BSc Ilorin MSc PhD Ibadan Department of Biochemistry EUI OUTLINE Definition Prevalence of MS Diseases associated with MS Pathophysiology of MS Positive energy balance Inflammatory ID: 934667
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METABOLIC SYNDROME
Sheu K. RAHAMONB.Sc. (Ilorin), M.Sc., Ph.D. (Ibadan)Department of Biochemistry,EUI.
Slide2OUTLINE
DefinitionPrevalence of MSDiseases associated with MS
Pathophysiology of MS
:
Positive energy balanceInflammatory hypothesisTherapeutic strategiesPieces of adviceConclusion
2
Slide33
Slide4Metabolic syndrome (MS)
MS* is a constellation of interconnected factors which increase the risk of cardiovascular diseases (CVD) and type 2 diabetes mellitus (T2DM) (Kassi
et al.
, 2011). One of the major public health challenges worldwide (Alberti et al., 2005) even, in the developing world where poverty is widespread. *Also known
as:
Cardiometabolic
syndrome
,
Syndrome
X, Insulin resistance syndrome and,Reaven's syndrome
4
Slide5Prevalence of MS
Progressive rise due to increasing poor dietary habit and sedentary lifestyle.USA: 34.2% of
the
adults population and ≈70% in women aged ≥
70 years (Moore et al., 2017).Europe: 30% (Cameron et al., 2007)South Korea: 31.4% (Park et al., 2015) Cameroon: 5.9% (Fezeu
et
al., 2007
)
Ghana: 35.9% (
Gyakobo
et al., 2012)
South Africa: 60.6% (Erasmus et al., 2012) 5
Female preponderance
Slide6Ife: 12.1% (
Adegoke et al., 2010) Ibadan: 16.3% (Charles-Davies et al., 2012)
Nigeria: 31.7% (
Oguoma
et al., 2015)
6
Slide7Causes:
Unhealthy dietsObesityRapidly growing number of inactive peopleIndustrialization and,
Mechanization
(
Gaziano, 2007; Hollman and Kristenson, 2008).
7
Slide8Implication of growing MS prevalence
An outbreak of glucometabolic and cardiovascular disorders worldwide
8
Slide9Figure
1: Risks associated with MS (Duvnjak and Duvnjak, 2009)
9
Slide10Tuesday, October 31, 2017
Do Our Cells Pay the Price When We Sit Too Much?
10
Slide11Pathophysiology
of MSMultiple and still
poorly
understood
Factors:Insulin resistance Central (visceral) obesityHyperglycaemia
Hypertension
Dyslipidaemia
11
Figure 2: Novel components of metabolic syndrome
Slide12Hypotheses
Positive energy balanceInflammation
12
Slide13Positive energy balance
Thermodynamics- energy and work of a systemFirst law of thermodynamics:Change in the internal energy (∆U) of a closed system = The amount of heat (Q) supplied to the system – the amount of work (W) done by the system on its surroundings
∆
U = Q -
W13
Slide1414
Slide1515
Slide16Figure 4: The inflammatory hypothesis
Adipocyte hypertrophy/necrosisDisordered adipokine production
Macrophage infiltration
Proinflammatory cytokines production
IRS phosphorylation (serine vs tyrosine)Insulin resistance
16
Slide17Diagnosis of MS
Remains a clinical challenge due to the poor understanding of its pathophysiology.
17
Slide18Table 1: Approved Diagnostic Criteria
NCEP-ATP III criteria (3 of 5)
WHO criteria: Hyperinsulinaemia or FPG ≥110mg/dl + any 2
IDF:
waist circumference
>94 men, >80 women + any 2
BP (mm/Hg)
130/85
or on medication
140/90
or on medication
≥130/85
or on treatment
TG (mg/dl)
≥150
≥150
≥150
or on treatment
HDL (mg/dl)
Male <40, female <50
<35 male
<40 female
<40 male
<50 female
Abdominal obesity
Waist:
>40 male
>35 female
Waist-hip ratio >0.9 male
0.85 female
BMI ≥30
FPG (mg/dl)
≥110
≥100
or already diagnosed T2DM
microalbuminuria
UAE rate >20µg/min
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Slide19Others include:
The European Group for the Study of Insulin Resistance (Balkau et al., 2002).
