In-depth intervention for metabolic syndrome: Clinical evidence from pathological features to motor reversal

Metabolic syndrome (MS) is a pathological condition characterized by hyperlipidemia, hyperglycemia, and hypertension. The Chinese Diabetes Society recommends the following diagnostic criteria suitable for the Chinese population: overweight or obesity (BMI ≥ 25.0); hyperglycemia (fasting FBG ≥ 6.1 mmol/L); hypertension ≥ 140/90 mmHg; and dyslipidemia (fasting TG ≥ 1.70 mmol/L). A diagnosis can be made if three or all of these four criteria are met. High-risk groups for metabolic syndrome include individuals over 40 years of age, those with pre-existing cardiovascular disease, non-alcoholic fatty liver disease, gout, or those with a family history of multiple conditions.

Obesity is a chronic metabolic disease caused by excessive accumulation of body fat. Obese patients often suffer from metabolic disorders, especially disorders of glucose and lipid metabolism, which seriously endanger their health. Non-alcoholic fatty liver disease (NAFLD) is the liver manifestation of metabolic syndrome. Insulin resistance is a major factor inducing metabolic syndrome; therefore, insulin resistance is also the initiating factor and central link in the development of NAFLD. The incidence of NAFLD is 10% to 24% in the general population, but as high as 75% in obese individuals.

Compared to peripheral adipose tissue, visceral adipose tissue has a more significant impact on non-alcoholic fatty liver disease (NAFLD). Currently, the increasing prevalence of fatty liver disease in clinical practice is primarily NAFLD associated with insulin resistance. Effective obesity control can significantly reduce the risk of fatty liver disease and other metabolic disorders. Moderate-intensity, prolonged aerobic exercise can significantly improve lipid metabolism, normalize blood lipid levels, and increase the sensitivity of tissue cells, especially skeletal muscle cells, to insulin. Long-term aerobic exercise can lower blood lipids, particularly reducing total cholesterol and LDL cholesterol, while increasing HDL cholesterol.

High-density lipoprotein (HDL) is mainly synthesized by the liver. It can cross the arterial intima to remove deposited cholesterol and carry it out of the blood vessel wall, repairing damaged vascular endothelial cells, thus earning it the reputation of a "vascular cleanser." Each type of lipoprotein carries a certain amount of cholesterol. HDL cholesterol, because of its protective effect on blood vessels, is usually called "good cholesterol." Low-density lipoprotein (LDL), on the other hand, is called "bad cholesterol." Excessive levels of LDL cholesterol can increase the burden on the cardiovascular system and are a major contributing factor to atherosclerosis.

Exercise significantly reduced fasting blood triglycerides, total cholesterol, and LDL cholesterol in obese adolescents. HDL cholesterol remained largely unchanged, but the HDL/LDL ratio increased. Moderate-intensity, prolonged aerobic exercise significantly reduced insulin resistance in obese patients. Patients with severe or severe obesity showed significantly elevated fasting insulin levels; although blood glucose levels may be relatively normal, elevated fasting insulin indicates the presence of insulin resistance.

After a period of aerobic exercise for weight loss, body fat percentage decreases significantly, and fasting insulin levels generally return to within the normal range. Some obese patients with type 2 diabetes, after losing weight through exercise, not only experience a reduction in obesity but also see their fasting blood glucose levels drop to the normal range, and their fasting insulin levels significantly decrease. Exercise for weight loss plays a very positive role in improving insulin resistance and metabolic syndrome. Exercise for weight loss can also reduce the risk factors for atherosclerosis in obese individuals.

Studies have found that after four weeks of exercise-based weight loss, plasma atherosclerotic index (AIP) and acyl-CoA cholesterol acyltransferase 2 (ACAT2) levels significantly decreased. This indicates that exercise-based weight loss plays a definite role in reducing the incidence of atherosclerosis in obese individuals in adulthood. Evaluating the effectiveness of weight loss is not only reflected in changes in body shape, but more importantly, in the degree to which weight loss improves metabolic syndrome. Any weight loss method that has adverse effects on health or does not improve metabolic syndrome is unreasonable or unscientific.