Endocrinology and Metabolism Clinics of North America
Review articleFocus on lifestyle change and the metabolic syndrome
Section snippets
Therapeutic lifestyle change and abdominal obesity
Weight gained after age 18 years carries a heavy metabolic price tag. In the Nurses' Health Study, a weight gain of 10 kg or more since the age of 18 was associated with increased mortality in middle adulthood [2]. Despite this statistic, there has been an alarming rate of growth in the incidence of overweight (body mass index [BMI], 25–29.9) and obesity (BMI, >30.0) in the United States [3]. BMI takes into account the effects of height and should be calculated in those individuals who have
Treatment of glucose abnormalities (impaired fasting glucose, impaired glucose tolerance, or type 2 diabetes mellitus)
For individuals with impaired glucose tolerance (IGT), the Da Qing trial [17], the Diabetes Prevention Program (DPP) [18], and the Finnish Diabetes Prevention Trial (FDPT) [19] provide convincing evidence for the benefits of lifestyle modification. The Da Qing trial examined 577 subjects with IGT and showed a large decrease in the development of type 2 diabetes mellitus (T2DM) in the exercise-only group, which was larger than that seen in the combined diet and exercise group. The results were
Treatment of dyslipidemia
The lipid triad consists of elevated TGs, low HDL-C, and increased small, dense LDL-C. These are the lipid abnormalities characteristically associated with the metabolic syndrome. The ATP III offered the following advice for individuals with the metabolic syndrome. First, the panel suggested that there should be a maximum reduction of LDL-C. The level of LDL-C is decreased by reducing saturated fat and dietary cholesterol (high-fat dairy products and fatty cuts of meat) including more fiber in
Hypertension
In the United States, the increases in overweight and obesity have led to obesity-associated hypertension. NHANES III data showed that particularly up to age 60, the higher the BMI, the greater the prevalence of hypertension [32]. Certainly in the Framingham study, the age-adjusted relative risk for new-onset hypertension was highly associated with overweight status for men and women [33]. More than 20 years ago, Reisin et al [34] found that in a trial of weight reduction without salt
Hypercoagulability/inflammation
Hypercoagulability and inflammation are not part of the ATP III definition but are clearly seen in individuals with metabolic syndrome. How does weight reduction and exercise help? Plasma tissue plasminogen activator inhibitor 1 (PAI-1) was predictive of coronary artery disease events in a prospective multicenter study of men with angina, although the associations disappeared after parameters reflecting insulin resistance were considered [42]. A study of obese subjects who underwent weight
Management of metabolic syndrome through life-habit changes—practical approaches
The first practical step is to try to prevent weight gain in patients who have the metabolic syndrome. Although this step seems obvious, many patients are counseled to begin medications such as steroids, antidepressants, oral hypoglycemics, and even certain antipsychotic medications that are known to cause weight gain without a strategy in place to combat the weight gain that occurs. The ATP III also counsels on first implementing LDL-lowering measures (the exception would be patients with TG
Summary
This article has attempted to provide the groundwork for understanding the basis and nonpharmacologic management of the metabolic syndrome. Weight loss can greatly reduce insulin resistance and all of the manifestations of the metabolic syndrome. Physicians' endorsement of eating and exercise behaviors that lead to a healthier waistline and improved BMI, lower blood pressure, improved HDL-C and TGs, and lower blood sugars along with a reduced CRP carries the promise of improved long-term
References (52)
- et al.
Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial
Lancet
(1990) - et al.
Improvement in medical risk factors and quality of life in women and men with coronary artery disease in the Multicenter Lifestyle Demonstration Project
Am J Cardiol
(2003) - et al.
Effects on coronary artery disease of lipid-lowering diet, or diet plus cholestyramine, in the St Thomas' Atherosclerosis Regression Study (STARS)
Lancet
(1992) - et al.
Long-term effects of ad libitum low-fat, high-carbohydrate diets on body weight and serum lipids in overweight subjects with metabolic syndrome
Am J Clin Nutr
(2002) - et al.
