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Treatment of the metabolic syndrome: The impact of lifestyle modification

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Abstract

Along with the increasing prevalence of obesity comes a constellation of metabolic derangements: dyslipidemias, hypertension, insulin resistance, and glucose intolerance, as well as increased prothrombotic and inflammatory markers. The association of these factors has been termed the “metabolic syndrome” and increases the risk of developing cardiovascular disease. Aside from pharmaceutical therapy, lifestyle modification is necessary to aggressively treat this syndrome in its entirety. This involves a holistic approach of behavioral counseling, education, increased physical activity, and dietary modification. Even modest weight loss (7% to 10% of body weight) results in decreased fat mass, blood pressure, glucose, low-density lipoprotein, and triglyceride levels. These benefits can also translate into improved long-term outcome, especially if weight loss and lifestyle alterations are maintained. However, the remaining challenge is how to promote long-term adherence to a healthier, more active lifestyle and avoid reversion to old habits.

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References and Recommended Reading

  1. Flegal KM, Carroll MD, Ogden CL, Johnson CL: Prevalence and trends in obesity among US adults, 1999–2000. JAMA 2002, 288:1723–1727.

    Article  PubMed  Google Scholar 

  2. Calle EE, Thun MJ, Petrelli JM, et al.: Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 1999, 341:1097–1105.

    Article  PubMed  CAS  Google Scholar 

  3. Grundy SM, Brewer HB Jr, Cleeman JI, et al.: Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004, 109:433–438.

    Article  PubMed  Google Scholar 

  4. Ford ES, Giles WH, Dietz WH: Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002, 287:356–359.

    Article  PubMed  Google Scholar 

  5. Grundy SM, Hansen B, Smith SC Jr, et al.: Clinical management of metabolic syndrome: report of the American Heart Association/National Heart, Lung, and Blood Institute/American Diabetes Association conference on scientific issues related to management. Circulation 2004, 109:551–556.

    Article  PubMed  Google Scholar 

  6. Anderson JL, Horne BD, Jones HU, et al.: Which features of the metabolic syndrome predict the prevalence and clinical outcomes of angiographic coronary artery disease? Cardiology 2004, 101:185–193.

    Article  PubMed  Google Scholar 

  7. Kip KE, Marroquin OC, Kelley DE, et al.: Clinical importance of obesity versus the metabolic syndrome in cardiovascular risk in women: a report from the Women’s Ischemia Syndrome Evaluation (WISE) study. Circulation 2004, 109:706–713.

    Article  PubMed  Google Scholar 

  8. Solymoss BC, Bourassa MG, Campeau L, et al.: Effect of increasing metabolic syndrome score on atherosclerotic risk profile and coronary artery disease angiographic severity. Am J Cardiol 2004, 93:159–164.

    Article  PubMed  Google Scholar 

  9. Lakka HM, Laaksonen DE, Lakka TA, et al.: The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002, 288:2709–2716.

    Article  PubMed  Google Scholar 

  10. Isomaa B, Almgren P, Tuomi T, et al.: Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001, 24:683–689.

    Article  PubMed  CAS  Google Scholar 

  11. Krauss RM, Eckel RH, Howard B, et al.: AHA Dietary Guidelines: revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation 2000, 102:2284–2299.

    PubMed  CAS  Google Scholar 

  12. National Institutes of Health: The Practical Guide: Identification, Evaluation and Treatment of Overweight and Obesity in Adults. Bethesda, MD: NIH; 2000.

    Google Scholar 

  13. Oster G, Thompson D, Edelsberg J, et al.: Lifetime health and economic benefits of weight loss among obese persons. Am J Pub Health 1999, 89:1536–1542.

    Article  PubMed  CAS  Google Scholar 

  14. Katzmarzyk PT, Church TS, Blair SN: Cardiorespiratory fitness attenuates the effects of the metabolic syndrome on all-cause and cardiovascular disease mortality in men. Arch Intern Med 2004, 164:1092–1097.

    Article  PubMed  Google Scholar 

  15. McAuley KA, Williams SM, Mann JI, et al.: Intensive lifestyle changes are necessary to improve insulin sensitivity: a randomized controlled trial. Diabetes Care 2002, 25:445–452.

    Article  PubMed  Google Scholar 

  16. Goodpaster BH: Measuring body fat distribution and content in humans. Curr Opin Clin Nutr Metab Care 2002, 5:481–487.

    Article  PubMed  Google Scholar 

  17. Janssen I, Fortier A, Hudson R, Ross R: Effects of an energy-restrictive diet with or without exercise on abdominal fat, intermuscular fat, and metabolic risk factors in obese women. Diabetes Care 2002, 25:431–438.

