and management of Cardiometabolic Syndrome Vanessa Kotzé RDSA Part time lecturer Dpt Human Nutrition UP Private practice Groenkloof Life Hospital Pretoria Insulin resistance syndrome ID: 907830
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Slide1
The role of nutrition and lifestyle in the prevention
and management of Cardiometabolic Syndrome
Vanessa Kotzé RD(SA)Part time lecturer, Dpt Human Nutrition, UPPrivate practice, Groenkloof Life Hospital, Pretoria
Slide2Insulin resistance syndrome
Syndrome X
hypertriglyceridemic
waist
The deadly quartet
Slide3Cardiometabolic syndrome
Cluster of metabolic abnormalities that include
hypertension,
central obesity,
insulin resistance, and
atherogenic dyslipidemiaStrongly associated with an increased risk for developing diabetes and atherosclerotic and nonatherosclerotic cardiovascular disease (CVD)
Slide4METABOLIC SYNDROME
Slide5Diagnosing cardiometabolic syndrome
Slide6Pathogenesis
Slide7Is it relevant in 2021?
Now even more so…
Impact of confinement during lockdown
Slide8Closed gyms
Restrictions on walking distance
lack of space and infrastructure of homes forphysical exercise
lack of technical knowledge on appropriate training routinesExercise restrictions
Slide9Effects on diet
Limited access to shops
Poor quality of food due to poor income
Overeating
Slide10Effects on acute inactivity and dietary changes
Parameters assessed:
Blood parameters
Inflammatory parameters
Lipid profile
Body composition Cardiorespiratory fitness (CRF)
Slide11Metabolic effects of acute inactivity in healthy adultsSeveral studiesless than 2 h of regular exercise/weekwalked < 3500 steps / dayBUT same dietary patternsParameters
Blood parameters:
↑ AUC for plasma insulin during an OGTT, ↑ C-peptide, increased insulin resistance and diminished insulin sensitivityInflammatory parameters: NoneLipid profile: ↑ TGBody composition: 7%
↑ intra-abdominal FM, ↓ FFMCardiorespiratory fitness (CRF): Maximal aerobic capacity (VO2max) ↓With ↑ in PANormal function return
Slide12Metabolic effects of acute inactivity in overweight adultsDixon et al & Bowden studies overweight vs normal weightMen & women< 4000 steps/day
Central obesityBUT same dietary patterns
Blood parameters: ↑ AUC for plasma insulin during an OGTT, ↑ C-peptide, increased insulin resistance and diminished insulin sensitivity, ↑ ALTInflammatory parameters: NoneLipid profile: ↑ TG, total-chol, LDLBody composition: ↑
intra-abdominal & total FM, ↓ FFMCardiorespiratory fitness (CRF): Maximal aerobic capacity (VO2max) ↓With ↑ in PANormal function return
Slide13Metabolic effects of acute sedentary lifestyle in elderlyPrevalence of sarcopenia highloss of skeletal muscle mass and strength
Repercussions on healthAging associated with abdominal obesityImportant contributor to: insulin resistance and metabolic syndrome, a higher level of proinflamatory cytokines drastic ↓
in PA could have worse consequences in elderly by accelerating the ageing process and the appearance of age-related diseases
Slide14Metabolic effects of acute sedentary lifestyle in elderlyHealthy older adultsUsual > 3500 steps --- ↓ 76% BUT same dietary patterns
Blood parameters:
↑ AUC for plasma insulin during an OGTT, ↑ C-peptide, increased insulin resistance and diminished insulin sensitivity, ↑ ALTInflammatory parameters: ↑ TNF, CRP & IL-6Lipid profile: ↑ TG, total-chol, LDLBody composition: ↑ intra-abdominal,
↓ skeletal leg muscle & protein synthsesisCardiorespiratory fitness (CRF): Maximal aerobic capacity (VO2max) ↓With ↑ in PAGlc homeostasis & inflammatory markers did not return to normal
Slide15Metabolic effects of acute sedentary lifestyle and overfeeding< 4000 steps/day> 50% increase in energy intake
Blood parameters: ↑ AUC for plasma insulin during an OGTT, ↑ C-peptide, increased insulin resistance and diminished insulin sensitivityInflammatory parameters:
-Lipid profile: -Body composition: ↑ total FM, android, gynoid and visceral fatCardiorespiratory fitness (CRF): Maximal aerobic capacity (VO2max) ↓
With ↑ in PA & ↓ eatingBody weight & adipocity did not return to normal
Slide16So what about reversing the acute effect?
Slide17What effect will dietary modifications have?
Slide18What effect will dietary modifications have?
Few RCT have examined the effects of calorie restriction on health
Study 1
three-month period of calorie restrictioncycles of a five-day fasting-mimicking diet Results↓ BMI, trunk, and total body fat ↓ blood pressure, TG, total and LDL, CRP, and insulin-like growth factor 1
Slide19What effect will dietary modifications have?
Slide20What does the guidelines recommend?