Insulin resistance +
any two or more of the following
:central obesity: waist circumference ≥ 94 cm (male), ≥ 80 cm (female)dyslipidemia: TG ≥ 2.0 mmol/L and/or HDL-C < 1.0 mmol/L or on treatment for dyslipidemiahypertension: blood pressure ≥ 140/90 mmHg or on antihypertensive
medication
fasting plasma glucose ≥ 6.1
mmol
/L
American
Heart Association/Updated NCEP
(Grundy et al., 2005).Elevated waist circumference: Men — >40 inches (102 cm)
Women
—
>35
inches (88 cm
)
Elevated triglycerides:
≥
150
mg/
dL
(1.7
mmol
/L
)
Reduced HDL -cholesterol:
Men
—
<40
mg/
dL
(1.03 mmol/L)Women — <50 mg/dL (1.29 mmol/L)
Elevated blood
pressure
≥
130/85
mmHg
or on anti-hypertensive
drugs
Elevated fasting glucose: ≥
100
mg/
dL
(5.6
mmol
/L) or on treatment for hyperglycemia
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Slide20Joint Interim
Statement (Alberti et al., 2009)
Includes any
3
of the following 5 risk factors:Elevated *waist circumference (≥94 cm for male subjects and ≥80 cm for female subjects)Elevated serum triglycerides (≥1.7
mmol
/L)
or on treatment for
dyslipidaemia
Reduced serum HDL cholesterol
(<1.0
mmol/L for male subjects and <1.3 mmol/L for female subjects) or on treatment for dyslipidaemiaElevated blood pressure (systolic blood pressure ≥130 mmHg and/or diastolic blood pressure ≥85 mmHg) or on anti-hypertensives
Elevated fasting blood glucose
(≥5.6
mmol
/L
)
or on treatment for
diabetes
*measured between the lower rib margins and the iliac crest
20
Slide21Therapeutic strategies
Lifestyle changes- Diet & Exercise Pharmacotherapy- poly pill
B
ariatric surgery
21
Slide22Therapeutic lifestyle changes (TLCs
)- DietDiets rich in dairy, fish, and cereal grains (Esposito et al., 2007;
Ruidavets
et al., 2007). Increased intake of polyphenols (Buitrago-Lopez et al., 2011).
Dietary modification-
The Whitehall II prospective cohort study reported that
dietary modification for
5
years reversed the risks associated with MS (
Akabaraly
et al., 2010).22
Slide2323
Slide2424
Slide25There is a problem!
70 – 90% failure rate within 1 – 2 yearsFeeding-
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A complex and motivational
behaviour
Slide26Figure 5: Factors affecting feeding
(Dr. J friedman’s Lecture- The biologic basis of obesity)
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Slide27Exercise
Aerobic training- most efficient mode of exerciseRegular moderate-intensity physical
activity-
at
least 30 minutes 5 days/week, ideal- 7 days/week(Fappa et al., 2008; Bateman et al., 2011).
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Slide28Problems?
Long-term adherence Cardio-respiratory fitness assessment- aerobic exercise
28
Slide29Pieces of advice
Consume diets rich in dairy, fish, legumes, cereal products and whole grains
Consume
more of vegetables and fruits
(five or more servings a day).Avoid eating in between meals. If you must eat, let it be fruits or vegetables.
Avoid red and processed meat, sweets, fried foods, refined grains,
alcohol
Exercise- Walk, ride bicycle, take the stairs etc.
Avoid
excessive sitting. Do not sit for more than 30 minutes at a go, stand up at intervals and walk
around.
Routine medical check-up especially when you are obese
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Lack of willpower?
https://www.ncbi.nlm.nih.gov/books/NBK235267/
Slide30Conclusion
Lifestyle intervention is an effective strategy against metabolic syndrome. Therefore, let us imbibe healthy eating habit and regular physical exercise to live a life free of chronic diseases.
30
Slide31References
Adegoke, O. A., Adedoyin, R. A., Balogun, M. O., Adebayo, R. A.,
Bisiriyu
, L. A. &
Salawu, A. A. 2010. Prevalence of metabolic syndrome in a rural community in Nigeria. Metabolic Syndrome and Related Disorders 8.1: 59-62.Akbaraly, T. N., Singh-Manoux, A., Tabak, A. G., Jokela, M., Virtanen, M., Ferrie, J. E., Marmot, M. G., Shipley, M. J. & Kivimaki, M. 2010. Overall diet history and reversibility of the metabolic syndrome over 5 years: the Whitehall II prospective cohort study.
Diabetes Care
33.11: 2339-2341.
Alberti
, K. G.,
Eckel
, R. H., Grundy, S. M.,
Zimmet, P. Z., Cleeman, J. I., Donato, K. A., Fruchart, J. C., James, W. P., Loria, C. M., Smith, S. C., Jr., International Diabetes Federation Task Force on Epidemiology and Prevention, National Heart, Lung, and Blood Institute, American Heart Association, World Heart Federation, International Atherosclerosis Society & International Association for the Study of Obesity. 2009. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120: 1640-1645.
