characterized by elevated triglycerides and low High-Density Lipoproteins (HDL cholesterol), elevated blood pressure (BP), hyperglycaemia, abdominal obesity and/or insulin resistance (IR). Metabolic syndrome is not a disease per se, but a combination of metabolic abnormalities which can present in different ways in accordance with the various components that constitute the syndrome.

density lipoproteins (HDL-c), hypertension and hyperglycaemia.

**2. Defining the metabolic syndrome (MetSy)**

and alcohol consumption [4].

maternal and perinatal conditions, and nutritional disorders combined [2, 3]. The risk factors associated with NCDs include smoking, high blood pressure, unhealthy diet, inactivity, overweight and obesity, hypercholesterolemia, elevated blood sugar

In 2016, the WHO recorded 39% of adults aged 18 years and over (39% of men and 40% of women) to be overweight and on the whole about 13% of the world's adult population (11% of men and 15% of women) were obese in 2016 [5]. Obesity and overweight). The worldwide prevalence of obesity nearly tripled between 1975 and 2016 [5]. Obesity in men in reproductive age is increasing worldwide, impacting negatively on reproductive potential, sperm function and assisted reproduction outcomes. Changes in modern eating behaviors are needed to invert the negative correlation between lifestyle and sperm quality [6]. Current studies predict that approximately 25% of children less than 16 years old will be obese by the year 2050. This is of serious concern as childhood obesity predisposes individuals to adult obesity and the associated obesity related medical sequelae. One such sequela is the

**192**

**Tables 1** and **2**.

• Fasting glucose ≥100 mg/dl (5.56 mmol/l).

American Association of Clinical Endocrinology (AACE): Impaired glucose tolerance plus two or more of the following:


International Diabetes Federation (IDF): Central obesity (defined by waist circumference with ethnicityspecific values#, but can be assumed if BMI > 30 kg/m2), plus two of the following:


American Heart Association in collaboration with National Heart, Lung and Blood Institute (AHA/NHLBI): Any three of the following:


WHO clinical criteria for defining MetS:


More any two of the following:


#### **Table 1.**

*Metabolic syndrome definitions [9].*
