Are we missing the chance to treat metabolic syndrome in young adults in Alberta?

An analysis of electronic medical records of young adults in northern Alberta has revealed that physicians and patients may be missing out on important markers for metabolic syndrome that could help with preventing long term complications, including cardiovascular disease and diabetes.

The study, published in CMAJ Open, analysed the electronic medical records of 15,766 adults aged 18-40 in northern Alberta to identify who did and did not have metabolic syndrome and its related risk factors in each group. The study team chose to look at metabolic syndrome in young adult Albertans given the global increase in obesity and diabetes at a younger age.

“Most people believe that chronic disease doesn't crop up until later in life, but with increasing rates of obesity, we are now seeing metabolic syndrome occurring in younger adults,” said Jamie Boisvenue, a PhD student who completed this work during his master of science in epidemiology in the University of Alberta’s School of Public Health. “Our goal was to look at the treatable risk factors leading to serious long-term harm in these younger adults”.

The team, led by Rose Yeung, U of A associate professor, Faculty of Medicine & Dentistry, member of the Alberta Diabetes Institute and an adjunct professor in the School of Public Health, studied metabolic syndrome, a clustering of conditions associated with the development of chronic diseases. Metabolic syndrome is defined as at least three of the five components: abdominal obesity, high blood pressure, high blood sugar, high triglycerides and low high-density lipoprotein cholesterol (or HDL). They looked at clinical measurements from physical examinations, lab tests and disease diagnoses to identify individuals with metabolic syndrome. 

The most striking finding from the study was the lack of testing in individuals with risk factors for metabolic syndrome. Importantly, 84 per cent of patients who were overweight or obese were missing measures for fasting blood glucose and 79 per cent were missing triglycerides. In those who were identified as having metabolic syndrome based on available data, 20 per cent were missing screening tests for diabetes.

“Metabolic syndrome can be missed by both patients and doctors in younger patients, because they usually are seen for other priorities, and elevations in blood pressure and blood sugar are often asymptomatic for years. If a patient goes in for a birth control refill, and the doctor is running behind, the opportunity to talk about the patient’s increasing weight gain may go unaddressed. We also know both patients and physicians can have difficulty discussing excess weight, which can be a sensitive topic, especially in younger patients,” said Yeung.

According to Boisvenue, the amount of missing data shows that there is more to explore with physicians and patients since early detection offers an opportunity for earlier prevention of its consequences, such as stroke and fatty liver. Metabolic syndrome can exist even in seemingly healthy individuals who are not overweight if the other components are present. The team hopes to further engage physicians and young adults to better understand their concerns and observations about young- onset metabolic syndrome for earlier prevention and intervention.

"Sometimes having conversations with the family doctor about our lifestyle habits is hard but necessary. We often live in the now with a plan for being healthy later not realizing that our habits are setting the stage for chronic disease development." said Boisvenue. The study team recommends speaking with your family doctor if you suspect you may have metabolic syndrome or any of its components.

This study was done in partnership with the Department of Medicine, Division of Endocrinology & Metabolism (Rose Yeung), School of Public Health (Jeff Johnson), Department of Family Medicine (Donna Manca) and the Department of Computing Science (Carlo Oliva).