Dr D Y Patil University Nerul Navi Mumbai METABOLIC SYNDROME Metabolic syndrome is a cluster of the most dangerous cardiovascular risk factors namely diabetes abdominal obesity high cholesterol and elevated ID: 929526
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Slide1
DR. AJIN JAYAN THOMAS,Department of Physiotherapy,Dr. D. Y. Patil University,Nerul, Navi Mumbai.
METABOLIC SYNDROME
Slide2“Metabolic syndrome is a cluster of the most dangerous cardiovascular risk factors
namely diabetes, abdominal obesity, high cholesterol and elevated blood pressure”.
1923, Kylin described the clustering of hyperglycemia, hyperurecemia
and hypertension.1988,
Reaven- “Syndrome X” referred to a group of connected disorders characterized by impaired glucose tolerance,
dyslipidemia
, hypertension, associated with increased risk of type 2 diabetes and cardiovascular disease.
METABOLIC SYNDROME
Slide3Syndrome XInsulin resistance syndromeMetabolic syndrome X Cardiometabolic syndrome
Dysmetabolic syndrome Deadly quartetMultiple metabolic syndrome
SYNONYMS OF METABOLIC SYNDROME
Slide4World Health Organization (WHO) 1998Adult Treatment Panel III, 2003International Diabetes Foundation (IDF
), 2005American Association of Clinical Endocrinologists (2003)European Group for the Study of Insulin Resistance, EGIR
American Heart Association (AHA) and National Heart, Lung and Blood Institute (NHLBI), 2005
Definitions & Criteria of Diagnosis
Slide5Slide6Any 3 of 5 constitute diagnosis of Metabolic SyndromeElevated Waist Circumference (cutoff for Asian Population)
90 cm (35 inches) in Men 80 cm (31 inches) in WomenElevated Triglycerides
150 mg/dL(1.7 mmol/L) Or On drug treatment for elevated TG
Reduced HDL-C <40 mg/dL in men /<50 mg/
dL in women Or On drug treatment for reduced HDL-CElevated Blood Pressure
130 mm Hg systolic blood pressure Or 85 mm Hg diastolic blood pressure Or On antihypertensive drug treatment
Elevated Fasting Glucose 100 mg/dL
Or On drug treatment for elevated glucose
American Heart Association (AHA) and National Heart, Lung and Blood Institute (NHLBI), 2005
Slide7Viswanathan Mohan and Mohan Deepa, (2006) The prevalence rates were
25.8% in India, 13% in China, 30% in Iran, 28% in Korea
,, 22% in Hong Kong, 18.5% in Vietnam, 17% in Oman and 15.2 % in Taiwan.
Rajeev Gupta et al., (2004) studied 1800 Indians. MetS
was present in 31.6% subjects; prevalence was 22.9% in men and 39.9% in women.
Ford Earl S. et al., (2002) studied the prevalence rates among
American adults and found that the prevalence of MetS
was
23.7
%
. Thus
they concluded that 47 million adults in the United
States had
metabolic syndrome
.
Prevalence
Slide8Slide9Evolution of Man……..
Slide10Causes 2-3 fold increase in cardiovascular risk of mortality.Considered as a risk factor for CHD and precursor of Diabetes mellitus (up to 5% fold increase in risk).Even with 2 to 3 components- increased mortality from CVD and CHD.Risk of stroke increases 3 fold.Reduced cardiorespiratory fitness.
Associated with: Essential hypertension, Polycystic ovarian syndrome, Nonalcoholic fatty liver disease Gallstone disease, Cancer (i.e., breast cancer), Sleep apnea
Why is MetS Important?
Slide11Review medical history and co-morbidities- hyperlipidemia with coronary heart disease (CHD), cardiovascular disease, cerebrovascular disease, peripheral vascular disease, diabetes, hypertension, renal disease, thyroid disease, surgical history, and obesity.
Vital signs and physical data (blood pressure, heart rate, waist circumference, weight, height, BMI, body fat).Review relevant tests, lab values FBS,
Hgb A1C, fasting lipid profile.Obtain comprehensive diet history including dietary intake data.
Evaluation of MetS
Slide12Assess physical activity pattern: type of physical activity, frequency, duration, tolerance, and motivationIdentify the risk category by using the Framingham Point Scores and PROCAM risk score.Cardiorespiratory Fitness: Six Minute Walk Test / Exercise Tolerance Test.
Slide13FIRST LINE THERAPY……LIFESTYLE MODIFICATIONWEIGHT REDUCTION
DIETERY MODIFICATIONS
PHYSICAL ACTIVITYWeight Reduction
: Reduce calorie intake and ExerciseReduction in 1 kg of body weight causes 2-5% reduction in visceral fat.
Realistic Goal………. 7-10% reduction of body weight in 6-12 months.
W
hat can be done
…….
