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METABOLIC SYNDROME

METABOLIC SYNDROME. DR. AJIN JAYAN THOMAS, Department of Physiotherapy, Dr. D. Y. Patil University, Nerul, Navi Mumbai. METABOLIC SYNDROME.

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METABOLIC SYNDROME

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  1. METABOLIC SYNDROME DR. AJIN JAYAN THOMAS, Department of Physiotherapy, Dr. D. Y. Patil University, Nerul, Navi Mumbai.

  2. METABOLIC SYNDROME “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, hyperurecemiaand 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.

  3. SYNONYMS OF METABOLIC SYNDROME • Syndrome X • Insulin resistance syndrome • Metabolic syndrome X • Cardiometabolic syndrome • Dysmetabolic syndrome • Deadly quartet • Multiple metabolic syndrome

  4. Definitions & Criteria of Diagnosis • World Health Organization (WHO) 1998 • Adult Treatment Panel III, 2003 • International Diabetes Foundation (IDF), 2005 • American 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

  5. American Heart Association (AHA) and National Heart, Lung and Blood Institute (NHLBI), 2005 Any 3 of 5 constitute diagnosis of Metabolic Syndrome • Elevated Waist Circumference (cutoff for Asian Population) 90 cm (35 inches) in Men 80 cm (31 inches) in Women • Elevated 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-C • Elevated 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

  6. Prevalence • Viswanathan 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. MetSwas 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.

  7. Evolution of Man……..

  8. Why is MetS Important? • Causes 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

  9. Evaluation of MetS • Review 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.

  10. Assess physical activity pattern: type of physical activity, frequency, duration, tolerance, and motivation • Identify the risk category by using the Framingham Point Scores and PROCAM risk score. • Cardiorespiratory Fitness: Six Minute Walk Test / Exercise Tolerance Test.

  11. What can be done……. FIRST LINE THERAPY……LIFESTYLE MODIFICATION • WEIGHT REDUCTION • DIETERY MODIFICATIONS • PHYSICAL ACTIVITY Weight Reduction : Reduce calorie intake and Exercise Reduction 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.

  12. DIETARY MODIFICATIONS • Adequate fluid consumption- 1.5 liters / day • Limit salt intake up to 6 g/day • Calories based on individual needs, initiate plan to achieve reasonable weight (BMI between 18 and 24 kg/m2) • 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.

  13. A 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.

  14. Mediterranean Diet Pyramid

  15. Physical Activity Moderate 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.

  16. Review of Exercise in MetSJ. Eriksson, S. Taimela, V.A. KoivistoDiabetologia (1997) 40: 125–135

  17. RESEARCH STUDIES

  18. EFFICACY OF INTERVAL TRAINING IN IMPROVING CARDIOVASCULAR FITNESS IN MetSAjin Jayan Thomas • 28 male patients between the ages of 40-55 years • Total 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 Distance

  19. Comparison of pre and post six minute walk Distances of the interval training and the conventional groups

  20. RESULTS • All 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 6MWD • Weight had no correlation with 6MWD

  21. TAKE HOME MESSAGE……………… • PREVENTION • Public Education about Metabolic syndrome • Screening for at risk individuals: • Family history • Blood Sugar / Hgb A1C, Lipids, Blood pressure • Smoking/Tobacco use • Activity Level / Dietary habits • Exercise prescription • Dietary advice HELP PREVENT INDIA FROM BECOMING CARDIOVASCULAR DISEASE CAPITAL OF THE WORLD

  22. RESOURCES

  23. Thank you 09769441388 ajinjt_physio@yahoo.com

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