Metabolic SyndromeAmber LeonJeanine MillsErin Prasad

Nutrition Assessment and Therapy 1Winter 2012

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A diagnosis of Metabolic Syndrome means that a person is at increased risk for developing◦ Cardiovascular Disease (2 times as likely)◦ Type 2 Diabetes Mellitus (5 times as likely)◦ Stroke

Introduction/Video

Metabolic syndrome represents the clustering of several risk factors and is not a disease unto itself.

In 1988 Gerald M. Reaven proposed insulin resistance as the underlying factor and named the constellation of abnormalities Syndrome X.

Insulin resistance may underlie the pathogenesis of metabolic syndrome.

Or insulin resistance may result from the increased visceral adipose tissue (VAT)

Pathophysiology

Fat distribution seems to be related to metabolic function with centrally obese people at higher risk of metabolic syndrome and it’s associated diseases than peripherally obese people.

Pathophysiology 2

VAT products that may activate components of the inflammatory pathway and inhibit insulin signaling.◦ Free fatty acids and their metabolites◦ Cytokines (ex: tumor necrosis factor alpha)◦ Adiponectin (hormone released from adipose

tissue) decreases, furthering insulin resistance.

VAT is a risk factor for coronary artery disease, dyslipidemia hypertension, stroke, type 2 diabetes and Metabolic Syndrome

Pathophysiology 3

3 out of these 5 must be present for diagnosis Central Obesity Impaired Glucose Tolerance Hypertension Dyslipidemia

◦ Elevated Serum Triglicerides◦ Lowered HDL Level

Symptoms

Additional symptoms includeProthrombotic state

high fibrinogen or plasminogen activator inhibitor [-1] in the blood

• Proinflammatory state elevated high-sensitivity C-reactive protein in the blood

Genetics Smoking Sedentary lifestyle High calorie diet High-fat diet Ethnicity

Additional Causes/Risk Factors

For Diagnosis Patient must have 3 out of 5 defining symptoms Screening/Labs

◦ Waist Circumference > 40 inches in males >35 inches in females

◦ Blood Pressure >140/90 >130/85

if insulin resistance present

◦ Fasting Blood Glucose > 110mg/dl

◦ Serum Triglycerides > 150mg/dl

◦ Serum HDL < 40mg/dl for males < 50mg/dl for females

Screening/Diagnosis/Labs

To increase mortality and decrease the co-morbidities associated with Metabolic Syndrome.

Weight Reduction◦ specifically reduction of visceral adipose tissue and decreased waist

circumference (waist to hip ratio, Index of Central Obesity)

Maintain normal blood glucose levels

Improve lipid profile (increase HDL, lower triglycerides)

Lower blood pressure

Decrease Systemic Inflammation

Goals for MNT

Dash Diet◦ Designed to reduce hypertension◦ Low sugar◦ Low fat◦ High fiber

Carbohydrate Counting/Exchanges◦ normalization of blood glucose

Fruit and Vegetable intake◦ May help to lower blood pressure◦ May help to lose weight◦ May replace other more refined carbohydrates

Omega 3 Fats◦ Reduction of inflammation

Refer for and Encourage physical activity◦ Improved glucose tolerance◦ Improved blood pressure◦ Improved lipid profile◦ Improved cardiovascular fitness and endurance◦ Improved depression

Medical Nutrition Therapy

Calculate calories for weight loss◦ 7% weight loss has been shown to be enough to reverse a Metabolic Syndrome

diagnosis

Protein within AMDR◦ 10-35% of calories

Fat within AMDR◦ 20-35% of calories◦ Emphasis on omega 3 and unsaturated fatty acids

Carbohydrate within AMDR◦ 45-65% of calories◦ Emphasis on whole foods sources◦ Emphasis on maintaining blood sugar levels as close to normal as

possible.

Fluids◦ 35ml/kg or 1ml/kcal

Nutrient Needs

Blood Glucose◦ Insulin◦ Oral medications

Sulfonylureas, Meglitinides Biguanides Thiazolidinediones Alpha-glucosidase inhibitors DPP-4 inhibitors

Cholesterol◦ Statins◦ Bile acid binding resins◦ Cholesterol absorption inhibitors◦ Combination cholesterol

absorption inhibitor and statin◦ Fibrates◦ Niacin

◦ Combination statin and niacin◦ Omega-3 Fatty Acids

Blood Pressure◦ Diuretics◦ Beta-blockers◦ ACE inhibitors◦ Angiotensin II receptor blockers◦ Alpha-2 receptor Agonist◦ Combined alpha and beta-

blockers◦ Central agonists◦ Peripheral adrenergic inhibitor◦ Vasodialoator

Medications

Insulin resistance◦ Chromium polynicotinate, ◦ Maitake mushrooms◦ Green tea polyphenols◦ Antioxidants ◦ Alpha lipoic acid ◦ Cinnamon◦ Oat beta-glucan◦ Omega 3 fatty acids◦ Holy Basil

Abnormal blood lipids◦ Omega-3 fatty acids◦ Niacin ◦ Oat beta-glucan◦ Holy Basil

Blood Pressure◦ Garlic◦ Omega-3 fatty acids◦ calcium ◦ magnesium◦ vitamin C◦ Miatake Mushrooms

Anti Inflammatory◦ B-vitamins

B6, B12, Folate◦ Omega 3 fatty acids◦ Turmeric◦ Ginger◦ Holy Basil

Supplements/Herbs/Botanicals

In 2006 The IDF (international diabetes foundation) estimated that 20-25% of the World population has Metabolic Syndrome.◦ Prevalence is increasing in the adult population worldwide◦ Prevalence is increasing in the US among children and adolescents

Secondary associated conditions include◦ Compromised renal function◦ Polycystic ovary syndrome◦ Non-alcoholic fatty-liver disease◦ Non-alcoholic steatohepatitis◦ Gestational diabetes mellitus◦ Inflammation◦ Depression

Metabolic Syndrome is COMPLICATED The causes and symptoms overlap and contribute to one another. Pharmacological interventions improve some symptoms while exacerbating others People with this diagnosis are likely to be overwhelmed and feeling hopeless about

their ability to improve their health. Diet and Exercise lifestyle changes can improve patients health dramatically.

Other Considerations

References