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Metabolic Syndrome

By

Hamdy sayed

Definition

Cluster of metabolic disorders most likely to be recognized in midlife and

includes high fasting blood glucose levels, hypertension, dyslipidemia,

and abdominal obesity. However metabolic syndrome may also develop

without the presence of a high body mass index.

Metabolic syndrome is also known as:

metabolic syndrome X,

cardio metabolic syndrome,

syndrome X,

insulin resistance syndrome,

Reaven's syndrome.

Prevalence

It is estimated that approximately 47 million people in the United States

have metabolic syndrome. (1)

Criteria: (2)

People who have 3 or more of these Criteria have metabolic syndrome

Elevated waist circumference:

o Men Equal to or greater than 40 inches (102 cm)

o Women Equal to or greater than 35 inches (88 cm)

Elevated triglycerides: Equal to or greater than 150 mg/dL

(1.7 mmol/L)

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Reduced HDL (good) cholesterol:

o Men Less than 40 mg/dL (1.03 mmol/L).

o Women Less than 50 mg/dL (1.29 mmol/L).

Elevated blood pressure: Equal to or greater than 130/85 mm

Hg or use of medication for hypertension.

Elevated fasting glucose: Equal to or greater than 100 mg/dL

(5.6 mmol/L) or use of medication for hyperglycemia.

Etiology

The exact mechanisms of the complex pathways of metabolic

syndrome are not yet completely known.The most important

predisposing factors are:

Genetic factors . (3)

Environmental factors (4(

1. Low activity level.

2. Sedentary lifestyle.

3. And progressive weight gain.

4. Smoking.

5. Growing older (the body naturally becomes more resistant to

insulin with age).

6. Eating an excessively high carbohydrate diet, high in calories and

saturated fat.

Pathophysiology

A major factor in metabolic syndrome is a defect in glucose metabolism,

Insulin resistance, cellular resistance to insulin that results in

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hyperinsulinemia; or excess insulin secretion by the body in an attempt to

regulate blood sugar.(5)

Insulin resistance occurs when cells

Pathophysiologic etiology of insulin resistance and the metabolic syndrome.

Clinical picture

Hypertension increased systolic and diastolic blood pressure.

Central Obesity, especially around your waist (with an "apple

shape").

Heart disease.

Stroke.

Type 2 diabetes mellitus.

Fatty liver.

Polycystic ovary syndrome.

Abnormalities of blood coagulation.(Hypercoagulability).

Elevated uric acid levels.

Renal dysfunction: micro- or macroalbuminuria

Therapy

The first line treatment is change of lifestyle (e.g., Dietary Guidelines for

Americans and physical activity). However, if in three to six months

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of efforts at remedying risk factors prove insufficient, and then drug

treatment is frequently required..

So the elements of treatment are:

1. Increase physical activity.

2. Lifestyle modification and weight loss.

3. Dietary modification.

4. Drug therapy.

Increase physical activity.

a. Increased frequency.

b. At least moderate intensity.

To reduce the risk of chronic disease in adulthood, 30 minutes a

day of moderate-intensity activity above the usual activity is

recommended most days.

To help manage weight and prevent gradual weight gain,

engage in approximately 60 minutes of moderate-vigorous

intensity activity on most days of the week in concert with a

balance of calorie intake.

To sustain weight loss, participate in at least 60 to 90 minutes of

daily moderate intensity-physical activity in concert with a

balanced caloric intake.

Dietary modification.

Restricting the overall dietary carbohydrate intake is more effective

in reducing the most common symptoms of metabolic syndrome than

the more commonly prescribed reduction in dietary fat intake

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Dietary Recommendation (10,11)

Fresh Fruits and Vegetables: The Major Constituent of Metabolic

Syndrome Diet

The best diet for metabolic syndrome is low fat low calorie food options,

free of empty carbohydrates. Fresh vegetables and fruits constitute thebest such food options.

