The Metabolic Syndrome Puzzles; Possible Pathogenesis and Management.

BACKGROUND AND AIMS: Metabolic syndrome is a multifactorial pathophysiological process with complicated homeostatic disorders that arises due to a combination of various systematic metabolic defects. Various theories underlie the development of metabolic syndrome, but are fully not understood. METHODS: Revising PubMed and Scopus literature data on metabolic syndrome pathogenesis and management. RESULTS: The most accepted hypothesis is that a cluster of risk factors combined to obtain a truly metabolic syndrome. The pathophysiology of metabolic syndrome depends on the underlying path of development, due to insulin resistance or chronic inflammation, and is usually combined with neurohormonal disturbance. While these defects can be inherited via loss of function of certain genes that lead to either severe obesity, early diabetes, or severe insulin resistance (with or without lipodystrophy). Chronic inflammation is also a driver of metabolic syndrome. Lifestyle is still the therapy of choice in the management of metabolic syndrome, but unfortunately during the lockdown, most people could not reserve a healthy regime; therefore, it can also be referred to as a pandemic with COVID-19. CONCLUSIONS: This powerful illustration shows how defects in specific encoded proteins located predominantly in the brain, pancreatic beta cell, muscle, or fat give rise to these distinct components of the metabolic syndrome. Primarily, obesity and its sequela are the initiators of metabolic syndrome. The presence of metabolic syndrome increases the risk and severity of other pathologies' emergence even in non-related metabolic syndrome diseases such as COVID-19. The article provides new insights into the pathogeneses and management of metabolic syndrome.

Clinical management of patients with genetic obesity during COVID-19 pandemic: position paper of the ESE Growth & Genetic Obesity COVID-19 Study Group and Rare Endo-ERN main thematic group on Growth and Obesity.

This article aims to provide guidance on prevention and treatment of COVID-19 in patients with genetic obesity. Key principals of the management of patients with genetic obesity during COVID-19 pandemic for patients that have contracted COVID-19 are to be aware of: possible adrenal insufficiency (e.g., POMC deficiency, PWS); a more severe course in patients with concomitant immunodeficiency (e.g., LEP and LEPR deficiency), although defective leptin signalling could also be protective against the pro-inflammatory phenotype of COVID-19; disease severity being masked by insufficient awareness of symptoms in syndromic obesity patients with intellectual deficit (in particular PWS); to adjust medication dose to increased body size, preferably use dosing in m2; the high risk of malnutrition in patients with Sars-Cov2 infection, even in case of obesity. Key principals of the obesity management during the pandemic are to strive for optimal obesity management and a healthy lifestyle within the possibilities of the regulations to prevent weight (re)gain and to address anxiety within consultations, since prevalence of anxiety for COVID-19 is underestimated.