Perex-Martinez 2017
Slide21Physical Activity to Mitigate the Metabolic Impacts of Confinement
What type of training is appropriate for an individual with metabolic syndrome?
improved waist circumference, fasting blood glucose, HDL-cholesterol, triglycerides, diastolic blood pressure, and VO2 peak
no changes
Slide22Physical Activity to Mitigate the Metabolic Impacts of Confinement
Q: how many steps per day are recommended?
More steps per day (8000 vs. 4000 steps per day) is associated with lower all-cause mortality No significant association between step intensity and mortality
Slide23What does the guidelines recommend?
Perex-Martinez 2017
Slide24Is it as simple as the energy balance
Slide25The role of microbiota
Slide26Trimethylamine N-oxide
(TMAO)
Slide27What about the diet patterns?
Slide28Mediterranean diet
Nutritional
districution
Improvements in MetSProtein: 15 – 18% TECVD: ↓ incidence & outcomesHPT: ↓ SBP & DBPDyslipidaemia: improvementT2DM: ↓ incidenceCHO: 35 – 45% TEFat: 35 – 45% TEMainly MUFA
Slide29What does the guideline say?
Slide30What does the guidelines recommend?
Slide31Nutritional distribution
Improvements in
MetSProtein: 18% TE
CVD: ↓ incidence & outcomesHPT: ↓ SBP & DBPCardiometabolic profile: improvementT2DM: ↓ incidenceAnthrop: ↓ BMI & WCCHO: 55% TEFat: 27% TE - SFA 6%
Slide32Plant based diets
Nutritional distribution
Improvements in MetS
Protein: restrict animal derived foodCVD: ↓ mortalityHPT: ↓ SBP & DBPT2DM: ↓ incidenceAnthrop: ↓ BMICHO: wholegrainsFat: rich in UFA
Slide33Low CHO & very low CHO
Nutritional distribution
Improvements in MetS
Protein: 20 - 30% TEHPT: ↓ DBPCardiometabolic profile: ↓ LDL & TG, ↑ HDLT2DM: ↓ HbA1c, insulin resistanceAnthrop: ↓ weight & maintenanceCHO: < 50% TE(in ketogenic: <10% TE)Fat: 30 - 70% TE
Slide34Low fat diet
Nutritional distribution
Improvements in MetS
Protein: 15 - 17% TE ↓ all-cause mortailityHPT: ↓ SBP & DBPCardiometabolic profile: short term improvementAnthrop: ↓ weight – short termCHO: 50 - 60% TEFat: <30% TE - SFA < 10% TE
Slide35High protein diet
Nutritional distribution
Improvements in MetS
Protein: 20 - 30% TE(1.34 – 1.5g/kg/d)Cardiometabolic profile: ↓ TGCHO: 40 - 50% TEFat: 20 - 40% TE
Slide36Nordic diet
Nutritional distributionImprovements in MetS
Protein: Low meatHPT: ↓ SBP & DBP
Cardiometabolic profile: ↑ HDLCHO: High in whole grain productsLow in processed food
Slide37Intermittent fasting
Nutritional distributionImprovements in MetS
Fasting for extended periodsCVD: ↓ riskHPT: ↓ SBP & DBP
Cardiometabolic profile: improvementT2DM: ↓ risk, insulin resistanceAnthrop: ↓ weight loss
Slide38What does the guidelines recommend regarding diets?
Slide39Do not forget about SAFBDG
Slide40Specific food sources?
Slide41What does the guidelines recommend for LEGUMES?
Slide42What does the guidelines recommend for GRAINS?
Slide43What does the guidelines recommend?
Slide44What does the guidelines recommend?
Slide45What does the guidelines recommend?
Slide46What does the guideline recommend?
Slide47What does the guidelines recommend?
Slide48What does the guidelines recommend?
Slide49Do not forget about SAFBDG – there is a place for it
Slide50How do you decide which diet?
Slide51What about neutraceuticals?
Slide52Tumeric
Slide53Garlic
Slide54Cinnamon
Slide55Neutraceuticals
Slide56Neutraceuticals
Slide57Take note
Small and few studies
Slide58Associated conditions
Slide59Non-alcoholic fatty liver disease (NAFLD)
Slide60Proposed lifestyle modification guidelines for NAFLD
Slide61Polycystic ovary syndrome (PCOS)
Slide62Lifestyle modifications
Slide63Nutritional correlates in PCOS
Slide64Closing notes
Slide65ReferencesMartinez-Ferran M, de la Guía-Galipienso F, Sanchis-Gomar F, Pareja-Galeano H. Metabolic Impacts of Confinement during the COVID-19 Pandemic Due to Modified Diet and Physical Activity Habits. Nutrients. 2020;12(6):1549
Rochlani Y, Pothineni NV, Kovelamudi S, Mehta JL. Metabolic syndrome: pathophysiology, management, and modulation by natural compounds. Ther Adv Cardiovasc Dis. 2017 Aug;11(8):215-225
Slide66ReferencesPérez-Martínez P, Mikhailidis DP, Athyros VG, Bullo M, Couture P, Covas MI, et al. Lifestyle recommendations for the prevention and management of metabolic syndrome: an international panel recommendation.
Nutr Rev. 2017 May 1;75(5):307-326.