An effective metabolic diet mandates serving fresh vegetables raw,

steamed, boiled, grilled, baked, or sauted in a healthy cooking medium

such as olive oil. The diet for metabolic syndrome excludes fried

vegetables. Legumes such as beans and peas also make good menu

options, and broccoli and leafy greens make excellent side dish options.

Fresh fruits rich in fiber are another ideal ingredient in the metabolic

syndrome diet. People suffering from metabolic syndrome should,

however, avoid fruit juice as it contains natural sugar. The recommended

way to serve fruit is raw, without any sugar-based dressings.

Non-Vegetarian Options in Metabolic Syndrome Diet Plan

Fresh fish such as tuna, salmon, whitefish, and mackerel constitute the

perfect non-vegetarian diet and the primary source of protein for people

suffering from metabolic syndrome. Fish contains omega-3 fatty acids

that contribute to a healthy heart. Serving fish baked, boiled, or poached

rather than breaded or fried helps avoid extra calories.

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Grilled, boiled, baked, broiled, or braised chicken, turkey, and other fowl,

served without cream sauces and gravy pass as safe diet for people

suffering from metabolic syndrome. Chicken breast serves as the best

meat and poultry option whereas red meat constitutes the worst option in

a metabolic syndrome diet. Lean meat is a good alternative to red meat.

Whole Grain and Diary Products in Diet for Metabolic Syndrome

Whole grains in the forms of brown rice, whole wheat pasta made from

quinoa, oatmeal, puffed grained cereals, and high fiber breads make a

good constituent of the metabolic syndrome diet. The fiber from wholegrain helps lower cholesterol and eliminate hunger pangs.

Dairy products are a rich source of calcium, but people suffering from

metabolic syndrome need to regulate their diary intake. Full-fat dairy

products such as whole milk, cheese, yogurt, and cottage cheese need to

be reduced in favor of their low-fat or skimmed versions. Margarine that

has no trans-fatty acids is a good alternative to butter.

Recommended Snacks in Diet for Metabolic Syndrome

Healthy snacks options in the diet for metabolic syndrome include:

Low-calorie foods such as carrot sticks, rice cakes, whole

grain crackers, whole wheat crackers, soy chips, fat free popcorn,

instant oatmeal and the like

High fiber foods such as fruits and vegetables that take more

time to digest and consequently reduce hunger pangs for an

extended period

Nuts such as almonds, brazil nuts, and walnuts, but not

sweeter nuts such as peanuts, cashews, and pistachios

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Probiotic snacks such as yogurt, containing good bacteria

that aid in digestion.

Sugary snacks such as fruit juice, candy, desserts, processed grains, and

processed foods such as packaged chips are high on the glycemic index

and contribute to metabolic syndrome. Most granola bars have little

nutritional value, and contain high sugar and salt.

The Mediterranean Diet(12)

Mediterranean food combines taste and healthy eating, and comes

primarily from plant-based sources and seafood. This diet promotes

consumption of green leafy vegetables, fruits, legumes, unrefined cereals,

and olive oil, while excluding meat and meat products and considerably

limiting consumption of diary products.

Studies establish the superiority of the Mediterranean Diet in controlling

metabolic syndrome. A four year study carried out in Greece indicate that

people who consumed the traditional Mediterranean diet had longer life

expectancy and lower risk of heart disease and cancer than people who

did not adhere to this lifestyle.

There are, however, general guidelines that can be followed to

incorporate a Mediterranean-style eating plan into any diet. According to

the Lyon Diet Heart Study, these guidelines for eating are:

meals high in fruits, vegetables, bread and other cereals,

potatoes, beans, nuts, and seeds

include olive oil as an important source of monounsaturated

fat

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dairy products, fish, and poultry consumed in low to

moderate amounts, little red meat

eggs consumed zero to four times weekly

wine consumed in low to moderate amounts

Yogurt

Yogurt is a popular food in Greek culture, but the version used in Greece

is slightly different than that used in the United States. The Greek version

is thicker and contains more protein and less sugar.

