Metabolic Syndrome

1. Metabolic Syndrome Amber Leon Jeanine Mills Erin Prasad Nutrition Assessment and Therapy 1 Winter 2012

2. Introduction/Video • http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=89&TopicID=925 • A diagnosis of Metabolic Syndrome means that a person is at increased risk for developing • Cardiovascular Disease (2 times as likely) • Type 2 Diabetes Mellitus (5 times as likely) • Stroke

3. Pathophysiology • Metabolic syndrome represents the clustering of several risk factors and is not a disease unto itself. • In 1988 Gerald M. Reaven proposed insulin resistance as the underlying factor and named the constellation of abnormalities Syndrome X. • Insulin resistance may underlie the pathogenesis of metabolic syndrome. • Or insulin resistance may result from the increased visceral adipose tissue (VAT)

4. Pathophysiology 2 • Fat distribution seems to be related to metabolic function with centrally obese people at higher risk of metabolic syndrome and it’s associated diseases than peripherally obese people.

6. Pathophysiology 3 • VAT products that may activate components of the inflammatory pathway and inhibit insulin signaling. • Free fatty acids and their metabolites • Cytokines (ex: tumor necrosis factor alpha) • Adiponectin (hormone released from adipose tissue) decreases, furthering insulin resistance. • VAT is a risk factor for coronary artery disease, dyslipidemia hypertension, stroke, type 2 diabetes and Metabolic Syndrome

7. Symptoms • 3 out of these 5 must be present for diagnosis • Central Obesity • Impaired Glucose Tolerance • Hypertension • Dyslipidemia • Elevated Serum Triglicerides • Lowered HDL Level Additional symptoms include Prothromboticstate high fibrinogen or plasminogen activator inhibitor [-1] in the blood • Proinflammatory state elevated high-sensitivity C-reactive protein in the blood

8. Additional Causes/Risk Factors • Genetics • Smoking • Sedentary lifestyle • High calorie diet • High-fat diet • Ethnicity

9. Screening/Diagnosis/Labs For Diagnosis Patient must have 3 out of 5 defining symptoms • Screening/Labs • Waist Circumference • > 40 inches in males • >35 inches in females • Blood Pressure • >140/90 • >130/85 • if insulin resistance present • Fasting Blood Glucose • > 110mg/dl • Serum Triglycerides • > 150mg/dl • Serum HDL • < 40mg/dl for males • < 50mg/dl for females

10. Goals for MNT • To increase mortality and decrease the co-morbidities associated with Metabolic Syndrome. • Weight Reduction • specifically reduction of visceral adipose tissue and decreased waist circumference (waist to hip ratio, Index of Central Obesity) • Maintain normal blood glucose levels • Improve lipid profile (increase HDL, lower triglycerides) • Lower blood pressure • Decrease Systemic Inflammation

11. Medical Nutrition Therapy • Dash Diet • Designed to reduce hypertension • Low sugar • Low fat • High fiber • Carbohydrate Counting/Exchanges • normalization of blood glucose • Fruit and Vegetable intake • May help to lower blood pressure • May help to lose weight • May replace other more refined carbohydrates • Omega 3 Fats • Reduction of inflammation • Refer for and Encourage physical activity • Improved glucose tolerance • Improved blood pressure • Improved lipid profile • Improved cardiovascular fitness and endurance • Improved depression

12. Nutrient Needs • Calculate calories for weight loss • 7% weight loss has been shown to be enough to reverse a Metabolic Syndrome diagnosis • Protein within AMDR • 10-35% of calories • Fat within AMDR • 20-35% of calories • Emphasis on omega 3 and unsaturated fatty acids • Carbohydrate within AMDR • 45-65% of calories • Emphasis on whole foods sources • Emphasis on maintaining blood sugar levels as close to normal as possible. • Fluids • 35ml/kg or 1ml/kcal

13. Medications • Blood Glucose • Insulin • Oral medications • Sulfonylureas, • Meglitinides • Biguanides • Thiazolidinediones • Alpha-glucosidase inhibitors • DPP-4 inhibitors • Cholesterol • Statins • Bile acid binding resins • Cholesterol absorption inhibitors • Combination cholesterol absorption inhibitor and statin • Fibrates • Niacin • Combination statin and niacin • Omega-3 Fatty Acids • Blood Pressure • Diuretics • Beta-blockers • ACE inhibitors • Angiotensin II receptor blockers • Alpha-2 receptor Agonist • Combined alpha and beta-blockers • Central agonists • Peripheral adrenergic inhibitor • Vasodialoator

14. Supplements/Herbs/Botanicals • Insulin resistance • Chromium polynicotinate, • Maitake mushrooms • Green tea polyphenols • Antioxidants • Alpha lipoic acid • Cinnamon • Oat beta-glucan • Omega 3 fatty acids • Holy Basil • Abnormal blood lipids • Omega-3 fatty acids • Niacin • Oat beta-glucan • Holy Basil • Blood Pressure • Garlic • Omega-3 fatty acids • calcium • magnesium • vitamin C • Miatake Mushrooms • Anti Inflammatory • B-vitamins • B6, B12, Folate • Omega 3 fatty acids • Turmeric • Ginger • Holy Basil

15. Other Considerations • In 2006 The IDF (international diabetes foundation) estimated that 20-25% of the World population has Metabolic Syndrome. • Prevalence is increasing in the adult population worldwide • Prevalence is increasing in the US among children and adolescents • Secondary associated conditions include • Compromised renal function • Polycystic ovary syndrome • Non-alcoholic fatty-liver disease • Non-alcoholic steatohepatitis • Gestational diabetes mellitus • Inflammation • Depression • Metabolic Syndrome is COMPLICATED • The causes and symptoms overlap and contribute to one another. • Pharmacological interventions improve some symptoms while exacerbating others • People with this diagnosis are likely to be overwhelmed and feeling hopeless about their ability to improve their health. • Diet and Exercise lifestyle changes can improve patients health dramatically.

16. References