Review article
Focus on lifestyle change and the metabolic syndrome

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Therapeutic lifestyle change and abdominal obesity

Weight gained after age 18 years carries a heavy metabolic price tag. In the Nurses' Health Study, a weight gain of 10 kg or more since the age of 18 was associated with increased mortality in middle adulthood [2]. Despite this statistic, there has been an alarming rate of growth in the incidence of overweight (body mass index [BMI], 25–29.9) and obesity (BMI, >30.0) in the United States [3]. BMI takes into account the effects of height and should be calculated in those individuals who have

Treatment of glucose abnormalities (impaired fasting glucose, impaired glucose tolerance, or type 2 diabetes mellitus)

For individuals with impaired glucose tolerance (IGT), the Da Qing trial [17], the Diabetes Prevention Program (DPP) [18], and the Finnish Diabetes Prevention Trial (FDPT) [19] provide convincing evidence for the benefits of lifestyle modification. The Da Qing trial examined 577 subjects with IGT and showed a large decrease in the development of type 2 diabetes mellitus (T2DM) in the exercise-only group, which was larger than that seen in the combined diet and exercise group. The results were

Treatment of dyslipidemia

The lipid triad consists of elevated TGs, low HDL-C, and increased small, dense LDL-C. These are the lipid abnormalities characteristically associated with the metabolic syndrome. The ATP III offered the following advice for individuals with the metabolic syndrome. First, the panel suggested that there should be a maximum reduction of LDL-C. The level of LDL-C is decreased by reducing saturated fat and dietary cholesterol (high-fat dairy products and fatty cuts of meat) including more fiber in

Hypertension

In the United States, the increases in overweight and obesity have led to obesity-associated hypertension. NHANES III data showed that particularly up to age 60, the higher the BMI, the greater the prevalence of hypertension [32]. Certainly in the Framingham study, the age-adjusted relative risk for new-onset hypertension was highly associated with overweight status for men and women [33]. More than 20 years ago, Reisin et al [34] found that in a trial of weight reduction without salt

Hypercoagulability/inflammation

Hypercoagulability and inflammation are not part of the ATP III definition but are clearly seen in individuals with metabolic syndrome. How does weight reduction and exercise help? Plasma tissue plasminogen activator inhibitor 1 (PAI-1) was predictive of coronary artery disease events in a prospective multicenter study of men with angina, although the associations disappeared after parameters reflecting insulin resistance were considered [42]. A study of obese subjects who underwent weight

Management of metabolic syndrome through life-habit changes—practical approaches

The first practical step is to try to prevent weight gain in patients who have the metabolic syndrome. Although this step seems obvious, many patients are counseled to begin medications such as steroids, antidepressants, oral hypoglycemics, and even certain antipsychotic medications that are known to cause weight gain without a strategy in place to combat the weight gain that occurs. The ATP III also counsels on first implementing LDL-lowering measures (the exception would be patients with TG

Summary

This article has attempted to provide the groundwork for understanding the basis and nonpharmacologic management of the metabolic syndrome. Weight loss can greatly reduce insulin resistance and all of the manifestations of the metabolic syndrome. Physicians' endorsement of eating and exercise behaviors that lead to a healthier waistline and improved BMI, lower blood pressure, improved HDL-C and TGs, and lower blood sugars along with a reduced CRP carries the promise of improved long-term

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