Yogurt is a food used in the Mediterranean diet, and a great choice for

breakfast. Greeks enjoy yogurt with honey and other natural additives.

On the Mediterranean Diet, yogurt, as a dairy product, should be

consumed only in small quantities.

Fruit

There are many fruits that on the Mediterranean Diet and can make a

great addition to breakfast. Those fruits include cantaloupe, apples, and

berries.

Fruit is often eaten as a dessert in Greece and can be used in snacks or as

a sweet treat on the Mediterranean Diet. A fruit cup can be a great

breakfast option, as can freshly-squeezed fruit juice. Fruit can also be

used to make shakes and smoothies for breakfast.

Breads and Cereals

Grains are allowed on the Mediterranean Diet in higher amounts, so

healthy cereals and whole grain breads can be great choices. Toast,

cereal, breakfast sandwiches, and wraps can all make hearty breakfast

food items.

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Milk

In small amounts, milk can be enjoyed with breakfast or used in

smoothies or shakes for breakfast. As a dairy product, the consumption of

milk is limited on the Mediterranean Diet.

Eggs

Eggs can be eaten up to four times a week on the Mediterranean Diet.

This allows for them to be used in a variety of ways and as a breakfast

food or in other foods later in the day. A veggie-stuffed two-egg omelette

can be a great start to the day. As a breakfast food, eggs are one of the

most versatile options of all.

To begin changing your diet to a more Mediterranean one and

reaping the potential health benefits, try the following tips:

Add a wide variety of vegetables into your diet. Fresh, frozen or canned

makes little difference, so don't feel you have to splurge on expensive

out-of-season fresh produce.

Mix it up by varying the color and texture of the vegetables you eat. Soft,

red, lycopene-rich tomatoes and crunchy green broccoli both provide

highly beneficial, yet different, nutrients to your diet. Try purple

eggplant, orange peppers, deep magenta beets, white cauliflower, blue-

green kale. Also try cooking or dressing vegetables in olive oil instead ofbutter to ditch the saturated fat and take advantage of olive oil's

monounsaturated fat.

All of the above goes for fruits as well, though they, being sweet, should

be eaten more moderately than vegetables. Think of fruit as dessert:

sliced fresh peaches, or a bowl of berries, cubes of melon, a juicy mango.

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Emphasize vegetarian sources of protein while going light on the animal

proteins. Choose beans, nuts, seeds, and whole grains. Whole grains like

quinoa contain surprisingly high amounts of protein, and they contain

micronutrients that refined flours have had stripped out of them. Eat fish

a few times a week, and other meats a few times a month. Avoid bacon

and other highly processed meats, including lunch meats, entirely.

Seek out monounsaturated sources of fat while cutting back on saturated

fat. The diet in Mediterranean countries is 35% to 40% fat, so don't worry

too much about getting too many of your calories from fat. You'll be

looking for olive and canola oil, nuts and seeds (high in monounsaturated

fat as well as the protein mentioned previously), olives, and avocados.

Cut back on:

dairy

white flour

sugar

white rice

butter

lard

mayonnaise

meat

processed foods

Research into the health benefits of eating Mediterranean style has shown

a relationship between several nutritional compounds that the diet is

heavy in and improved health. It is low in saturated fat, with most and

sometimes all of its fat coming from monounsaturated sources think

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olives, nuts, avocados and olive and canola oil which has been linked

to lower incidence of heart disease.

The diet is also rich in omega-3 fatty acids, especially alpha-linolenicacid, which is found in plants. Omega-3s are also believed to protect

against heart disease. High levels of micronutrients found in the

Mediterranean region's colorful array of vegetables and fruits, as well as

in wine, help to do the following:

lower blood pressure

lower cholesterol

lower the risk of Alzheimer's disease

lower the risk of diabetes

lower the risk of chronic obstructive pulmonary disease

(COPD)

improves rheumatoid arthritis

lower risk of cancer

One additional, and pleasant benefit of eating Mediterranean is weight

loss. The diet is so high in fiber and satiating fats that people often

lose weight once adopting the diet.

