I read with great interest the arguments presented both by E.A.M.
Gale and by K.G.M.M. Alberti and P.Z. Zimmet on the metabolic syndrome
[1,2]. I fear, however, that I may have contributed to the “existing
confusion” [1] by suggesting the existence of a broader syndrome,
including not only the standard features of the metabolic syndrome, but
also other entities such as sleep apnea, under the name “barisystemic
syndrome” [3]. This entity has been suggested as consisting of “the
systemic consequences of excessive weight, including hormonal, body
habitus, metabolic, hemodynamic and respiratory parameters” [3].
The suggestion has its grounds on what I think are extremely clear
data linking weight loss associated to bariatric surgery and a frequent
finding of a complete resolution or improvement of diabetes,
hyperlipidemia, hypertension, and obstructive sleep apnea. As I have
stated previously, “The assumption of excessive weight/obesity as the
probable cause for the association of a number of other important
cardiovascular risk factors may lead to a general revision of the
reasoning concerning this important topic” [3].
Could we turn to causality, recognizing that, at least in many cases,
even if these clinical features may be “running together”, the start of
the race is likely to have been excessive weight/obesity?
References
1. Gale EAM. Should we dump the metabolic syndrome? Yes. BMJ 2008;
336: 640.
2. Alberti KGMM, Zimmet PZ. Should we dump the metabolic syndrome?
No. BMJ 2008; 336: 641.
3. Nunes JPL. The risk factor association syndrome as a barisystemic
syndrome: a view on obesity and the metabolic syndrome. Med Hypotheses
2007; 68: 541-5. Epub 2006 Oct 9.
Competing interests:
None declared
Competing interests:
No competing interests
28 March 2008
José Pedro L. Nunes
Associate professor
Faculdade de Medicina da Universidade do Porto, Portugal
Rapid Response:
Focus on causality.
I read with great interest the arguments presented both by E.A.M. Gale and by K.G.M.M. Alberti and P.Z. Zimmet on the metabolic syndrome [1,2]. I fear, however, that I may have contributed to the “existing confusion” [1] by suggesting the existence of a broader syndrome, including not only the standard features of the metabolic syndrome, but also other entities such as sleep apnea, under the name “barisystemic syndrome” [3]. This entity has been suggested as consisting of “the systemic consequences of excessive weight, including hormonal, body habitus, metabolic, hemodynamic and respiratory parameters” [3].
The suggestion has its grounds on what I think are extremely clear data linking weight loss associated to bariatric surgery and a frequent finding of a complete resolution or improvement of diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea. As I have stated previously, “The assumption of excessive weight/obesity as the probable cause for the association of a number of other important cardiovascular risk factors may lead to a general revision of the reasoning concerning this important topic” [3].
Could we turn to causality, recognizing that, at least in many cases, even if these clinical features may be “running together”, the start of the race is likely to have been excessive weight/obesity?
References
1. Gale EAM. Should we dump the metabolic syndrome? Yes. BMJ 2008; 336: 640.
2. Alberti KGMM, Zimmet PZ. Should we dump the metabolic syndrome? No. BMJ 2008; 336: 641.
3. Nunes JPL. The risk factor association syndrome as a barisystemic syndrome: a view on obesity and the metabolic syndrome. Med Hypotheses 2007; 68: 541-5. Epub 2006 Oct 9.
Competing interests: None declared
Competing interests: No competing interests