    Article  PubMed  Google Scholar 

  18. Ross R, Dagnone D, Jones PJ, et al.: Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men. A randomized, controlled trial. Ann Intern Med 2000, 133:92–103.

    PubMed  CAS  Google Scholar 

  19. You T, Ryan AS, Nicklas BJ: The metabolic syndrome in obese postmenopausal women: relationship to body composition, visceral fat, and inflammation. J Clin Endocrinol Metab 2004, 89:5517–5522.

    Article  PubMed  CAS  Google Scholar 

  20. Goodpaster BH, Kelley DE, Wing RR, et al.: Effects of weight loss on regional fat distribution and insulin sensitivity in obesity. Diabetes 1999, 48:839–847.

    Article  PubMed  CAS  Google Scholar 

  21. Anderson JW, Johnstone BM, Cook-Newell ME: Meta-analysis of the effects of soy protein intake on serum lipids. N Engl J Med 1995, 333:276–282.

    Article  PubMed  CAS  Google Scholar 

  22. Beard CM, Barnard RJ, Robbins DC, et al.: Effects of diet and exercise on qualitative and quantitative measures of Idl and its susceptibility to oxidation. Arterioscler Thromb Vasc Biol 1996, 16:201–207.

    PubMed  CAS  Google Scholar 

  23. Chandalia M, Garg A, Lutjohann D, et al.: Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus. N Engl J Med 2000, 342:1392–1398.

    Article  PubMed  CAS  Google Scholar 

  24. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico. Lancet 1999, 354:447–455.

  25. Burr ML, Gilbert JF, Holliday RM, et al.: Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: Diet and Reinfarction Trial (DART). Lancet 1989, 334:757–761.

    Article  Google Scholar 

  26. Cutler JA, Follmann D, Allender PS: Randomized trials of sodium reduction: an overview. Am J Clin Nutr 1997, 65:643S-651S.

    PubMed  CAS  Google Scholar 

  27. Sacks FM, Svetkey LP, Vollmer WM, et al.: Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 2001, 344:3–10.

    Article  PubMed  CAS  Google Scholar 

  28. Huang Z, Willett WC, Manson JE, et al.: Body weight, weight change, and risk for hypertension in women. Ann Intern Med 1998, 128:81–88.

    PubMed  CAS  Google Scholar 

  29. Yong LC, Kuller LH, Rutan G, Bunker C: Longitudinal study of blood pressure: changes and determinants from adolescence to middle age. The Dormont High School follow-up study, 1957–1963 to 1989–1990. Am J Epidemiol 1993, 138:973–983.

    PubMed  CAS  Google Scholar 

  30. Appel LJ, Champagne CM, Harsha DW, et al.: Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA 2003, 289:2083–2093.

    Article  PubMed  Google Scholar 

  31. Miller ER III, Erlinger TP, Young DR, et al.: Results of the Diet, Exercise, and Weight Loss Intervention Trial (DEW-IT). Hypertension 2002, 40:612–618.

    Article  PubMed  CAS  Google Scholar 

  32. Stevens VJ, Obarzanek E, Cook NR, et al.: Long-term weight loss and changes in blood pressure: results of the Trials of Hypertension Prevention, phase II. Ann Intern Med 2001, 134:1–11.

    PubMed  CAS  Google Scholar 

  33. Whelton PK, Appel LJ, Espeland MA, et al.: Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). TONE Collaborative Research Group. JAMA 1998, 279:839–846.

    Article  PubMed  CAS  Google Scholar 

  34. Effects of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal blood pressure. The Trials of Hypertension Prevention, phase II. The Trials of Hypertension Prevention Collaborative Research Group. Arch Intern Med 1997, 157:657–667.

  35. Neter JE, Stam BE, Kok FJ, et al.: Influence of weight reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension 2003, 42:878–884.

    Article  PubMed  CAS  Google Scholar 

  36. Pleis J, Coles R: Summary health statistics for U.S. adults: National Health Interview Survey, 1999. National Center for Health Statistics. Vital Health Stat 2003, 10:9.

    Google Scholar 

  37. Whelton SP, Chin A, Xin X, He J: Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med 2002, 136:493–503.

    PubMed  Google Scholar 

  38. Cook NR, Cohen J, Hebert PR, et al.: Implications of small reductions in diastolic blood pressure for primary prevention. Arch Intern Med 1995, 155:701–709.

    Article  PubMed  CAS  Google Scholar 

  39. Klein S, Sheard NF, Pi-Sunyer X, et al.: Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies. A statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition. Am J Clin Nutr 2004, 80:257–263.

    PubMed  CAS  Google Scholar 

  40. Knowler WC, Barrett-Connor E, Fowler SE, et al.: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002, 346:393–403.

