The
metabolic syndrome (MS) describes a cluster of metabolic disturbances including
type 2 diabetes and/or
insulin resistance,
hypertension,
dyslipidemia and
obesity, which predict a high risk of cardiovascular disorders. The associated
hyperinsulinemia and hyperleptinemia may contribute to the cardiovascular risk. However, the operational value of the MS in elderly patients is questionable. We therefore investigated the prevalence and significance of the MS in geriatric care. In a survey of 98 consecutive admissions of diabetic patients, <40% had a MS; this is a low value compared to younger diabetic adults, due to a low prevalence of
obesity and
dyslipidemia. We found a high prevalence of low BMI (<20 kg/m2),
hypoalbuminemia and low total
cholesterol levels, suggesting that the MS may be modified by
undernutrition. The interplay between the MS and
undernutrition was further studied in 30 non-diabetic patients. Both leptinemia and
insulin resistance indexes (HOMA-IR and QUICKI) were strongly associated with BMI and body fat (measured by Bioelectrical impedance Analysis). BMI, leptinemia and
insulin resistance indexes were associated with the Mini Nutritional Assessment (MNA) score. Thus,
undernutrition is associated with low
leptin and
insulin levels and may obscure the association of these parameters with cardiovascular risk. In conclusion, the MS has a low prevalence in our population of elderly diabetic patients, and is of questionable prognostic value. It can be oveshadowed by
undernutrition, which is associated with low
body weight, leptinemia and
insulin resistance indexes. Prevention of
undernutrition and/or adjustment to its consequences should receive higher priority in the care of elderly diabetic patients.