Metabolomic Profile

Overview:

The Metabolomic Profile provides an assessment of the likelihood of Metabolic syndrome in at-risk patients. The Metabolomic Profile evaluates five biomarkers that may reflect a patient’s risk of developing Metabolic syndrome, which is identified by a cluster of cardiometabolic risk factors, with insulin resistance and adiposity as its central features. Identification of individuals with metabolic syndrome is important due to its association with an increased risk of and type 2 diabetes mellitus and coronary heart disease.

Detailed Information

The profile is designed to assess the likelihood of Metabolic syndrome (MetS) in at-risk patients.  Metabolic syndrome may occur at all stages in life.  The number of people with MetS has increased over the last two decades. It is estimated that greater than 18% of US adolescents, 30% of young – midlife adults, and 40% of senior adults (> 70 y.o.) have MetS.  

The incidence of MetS is increasing at an alarming rate. Controllable epigenetic factors clearly have a causal role.  Contributing factors may include obesity, insulin resistance, polycystic ovary disease, hormone imbalance, or a sedentary, unhealthy (smoking, etc.) lifestyle.    “Over nutrition” and poor dietary choices (highly processed, high fat, high salt, high sugar “empty-calorie” foods), combined with sedentary habits, interact with our genetic programming: we store extra calories as fat.  Fat cells (adipocytes) produce hormones (adipokines) that interact with the hypothalamus and or immune system and may have pro-inflammatory or anti-inflammatory effects.  Altered adipokine levels have been observed in MetS.  Insulin (fasting) resistance is a hallmark feature of MetS. The biomarkers that constitute the Metabolomic Profile include:

Glycomark (1,5-anhydroglucitol) –indicates poor control of blood glucose spikes, specifically frequent hyperglycemic events over the past two weeks (not evident from HbA1c). Postprandial hyperglycemia is associated with Cardiovascular disease, and reduction of hyperglycemic events appear to decrease macro- and microvascular complications in diabetic patients. Low 1,5-AG is also associated with renal damage. Hemoglobin A1c (HbA1c) – estimates the average blood glucose concentration for the life of the red blood cell (120 days)
Insulin – levels of insulin elevate early in type II diabetes, and then decrease as pancreatic beta cells lose function.
Leptin – is a hormone produced by adipocytes to provide a satiety signal to the hypothalamus. Elevated circulating levels of leptin are associated with adipose tissue abundance and leptin resistance. High levels of this adipokine have pro-inflammatory effects, and leptin accelerates arterial foam cell formation. Adiponectin – improves insulin sensitivity and stimulates glucose uptake and hepatic fatty acid oxidation. Very low levels of this anti-inflammatory adipokine may increase the risk for CVD and some cancers.
Leptin to Adiponectin ratio- the ratio of leptin to adiponectin appears to be a sensitive indicator for a variety of adverse health conditions.
Cystatin C, Creatinine, and eGFR – renal damage is a common consequence of MetS and hyperglycemia. Cystatin C is considered to be a better indicator of GFR than serum creatinine or calculated GFR (eGFR).

Patients that may especially benefit from the Metabolomic Profile include those with:

• Excess abdominal adiposity or body mass index (BMI) >30
• High triglycerides or need for cholesterol medication
• Low HDL cholesterol or need for cholesterol medication
• Hypertension or need for hypertension medication
• Fasting Glucose > 100 mg/dL
• Family or personal history of cardiovascular disease, high cholesterol, or type II diabetes
• Personal history of chronic inflammatory disease

Except for obesity, the risk factors for MetS, and the chronic diseases that may develop from it, may present no symptoms until well advanced.  The greatest window of opportunity to prevent the development of atherosclerosis, type II diabetes, renal damage, or heart failure may occur during the early, symptom-free stages of MetS.  Early detection and intervention through diet and lifestyle changes may prevent the development of symptoms or disease complications. The Metabolomic Profile facilitates clinicians in the early detection of Metabolic syndrome.

Performing Lab: DDINT