Slide14DIETARY MODIFICATIONSAdequate fluid consumption- 1.5 liters / day
Limit salt intake up to 6 g/dayCalories based on individual needs, initiate plan to achieve reasonable weight (BMI between 18 and 24 kg/m
2)Select 5 to 6 servings/day of fruits and vegetables and 6 servings/day of whole-grain products.
Choose foods with lower glycemic index.
Use olive oil instead of sunflower oil/coconut oil/palm oil in preparation of food.Low fat diary products- yogurt & cheese everyday, reduce butter and cream.
Vegetables and fruits everyday.
Slide15A FEW TIMES A WEEK……..Fish: Herring, Mackerel, Salmon, Sardine and Tuna- A high intake of omega-3 fatty acids is associated with a lower risk of coronary heart disease. Meat: Poultry recommended over beef, pork and lamb due to lower content of fat and saturated fatty acids.
Red meat only 2-3 times a month.Eggs : 2-3 eggs a week ("hidden" eggs in baked or cooked food (e.g. cake, biscuits).Alcohol:
May be good for you…….. Don’t start for health reasons…..but reduce amount to 1-2 glasses of wine.
Slide16Slide17Mediterranean Diet Pyramid
Slide18Physical ActivityModerate intensity, continuous or intermittent, more than 30 minutes, 5 days a week, resistance training for 2 days a week.
Reduces blood glucose, SBP/DBP, LDL TG, visceral body fat,
Increase in HDL, improves cardio-vascular risk factors,Improves functional capacity.
Slide19Review of Exercise in MetSJ. Eriksson, S. Taimela, V.A. Koivisto
Diabetologia (1997) 40: 125–135
Slide20Slide21Sean Carroll and Mike
Dudfield
, (2004)systematic review
25 RCT’s ReviewedInsulin sensitivity improves by 60%
Reduction in body weight 8% (without calorie restriction)Reduction in incidence of DM by 41-58%Reduction in 3mmHg of SBP/DBP by 3-9% weight loss
Recommendation: CLINICAL TRIALS NEEDED IN ETHINIC MINORITY POPULATIONS SUCH AS INDIANS
Katzmarzyk
P. T et al.,
(2003).
HERITAGE Family Study
20 wk of aerobic exercise training
Overall
reduction in prevalence of
MetS
reduced from 16.9 to 11.8 %
Rennie
K. L et al., (2003)
5153 white European participants
moderate and vigorous physical leisure-time activities
Reduced BMI and increased cardiovascular fitness.
Reduction in cluster of risk factors.
RESEARCH STUDIES
Slide22Kerry J. Stewart et al., (2005)
51 men and 53 women with
MetS. 6 months exercise
Increased aerobic and muscle fitness, lean mass, and HDL and reduced total and abdominal fat. Diastolic BP was reduced .
Orchard TJ,
Temprosa
M, Goldberg R, et al
(2005)
3234 participants
150 minutes of exercise per week
3 year follow up.
Incidence of the metabolic syndrome was reduced by 41% in the lifestyle intervention group and by 17% in the
metformin
group
Christos
Pistavos
et al.,
(2006)
Systematic review of 13 studies on effect of exercise on
MetS
Decreased risk of CHD mortality
Reduced risk of developing DM
Ex shown to modify blood lipid profiles
Improvements difficult to maintain
Tjonnas
AE, Lee SJ,
Rogonmo
O, et al
(2008)
Aerobic interval training vs. continuous moderate exercise
32 patients
Increase of 25% in HDL levels, improvement in insulin sensitivity, aerobic capacity in interval training group.
Slide2328 male patients between the ages of 40-55 yearsTotal exercise time for both groups was 45 minutes, 5 days a week for two weeks. The interval training group during their 25 minutes of resistance exercise alternated between 30% of baseline peak work rate for 2 minutes and then 70% of baseline peak work rate for 3 minutes on the cycle
ergometer.The conventional group (Group B) during the 25 minutes of resistance exercise performed cycling at 50% of the baseline peak work rate
Out come: Six Minute Walk DistanceEFFICACY OF INTERVAL TRAINING IN IMPROVING CARDIOVASCULAR FITNESS IN MetS
Ajin Jayan Thomas
Slide24Comparison of pre and post six minute walk Distances of the interval training and the conventional groups
Slide25RESULTSAll participants showed significant improvement in the six minute walk distances.Statistically significant difference between the post test six minute walk distances of the two groups. Interval training group showed more improvement in their six minute walk distances.
Negative correlation of age with 6MWD
Postive correlation of height with 6MWDWeight had no correlation with 6MWD
Slide26PREVENTIONPublic Education about Metabolic syndromeScreening for at risk individuals:Family historyBlood Sugar / Hgb
A1C, Lipids, Blood pressureSmoking/Tobacco useActivity Level / Dietary habits
Exercise prescriptionDietary adviceHELP PREVENT INDIA FROM BECOMING CARDIOVASCULAR DISEASE CAPITAL OF THE WORLD
TAKE HOME MESSAGE………………
Slide27Slide28RESOURCES
Slide29Slide3009769441388
a
jinjt_physio@yahoo.com
Thank
you