Randomized clinical trials on the effects of dietary fat and carbohydrate on plasma lipoproteins and cardiovascular disease
Am J Med
(2002) - et al.
Reduced LDL particle size in children consuming a very-low-fat diet is related to parental LDL-subclass patterns
Am J Clin Nutr
(2000) High-monounsaturated-fat diets for patients with diabetes mellitus: a meta-analysis
Am J Clin Nutr
(1998)- et al.
Body fat distribution, blood pressure, and hypertension. A prospective cohort study of men in the normative aging study
Ann Epidemiol
(1990) - et al.
Effect of weight loss on blood pressure and insulin resistance in normotensive and hypertensive obese individuals
Am J Hypertens
(1995) Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): final report
Circulation
(2002)
Body weight and mortality among women
N Engl J Med
Prevalence of the metabolic syndrome among US adults: findings from the Third National Health and Nutrition Examination Survey
JAMA
Body mass index, waist circumference, and health risk: evidence in support of current National Institutes of Health guidelines
Arch Intern Med
Pathobiological Determinants of Atherosclerosis in Youth (PDAY) research group. Obesity accelerates the pregression of coronary atherosclerosis in young men
Circulation
Efficacy and safety of low carbohydrate diets: a systematic review
JAMA
A low-carbohydrate as compared with a low-fat diet in severe obesity
N Engl J Med
A randomized trial of a low-carbohydrate diet for obesity
N Engl J Med
Diet, obesity, and cardiovascular risk
N Engl J Med
A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women
J Clin Endocrinol Metab
AHA dietary guidelines: revision 2000: a statement for healthcare professionals from the Nutrition Committee of the American Heart Association
Circulation
Successful weight loss maintenance
Annu Rev Nutr
Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study
Diabetes Care
Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin
N Engl J Med
Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance
N Engl J Med
Improvement of BMI, body composition, and body fat distribution with lifestyle modification in Japanese Americans with impaired glucose tolerance
Diabetes Care
Improved carbohydrate metabolism after physical training and dietary intervention in individuals with the “atherothrombogenic syndrome.” Oslo Diet and Exercise Study (ODES). A randomized trial
J Intern Med
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2007, Nutrition ResearchCitation Excerpt :Among other etiological factors, lifestyle (especially a sedentary lifestyle and dietary habits) strongly correlates with obesity, insulin resistance, dyslipidemia, and inflammation [3,4]. Therefore, the American Diabetes Association and the National Cholesterol Education Program Adult Treatment Panel III have suggested that the starting point for the treatment of MS should be therapeutic lifestyle changes such as loss of excess body fat, increased physical activity, smoking cessation, and of course dietary modifications [5,6]. Postprandial hyperglycemia and hyperlipidemia are common features of MS and early markers for diabetes and atherosclerosis [7,8].
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2006, Primary Care - Clinics in Office PracticeCitation Excerpt :The role of dietary modification is stressed in adolescents with type 2 DM and obesity to achieve weight control and weight loss, as is the need for increased physical activity and exercise. The role of lifestyle modifications in achieving weight loss and control has been documented to be at least as effective as medications [7,8]. The social worker or psychologist discusses the psychosocial aspects of life with the adolescents, including the home environment and support system, interaction with peers, and school functioning.
Metabolic Syndrome
2006, Nutrition Clinique et MetabolismeManagement of the metabolic syndrome
2005, American Journal of the Medical SciencesCitation Excerpt :The adverse cardiovascular effects of elevated serum LDL cholesterol levels are now well established, in patients with and in patients without documented atherosclerotic vascular disease.9,55 There is an increasing body of evidence to suggest that the triad of elevated serum triglyceride levels, low serum HDL cholesterol levels, and small dense LDL cholesterol particles is also highly atherogenic.1–3,9,18,19,52–55 For this reason, the clinician is faced with the task of treating both types of atherogenic lipid abnormalities in many patients with the metabolic syndrome.