basic information and introduction to strategies for its prevention and management

1. METABOLIC SYNDROME
&
PREVENTIVE STRATEGIES
CLINICAL NUTRITON SEMINAR
BY
DEEPIKA RANI V.S.
MSC 1ST YEAR- APPLIED NUTRITON
REG NO.:15MSAN16
NATIONAL INSTITUTE OF NUTRITON, ICMR
HYDERABAD- 500007

2. • 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

3. • 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

4. 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.

5. DIAGNOSTIC CRITERIA FOR METS
1. 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

6. 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
Percent
Men
Women

7. RISK FACTORS
Modifiable
• Physical inactivity
• Unhealthy diet
• Developmental origin's of health
and disease
Non- modifiable
• Aging
• Genetics etc.

8. PATHOPHYSIOLOGY OF METS
RISK FACTORS
VISCERAL OBESITY
INSULIN RESISTANCE
HYPERINSULINEMIA
HYPERGLYCEMIA
↑TG
↑ LDL
↓HDL
↑LIPOLYSIS
HYPERTENSION
PRO-THROMBOTIC STATE
↑CRP
↑URIC ACID
DM
CVD
KIDNEY
DISEASES

9. PREVENTIVE STRATEGIES FOR METS
LIFE STYLE MODIFICATIONS
USE OF NUTRICEUTICALS
USE OF PHARMACEUTICALS

10. 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.

11. CATEGORY COMPONENT EFFECT ON HEALTH / RDA
PHYSICAL
ACTIVITY
150 min/ week of
moderate PA
Reduces IR, HN & improves
dyslipidemia- HDL .
WEIGHT
LOSS
Energy restriction Improve body composition, BP, plasma
lipids, insulin sensitivity
Low glycemic foods Improve insulin sensitivity, improved
blood lipid profiles
Fibers (soluble &
insoluble)
Improve insulin levels, hyperglycemia,
plasma lipids
HEALTHY
DIET
Saturated fat Inc. in markers associated with E.R
stress and live dysfunction
So, Restricted to <7% of total calories
Trans fats Alter lipid profiles
0.00% 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…

12. 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 micronutrients
Improve BP, dyslipidemia, and BC
Proteins Sardine protein effective against IR,
adipose tissue oxidative stress etc.
Alcohol Raise BP, TG & weight gain- adds extra
calories
so limit alcohol intake
Salt restriction Effective in lowering BP.
So restricted to 3gm/ day

13. CONTD…
CATEGORY COMPONENT EFFECT ON HEALTH / RDA
Macronutrient
distribution of diet
Carbohydrate 50- 60 % of total calories
Reduce 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.

14. 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

15. 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

16. 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.