Calorie Control (13)

Obese people are more susceptible to metabolic syndrome and the diet for

metabolic syndrome need to center around increasing or decreasing

calories to maintain body weight to within 20% of the "ideal" weight. The

optimal body weight for men is 106 pounds for the first five feet of

height, and six pounds for every additional inch. For women, the optimal

weight is 100 pounds for the first five feet of height, and five pounds for

every additional inch.

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While the total quantity of calories consumed is important, the quality of

calories consumed also plays a major role in controlling metabolic

syndrome. While most people do not need more than 2,000 calories a

day, consumption of less than 1,200-1,500 calories a day would deprive

the body of key nutrients. Patients suffering from metabolic syndrome

need a smart diet that eliminates empty calories so that the calorie

count remains within optimal limits.

Smart Eating Habits (13)

Smart eating habits also go a long way in controlling metabolic

syndrome.A good eating approach is to eat small quantity of food in the

range of 150 to 200 calories frequently than one or two large meals a day.

This approach helps in maintaining energy and optimal nutrient levels.

These mini-meals or snacks should however be consumed on a regular

basis, for infrequent eating cause the body to go into a "stress mode"

between meals.

Another good eating habit is to eat early when energy levels are at the

highest and not skipping breakfast in any case. It is optimal to consume

most of the daily calories by midday, and fewer calories at night.

Food Preparation

A major part of the metabolic syndrome diet plan is selecting the right

kind of cooking oil. The best cooking oil are that which contain

unsaturated fats, no trans-fats, and limited saturated fats.

Polyunsaturated fats from sources rich in Omega-3 and Omega-6 ranks

among the best cooking oil. Oil from Fish, walnut, flaxseed and soybeans

are rich in Omega-3 fatty acids, whereas corn oil, safflower oil, sunfloweroil, cottonseed oil and soybean oil are rich in Omega-6 fatty acids. It is

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important to maintain a reasonable balance of less that 10:1 between

Omega 6 and Omega 3 oils.

Olive oil, Canola oil and other cold-pressed oils that containmonounsaturated fats are also good cooking oil options. The cooking oils

that need avoidance are solid dairy or vegetable fats such as butter,

margarine and Crisco.

The best option is however to avoid frying altogether and bake, grill,

broil, braise or saut the food.

Drug therapy

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References

1. Ford ES et al: Prevalence of the metabolic syndrome among

U.S. adults: findings from the third National Health and NutritionExamination Strvey, JAMA 287-356, 2002.

2. Anderson PJ, Critchley JAJH, Chan JCN et al. Factor

analysis of the metabolic syndrome: obesity vs insulin resistance

as the central abnormality. International Journal of Obesity2001;25:1782

3. Pollex, R.L.; Hegele, R.A. (2006). "Genetic determinants of

the metabolic syndrome". Nat Clin Pract Cardiovasc Med3 (9):4829.

4. Katzmaryk,, Peter T; Leon, Arthur S.; Wilmore, Jack H.;

Skinner, James S.; Rao, D. C.; Rankinen, Tuomo; Bouchard,

Claude (October 2003). "Targeting the Metabolic Syndrome with

Exercise: Evidence from the HERITAGE Family Study.". Med.Sci. Sports Exerc35 (10): 17031709.