Alberti
, K. G.,
Zimmet
, P. & Shaw, J. 2005. The metabolic syndrome– a new worldwide definition.
Lancet
366:1059-1062.
Bateman, L. A.,
Slentz
, C. A., Willis, L. H., Shields, A. T.,
Piner
, L. W., Bales, C. W.,
Houmard
, J. A. & Kraus, W. E. 2011. Comparison of aerobic versus resistance exercise training effects on metabolic syndrome (from the Studies of a Targeted Risk Reduction Intervention Through Defined Exercise-STRRIDE-AT/RT).
American Journal of Cardiology
108.6: 838-844.
Buitrago
-Lopez, A., Sanderson, J., Johnson, L.,
Warnakula
, S., Wood, A., Di
Angelantonio
, E. & Franco, O. H. 2011. Chocolate consumption and cardiometabolic disorders: systematic review and meta-analysis. British Medical Journal 343: d4488Cameron, A. J., Magliano, D. J., Zimmet, P. Z., Welborn, T. & Shaw, J. E. 2007. The metabolic syndrome in Australia: prevalence using four different definitions.
Diabetes Research and Clinical Practice
77: 471–478.
Després
, J. and Lemieux, I. 2006. Abdominal obesity and metabolic syndrome.
Nature
444: 881-887.
Duvnjak
L,
Duvnjak
M. 2009. The metabolic syndrome - an ongoing story.
Journal of Physiology and Pharmacology
60.S7: 19-24.
Erasmus, R. T.,
Soita
, D. J., Hassan, M. S., Blanco-Blanco, E.,
Vergotine
, Z.,
Kegne
, A. P. &
Matsha
, T. E. 2012. High prevalence of diabetes mellitus and metabolic syndrome in a South African
coloured
population: baseline data of a study in Bellville, Cape Town.
South African Medical Journal
102.11Pt1: 841-844.
Esposito, K.,
Ceriello
, A.,
Giugliano
, D. Diet and the Metabolic Syndrome
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2007. Metabolic Syndrome And Related Disorders 5: 291–295.Fappa, E., Yannakoulia, M., Pitsavos, C., Skoumas, I., Valourdou, S. & Stefanadis, C. 2008. Lifestyle intervention in the management of metabolic syndrome: could we improve adherence issues? Nutrition 24.3: 286-291 Fezeu, L., Balkau, B., Kengne, A., Sobngwi, E. & Mbanya, J. C. 2007. Metabolic syndrome in a Sub-Saharan African setting: Central obesity may be the key determinant. Atherosclerosis 193: 70–76.Gaziano, T. A., Galea, G. & Reddy, K. S. 2007. Scaling up interventions for chronic disease prevention: the evidence. Lancet 370: 1939–1946.Gyakobo M, Moah AGB, Martey-Marbell D, Snow RC. 2012. Prevalence of the metabolic syndrome in a rural population in Ghana. BMC Endocrine Disorders 12:25.Hollman, G. and Kristenson, M. 2008. The prevalence of the metabolic syndrome and its risk factors in a middle-aged Swedish population--mainly a function of overweight? European Journal of Cardiovascular Nursing 7.1: 21-26. Kassi, E., Pervanidou, P., Kaltsas, G. & Chrousos, G. 2011. Metabolic syndrome: definitions and controversies. BMC Medicine 9: 48.Moore JX, Chaudhary N, Akinyemiju T. 2017. Metabolic syndrome prevalence by race/ethnicity and sex in the United States, National Health and Nutrition Examination Survey, 1988-2012. Prev Chronic Dis 14:160287.Oguoma VM, Nwose EU, Richards RS, 2015. Prevalence of cardio-metabolic syndrome in Nigeria: a systematic review. Public Health 129(5): 413-423.Park SY et al. 2015. Normal range albuminuria and metabolic syndrome in South Korea: the 2011-2012 Korean National Health and Nutrition Examination Survey. PLoS One 10(5): e0125615.Ruidavets JB, Bongard V, Dallongeville J, Arveiler D, Ducimetière P, Perret B, et al. 2007. High consumptions of grain, fish, dairy products and combinations of these are associated with a low prevalence of metabolic syndrome. J Epidemiol Community Health 61(9):810-817.
Slide32“To lengthen thy life, lessen thy meals.”
Benjamin Franklin, Poor Richards Almanac (1737).THANK YOU FOR LISTENING
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