METABOLIC SYNDROME Sheu K. RAHAMON - PowerPoint Presentation

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METABOLIC SYNDROME

Sheu K. RAHAMONB.Sc. (Ilorin), M.Sc., Ph.D. (Ibadan)Department of Biochemistry,EUI.

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OUTLINE

DefinitionPrevalence of MSDiseases associated with MS

Pathophysiology of MS

:

Positive energy balanceInflammatory hypothesisTherapeutic strategiesPieces of adviceConclusion

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Metabolic 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

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Prevalence 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

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Ife: 12.1% (

Adegoke et al., 2010) Ibadan: 16.3% (Charles-Davies et al., 2012)

Nigeria: 31.7% (

Oguoma

et al., 2015)

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Causes:

Unhealthy dietsObesityRapidly growing number of inactive peopleIndustrialization and,

Mechanization

(

Gaziano, 2007; Hollman and Kristenson, 2008).

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Implication of growing MS prevalence

An outbreak of glucometabolic and cardiovascular disorders worldwide

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Figure

1: Risks associated with MS (Duvnjak and Duvnjak, 2009)

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Tuesday, October 31, 2017

Do Our Cells Pay the Price When We Sit Too Much?

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Pathophysiology

of MSMultiple and still

poorly

understood

Factors:Insulin resistance Central (visceral) obesityHyperglycaemia

Hypertension

Dyslipidaemia

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Figure 2: Novel components of metabolic syndrome

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Hypotheses

Positive energy balanceInflammation

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Positive 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

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Figure 4: The inflammatory hypothesis

Adipocyte hypertrophy/necrosisDisordered adipokine production

Macrophage infiltration

Proinflammatory cytokines production

IRS phosphorylation (serine vs tyrosine)Insulin resistance

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Diagnosis of MS

Remains a clinical challenge due to the poor understanding of its pathophysiology.

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Table 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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Others 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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Joint Interim

Statement (Alberti et al., 2009)

Includes any

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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

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Therapeutic strategies

Lifestyle changes- Diet & Exercise Pharmacotherapy- poly pill

B

ariatric surgery

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Therapeutic 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

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There is a problem!

70 – 90% failure rate within 1 – 2 yearsFeeding-

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A complex and motivational

behaviour

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Figure 5: Factors affecting feeding

(Dr. J friedman’s Lecture- The biologic basis of obesity)

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Exercise

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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Problems?

Long-term adherence Cardio-respiratory fitness assessment- aerobic exercise

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Pieces 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/

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Conclusion

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.

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References

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.

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Després

, J. and Lemieux, I. 2006. Abdominal obesity and metabolic syndrome.

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444: 881-887.

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L,

Duvnjak

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Soita

, D. J., Hassan, M. S., Blanco-Blanco, E.,

Vergotine

, Z.,

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, 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.

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“To lengthen thy life, lessen thy meals.”

Benjamin Franklin, Poor Richards Almanac (1737).THANK YOU FOR LISTENING

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