الفهرس 
Definition and Diagnostic criteriaOnly 14 pages are availabe for public view
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Abstract
The metabolic syndrome is a complicated condition in which several of normal metabolisms are affected.
Recently, metabolic syndrome is defined by International Diabetes Foundation as: Central obesity (measured mainly by waist circumference), together with increase in fasting blood glucose level plus hypertension or hypertriglyceraldemia.
Etiology of metabolic syndrome is multifactorial in which abnormality in adipose tissue metabolism is considered as a cornerstone in its pathophysiology. There is increase level of non-esterified fatty acids in adipose tissue, which increase insulin resistance in the muscles and liver. It also secrets various types of adipokinies which also increase insulin resistance and act as proinflammtory mediator with enhances atherosclerosis. Inherited genetic and environmental factors also play a role.
Previously, the management of metabolic syndrome considered to be mainly medical through changing life style (exercise, stopping smoking and decrease fatty diet) and through treatment of complications pharmacologically (diabetes, hypertension and hyperlipidmia).
Recently, it was found that bariatric surgery is associated with significant effects on the metabolic aspect of the syndrome specially diabetes.
Several bariatric surgery procedures have been introduced including malabsorptive, restrictive and combined techniques.
Malabsorptive bariatric surgery includes biliopancreatic diversion which is done with or without duodenal switch and mainly acts by exclusion of the duodenum and jejnum which prevents full absorption of nutrients.
Restrictive bariatric surgery as gastric banding and vertical band gastroplasty act mainly by decreasing gastric capacity to limit diet intakes.
Combined bariatric surgery as gastric bypass acts by both mechanisms decreasing gastric capacity and excluding the duodenum which decreases nutrient absorption.
Ileal transposition operations involve translocating an ileal segment higher into the intestinal pathway. In this part of the procedure, ingested food passes through the downstream intestine - the ileum - much earlier than it otherwise would be. When this occurs, the body reacts to carbohydrate meals much differently. The production of naturally occurring hormones in the intestine - such as glucagon like peptide-1 hormones or enteroglucagon is increased, which have the effect of improving insulin resistance, which results in fewer calories being converted into body fat.
Omentectomy is a novel additional treatment may associate with weight loose surgeries in the management of metabolic syndrome.
Recently, randomized clinical trials including patients with body mass index from 30-35 (non-obese patients) found that components metabolic syndrome markedly improve with surgical treatment, especially diabetes.
These trials were based on: duodenal exclusion which decreases nutrient absorption and neuroendocrine bases surgery (digestive adaptation with intestinal reserve) which amplified postprandial neuroendocrine response through decreasing postprandial Ghrelin and Resistin hormone by bypassing the forgut and increasing nutrient delivery to the hindgut which increase peptide YY and glucagon like peptide-1 hormones.