5. Fukuchi S, Hamaguchi K, Seike M, Himeno K,Sakata T, Yoshimatsu H. (1 June 2004). "Role ofFatty Acid Composition in the Development ofMetabolic Disorders in Sucrose-Induced ObeseRats". Exp Biol Med229 (6): 486493

6. Online References

Blood cholesterol and lipids

The appendix of the At-A-Glance: Quick Desk Reference by theNCEP ATP III provides further information on the risk

determination and treatment for elevated cholesterol levels. The

quick reference guide, as well as the full report, are available at the

following website:

http://www.nhlbi.nih.gov/guidelines/cholesterol/atglance.pdf

A risk assessment tool for estimating 10-year risk of developing

hard CHD is available at the following website:

http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=prof

A similar risk assessment tool, based on Strong Heart data forAmerican Indians, can be found at:

http://www.ms-se.com/pt/re/msse/abstract.00005768-200310000-00013.htmhttp://www.ms-se.com/pt/re/msse/abstract.00005768-200310000-00013.htmhttp://www.ebmonline.org/cgi/content/full/229/6/486http://www.ebmonline.org/cgi/content/full/229/6/486http://www.ebmonline.org/cgi/content/full/229/6/486http://www.ebmonline.org/cgi/content/full/229/6/486http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=profhttp://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=profhttp://www.ms-se.com/pt/re/msse/abstract.00005768-200310000-00013.htmhttp://www.ms-se.com/pt/re/msse/abstract.00005768-200310000-00013.htmhttp://www.ebmonline.org/cgi/content/full/229/6/486http://www.ebmonline.org/cgi/content/full/229/6/486http://www.ebmonline.org/cgi/content/full/229/6/486http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=prof

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http://strongheart.ouhsc.edu/chdcalculator/calculator.html

http://www.nimh.nih.gov

7. Online References Diabetes prevention

American Diabetes Associationhttp://www.diabetes.org/

Diabetes Prevention Program

http://www.bsc.gwu.edu/dpp/index.htmlvdoc

National Diabetes Education Program

The Small StepsBig Rewards Programs publication titled, YourGame Plan for Preventing Type 2 Diabetes: Health CareProviders Toolkit, is available at the following website:http://www.ndep.nih.gov/campaigns/SmallSteps/SmallSteps_ind

ex.htm

8. Online References

Exercise and nutrition

The American College of Sports Medicines Position Statements

are available at the following website:

http://www.acsm-

msse.org/pt/re/msse/positionstandards.htm;jsessionid=lytbwdwctj

c7hd2hwnymrgt3plrfchs7btx6q1nhyfmm2h4hztq2!526656812!

181195628!8091!-1

9. American Heart Association

http://my.americanheart.org/portal/professional

10. American Family Physician:

http://www.aafp.org/afp/2004/0615/p2887.html

11. Medicine Plus: U.S. National Library of Medicine and the

National Institutes of Health:

http://www.nlm.nih.gov/medlineplus/metabolicsyndrome.html

12. Medicine Plus: U.S. National Library of Medicine and theNational Institutes of Health:

http://www.nlm.nih.gov/medlineplus/metabolicsyndrome.html

13. American Family Physician:

http://www.aafp.org/afp/2004/0615/p2887.html

http://www.nimh.nih.gov/http://www.nimh.nih.gov/http://www.ndep.nih.gov/campaigns/SmallSteps/SmallSteps_index.htmhttp://www.ndep.nih.gov/campaigns/SmallSteps/SmallSteps_index.htmhttp://www.ndep.nih.gov/campaigns/SmallSteps/SmallSteps_index.htmhttp://my.americanheart.org/portal/professionalhttp://my.americanheart.org/portal/professionalhttp://www.aafp.org/afp/2004/0615/p2887.htmlhttp://www.nlm.nih.gov/medlineplus/metabolicsyndrome.htmlhttp://www.nimh.nih.gov/http://www.ndep.nih.gov/campaigns/SmallSteps/SmallSteps_index.htmhttp://www.ndep.nih.gov/campaigns/SmallSteps/SmallSteps_index.htmhttp://my.americanheart.org/portal/professionalhttp://www.aafp.org/afp/2004/0615/p2887.htmlhttp://www.nlm.nih.gov/medlineplus/metabolicsyndrome.html