METABOLIC SYNDROME &

PREVENTIVE STRATEGIES

CLINICAL NUTRITON SEMINAR

BYDEEPIKA RANI V.S.

MSC 1ST YEAR- APPLIED NUTRITONREG NO.:15MSAN16

NATIONAL INSTITUTE OF NUTRITON, ICMR

HYDERABAD- 500007

• Introduction

• Criteria for MetS ?

• Why MetS is such a concern ?

• Risk factors ?

• Pathophysiology of MetS ?

• Preventive strategies for MetS ?

• Diet plan for MetS.

• Conclusion

CONTENTS

• Lifestyle changes - dietary habits, sedentary life and

consumption of energy dense foods→ abdominal obesity →↑

prevalence of metabolic syndrome.

Evolution of MetS Definition:

• 1923- Eskil Kylin- first to described MetS with hypertension,

hyperglycemia, obesity and hyperuricemia.

• 1947

• 1965

• 1981 - Hanefield and Leonhardt used the phrase ‘metabolic

syndrome’

• 1988 - Reaven’s description of ‘syndrome X’

INTRODUCTION

Contd…

• 1989- Norman Kaplan introduced the theory of ‘The Deadly Quartet’

• 1922- Haffner et al observed hyperinsulinema and named it as ‘insulin

resistance syndrome’.

• 1998- Diagnostic criteria for MetS syndrome was made by WHO.

• 1999- EGIR

• 2000

• 2001- NCEP-ATP III: new approach to define MetS with focus on CVD

risk.

• 2004- IDF

• 2005- AHA/ NHLBI:

• 2009- Harmonized definition for MetS by Albert et al.

DIAGNOSTIC CRITERIA FOR METS1. Central obesity: Waist circumference : ≥102cm

in men ; ≥88cm in women

2. WHR : ≥0.90 in men ; ≥0.85 in women

3. BMI : ≥30 Kg/m2

4. Triglycerides: ≥150mg/dL

5. HDL Cholesterol : <40mg/dl in men; <50mg/dl in women

6. Blood pressure: SBP ≥130mm Hg/DBP ≥85mmHg

7. Fasting plasma glucose: ≥110mg/dL

8. Micro-albuminuria: UAER > 20µg/min.

If any of the 3 present - characterized as MetS

CONCERN FOR METS• 25%- world’s population

• 30%- Indians

• MetS affects 12% children, 20% of adults, 50% of elderly

Prevalence (%) of metabolic syndrome* among urban adults by gender and age groups

*WHO criteria used

Laxmaiah A et al 2012

MetS - ↑ risk for obesity induced DM (5- fold), CVD (2- fold), Hypertension, stroke, PCOD etc.

0

5

10

15

20

25

20-35 years 35-60 years

2.4

20.1

1.8

12.9

Pe

r c

en

t

Men

Women

RISK FACTORS

Modifiable

• Physical inactivity

• Unhealthy diet

• Developmental origin's of health and disease

Non- modifiable

• Aging

• Genetics etc.

PATHOPHYSIOLOGY OF METS

RISK FACTORS

VISCERAL OBESITY

INSULIN RESISTANCE

HYPERINSULINEMIA

HYPERGLYCEMIA

↑TG

↑ LDL

↓HDL

↑LIPOLYSIS

HYPERTENSION

PRO-THROMBOTIC STATE

↑CRP

↑URIC ACID

DMCVDKIDNEY DISEASES

PREVENTIVE STRATEGIES FOR METS

LIFE STYLE MODIFICATIONS

USE OF NUTRICEUTICALS

USE OF PHARMACEUTICALS

LIFE STYLE MODIFICATIONS

HEALTHY DIET

PHYSICAL ACTIVITY

BEHAVIOUR MODIFICATION

LIFE STYLE MODIFICATIONS

Low cost, effective than some drug interventions.

First line or parallel intervention in MetS.

CATEGORY COMPONENT EFFECT ON HEALTH / RDA

PHYSICAL ACTIVITY

150 min/ week of moderate PA

Reduces IR, HN & improves dyslipidemia- HDL .

WEIGHTLOSS

Energy restriction Improve body composition, BP, plasma lipids, insulin sensitivity

Low glycemic foods Improve insulin sensitivity, improvedblood lipid profiles

Fibers (soluble &insoluble)

Improve insulin levels, hyperglycemia, plasma lipids

HEALTHYDIET

Saturated fat Inc. in markers associated with E.R stress and live dysfunctionSo, Restricted to <7% of total calories

Trans fats Alter lipid profiles0.00% of total calories

PUFA (n-6:n-3 = 6:1)n-6

n-3

Improve lipid and other indexes.Improve peripheral IS & lower cholesterol conc.Dec. plasma TG, FFA’s, VLDL, lipogenesis in liver etc.Upto 10% of total calories

CONTD…

CONTD…

CATEGORY COMPONENT EFFECT ON HEALTH / RDA

MUFA Dec. oxidized LDL, VLDL, TG, &TC conc.Up to 20 % of total calories

FUNCTIONAL FOODS &NUTRIENTS

Vegetables & fruits

Bioactive constituents prevent chronic diseases

Dairy Rich in protein and micronutrientsImprove BP, dyslipidemia, and BC

Proteins Sardine protein effective against IR,adipose tissue oxidative stress etc.

Alcohol Raise BP, TG & weight gain- adds extra caloriesso limit alcohol intake

Salt restriction Effective in lowering BP.So restricted to 3gm/ day

CONTD…CATEGORY COMPONENT EFFECT ON HEALTH / RDA

Macronutrientdistribution of diet

Carbohydrate 50- 60 % of total caloriesReduce TG, BP, inc. LDL partical size etc.

Total fat 20-25% of total calories.Beneficial for metS parameters

fiber 20- 35 g/day

Protein 15% of total calories

cholesterol < 200mg/day

Energy intake = expenditure to maintain desirable body weight

Dietary patterns:diets rich in fruit, vegetables, whole grains, low fat dairy

products, MUFA and PUFA are associated with low prevalence of MetS.e.g. DASH, Mediterranean diet, TLC diet etc.

Behavioral modification

• Identify maladaptive behavior- children and

younger adults.

• Essential to continue corrective measures even

after achievement of healthy lifestyle.

• Quit smoking

• Manage stress.

Life style modifications are helpful in proper prevention and treatment of MetS

Diet plan for MetS

3cups/day

1 or 2/day

1 cup/day

300g/day

Fiber 30g- 7 to 13 soluble fibre

20 -30ml/day

2 servings/ day

2-4 times/ week 5 servings/ week

1500mg/day

30min/day

CONCLUSION• Caused due to unhealthy dietary habits and sedentary

lifestyle.

• Can be prevented by simple diet modifications and

moderate physical activity.

• Increasing prevalence of MetS alarms us to take quick

action against it.

• Initiation should be done as early as with adequate

nutrition during intrauterine period.

• Later continuation as multipronged approach ( dietary,

behavior modifications, increase in physical activities,

prevention of smoking & alcohol excess) is best strategy

to prevent and combat MetS & co- morbidities.