The current epidemic of the metabolic syndrome has been seen as the unwanted result of the dietary low-fat crusade of the second half of the past century. However, this view may be too simplistic. The effect of a Mediterranean-style diet on body weight was evaluated in overweight women who were followed for up to 2 y 6. Women who consumed a low-carbohydrate diet lost more weight than did those who consumed a high-carbohydrate diet Figure 1. As suggested by Howard 8 , the results of diet trials underscore that nutrition information is complex and cannot always be delivered as simple sound messages.
Whereas each risk factor of the metabolic syndrome visceral obesity, atherogenetic dyslipidemia, elevated blood pressure, and dysglycemia can be dealt with individually, the initial therapeutic approach to the metabolic syndrome should focus on reversing its root causes, ie, an atherogenetic diet, a sedentary lifestyle, and overweight or obesity. Whether there is general agreement about increasing physical activity and reducing body weight, no single diet is currently recommended for patients with the metabolic syndrome.
A series of recent scientific statements recommend the modification of atherogenetic diets as a major lifestyle intervention to reduce metabolic risk factors 9. In the very recent American Heart Association scientific statement on diet and lifestyle recommendation , consumption of moderate fat intake for patients with the metabolic syndrome is reinforced It seems ironic that popular diets seem more interested in proving their innocence than their merit.
In the Women's Health Initiative Dietary Modification Trial 5 , a low-fat eating pattern is said to result in no weight gain in postmenopausal women during a mean follow-up of 7. Low-fat diets tend to be high in carbohydrates; there is ample evidence that such diets may increase triacylglycerols and further reduce HDL cholesterol. Needless to say, elevated concentrations of triacylglycerols and low concentrations of HDL cholesterol are 2 criteria for the diagnosis of metabolic syndrome. Epidemiologic studies have documented that dietary factors may affect the prevalence of the metabolic syndrome.
Williams et al 12 showed that, in subjects aged 40—65 y, dietary patterns with a frequent intake of raw and salad vegetables, fruit in both summer and winter, fish, pasta, and rice and a low intake of fried foods, sausages, fried fish, and potatoes was negatively correlated with many components of the metabolic syndrome, including central obesity, fasting plasma glucose, and triacylglycerols and were positively correlated with HDL cholesterol.
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In the third National Health and Nutrition Examination Survey NHANES III , participants with the metabolic syndrome were found to have significantly lower concentrations of several antioxidants, such as retinyl esters, vitamin C, and carotenoids, except lycopene, and to consume fewer fruit and vegetables than those without the metabolic syndrome Low physical activity level, high carbohydrate intake, and current smoking habits were all significantly associated with an increased risk of having the metabolic syndrome, even after adjustment for other related covariates The epidemiologic evidence suggests a lower prevalence of the metabolic syndrome associated with dietary patterns rich in fruit, vegetables, whole grains, dairy products, and unsaturated fats.
No individual component seems to be wholly responsible for the association of diet with metabolic syndrome and its components. Rather, it is likely that the interaction between many components of the diet or the overall diet quality offers protection against the metabolic syndrome This view seems to be consistent with the results of recent epidemiologic studies indicating the importance of dietary patterns as risk factors for the occurrence of the metabolic syndrome in women 19 — The y prospective analysis of healthy women in the Framingham Offspring-Spouse study who were free of risk factors for the metabolic syndrome at baseline showed that participants with a higher nutritional risk profile consumed more dietary lipids and alcohol and less fiber and micronutrients.
Compared with women with the lowest nutritional risk, those in the highest tertile had a 2- to 3-fold risk of developing the metabolic syndrome Lifestyle interventions are the initial therapies recommended for treatment of the metabolic syndrome 9. This recommendation, however, seems to have been built up exclusively on the assumption that, being key elements in the treatment of all components of the syndrome when they occur in isolation, lifestyle interventions promise to be an effective treatment for the metabolic syndrome as a whole.
The ideal therapy for the metabolic syndrome should be the one leading to its resolution: to use an old adage, no disease, no risk! We wondered whether there are treatments specific to the syndrome itself rather than to its clustered and associated cardiovascular disease risk factors. We identified 3 studies based on lifestyle interventions 22 — Figure 2. This was a randomized controlled outpatient trial conducted in patients with the metabolic syndrome.
Resolution of the metabolic syndrome according to treatment. The numbers within or above the columns represent the percentage resolution after treatment; the numbers below the columns in parentheses indicate the number of studies in the reference list. We identified 5 studies based on drug therapy, 3 with rimonabant 25 — 27 , 1 with metformin 23 , and 1 with rosiglitazone All rimonabant studies 25 — 27 lasted 1 y and used a fixed mg daily dose.
The number of patients with the metabolic syndrome assigned to rimonabant or placebo in the 3 studies was and , and , and and , respectively. The metformin study represented one arm of the Diabetes Prevention Program trial 23 : patients took metformin mg twice daily and patients took placebo. We identified 3 studies based on laparoscopic weight- reduction surgery. Finally, of 32 obese patients with the syndrome at baseline, only 1 still had features of the syndrome 6 mo after gastric bypass The striking resolution of the metabolic syndrome after weight-reduction surgery strongly suggests that obesity is the driving force for the occurrence of this condition.
Obviously, surgery has precise indications and is not to be considered a routine treatment for the metabolic syndrome. Moreover, there is agreement that full expression of the syndrome depends on a complex interaction between genetic determinants still largely unknown and acquired factors related mainly to lifestyle habits.
The role of nutrition therapy and dietitians in the management of the metabolic syndrome
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Hypertension and dyslipidemia in diabetic patients produces substantial decreases in cardiovascular and microvascular diseases. Nutritional and Therapeutic Interventions for Diabetes and Metabolic Syndrome provides an overview of the current epidemic, outlines the consequences of this crisis and lays out strategies to forestall and prevent diabetes, obesity and other intricate issues of metabolic syndrome. The contributing experts from around the world give this book relevant and up-to-date global approaches to the critical consequences of metabolic syndrome and make it an important reference for those working with the treatment, evaluation or public health planning for the effects of metabolic syndrome and diabetes.
Product details Format Hardback pages Dimensions x x He has published papers in peer reviewed journals, 30 books, and 18 patents. His research interests are diabetes and cardiovascular disease.