    Article  PubMed  CAS  Google Scholar 

  41. Pan XR, Li GW, Hu YH, et al.: Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 1997, 20:537–544.

    Article  PubMed  CAS  Google Scholar 

  42. Tuomilehto J, Lindstrom J, Eriksson JG, et al.: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001, 344:1343–1350.

    Article  PubMed  CAS  Google Scholar 

  43. Castaneda C, Layne JE, Munoz-Orians L, et al.: A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes. Diabetes Care 2002, 25:2335–2341.

    Article  PubMed  Google Scholar 

  44. Collins RW, Anderson JW: Medication cost savings associated with weight loss for obese non-insulin-dependent diabetic men and women. Prev Med 1995, 24:369–374.

    Article  PubMed  CAS  Google Scholar 

  45. Williamson DF, Thompson TJ, Thun M, et al.: Intentional weight loss and mortality among overweight individuals with diabetes. Diabetes Care 2000, 23:1499–1504.

    Article  PubMed  CAS  Google Scholar 

  46. Ryan DH, Espeland MA, Foster GD, et al.: Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes. Control Clin Trials 2003, 24:610–628.

    Article  PubMed  Google Scholar 

  47. Ribstein J, Du CG, Mimran A: Combined renal effects of overweight and hypertension. Hypertension 1995, 26:610–615.

    PubMed  CAS  Google Scholar 

  48. Verhave JC, Hillege HL, Burgerhof JG, et al.: Sodium intake affects urinary albumin excretion especially in overweight subjects. J Intern Med 2004, 256:324–330.

    Article  PubMed  CAS  Google Scholar 

  49. Mogensen CE: Prediction of clinical diabetic nephropathy in IDDM patients. Alternatives to microalbuminuria? Diabetes 1990, 39:761–767.

    Article  PubMed  CAS  Google Scholar 

  50. Maddox DA, Alavi FK, Santella RN, Zawada ET Jr: Prevention of obesity-linked renal disease: age-dependent effects of dietary food restriction. Kidney Int 2002, 62:208–219.

    Article  PubMed  Google Scholar 

  51. Ridker PM, Hennekens CH, Buring JE, Rifai N: C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med 2000, 342:836–843.

    Article  PubMed  CAS  Google Scholar 

  52. Pradhan AD, Manson JE, Rifai N, et al.: C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. JAMA 2001, 286:327–334.

    Article  PubMed  CAS  Google Scholar 

  53. Tchernof A, Nolan A, Sites CK, et al.: Weight loss reduces c-reactive protein levels in obese postmenopausal women. Circulation 2002, 105:564–569.

    Article  PubMed  Google Scholar 

  54. Esposito K, Pontillo A, Di Palo C, et al.: Effect of weight loss and lifestyle changes on vascular inflammatory markers in obese women: a randomized trial. JAMA 2003, 289:1799–1804.

    Article  PubMed  CAS  Google Scholar 

  55. Meade TW, Ruddock V, Stirling Y, et al.: Fibrinolytic activity, clotting factors, and long-term incidence of ischaemic heart disease in the Northwick Park Heart Study. Lancet 1993, 342:1076–1079.

    Article  PubMed  CAS  Google Scholar 

  56. Thogersen AM, Jansson JH, Boman K, et al.: High plasminogen activator inhibitor and tissue plasminogen activator levels in plasma precede a first acute myocardial infarction in both men and women: evidence for the fibrinolytic system as an independent primary risk factor. Circulation 1998, 98:2241–2247.

    PubMed  CAS  Google Scholar 

  57. Janand-Delenne B, Chagnaud C, Raccah D, et al.: Visceral fat as a main determinant of plasminogen activator inhibitor 1 level in women. Int J Obes Relat Metab Disord 1998, 22:312–317.

    Article  PubMed  CAS  Google Scholar 

  58. Landin K, Stigendal L, Eriksson E, et al.: Abdominal obesity is associated with an impaired fibrinolytic activity and elevated plasminogen activator inhibitor-1. Metabolism 1990, 39:1044–1048.

    Article  PubMed  CAS  Google Scholar 

  59. Yarnell JW, Sweetnam PM, Rumley A, Lowe GD: Lifestyle and hemostatic risk factors for ischemic heart disease: the Caerphilly Study. Arterioscler Thromb Vasc Biol 2000, 20:271–279.

    PubMed  CAS  Google Scholar 

  60. Lee KW, Lip GY: Effects of lifestyle on hemostasis, fibrinolysis, and platelet reactivity: a systematic review. Arch Intern Med 2003, 163:2368–2392.

    Article  PubMed  Google Scholar 

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Pritchett, A.M., Foreyt, J.P. & Mann, D.L. Treatment of the metabolic syndrome: The impact of lifestyle modification. Curr Atheroscler Rep 7, 95–102 (2005). https://doi.org/10.1007/s11883-005-0030-4

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