DR. AJIN JAYAN THOMAS,Department of Physiotherapy,

Dr. D. Y. Patil University,Nerul, Navi Mumbai.

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, hyperurecemia and 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.

METABOLIC SYNDROME

Syndrome XInsulin resistance syndromeMetabolic syndrome X Cardiometabolic syndromeDysmetabolic syndrome Deadly quartetMultiple metabolic syndrome

SYNONYMS OF METABOLIC SYNDROME

World Health Organization (WHO) 1998Adult Treatment Panel III, 2003International Diabetes Foundation (IDF),

2005American Association of Clinical

Endocrinologists (2003)European Group for the Study of Insulin

Resistance, EGIRAmerican Heart Association (AHA) and

National Heart, Lung and Blood Institute (NHLBI), 2005

Definitions & Criteria of Diagnosis

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 Triglycerides150 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 Pressure130 mm Hg systolic blood pressure Or 85 mm Hg diastolic blood pressure Or On antihypertensive drug treatment

Elevated Fasting Glucose100 mg/dL Or On drug treatment for elevated glucose

American Heart Association (AHA) and National Heart, Lung and Blood Institute (NHLBI), 2005

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. MetS was 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.

PREVALENCE

Evolution of Man……..

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

Why is MetS Important?

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.

Evaluation of MetS

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.

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.

What can be done…….

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.

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.

Mediterranean Diet Pyramid

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.

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

Sean Carroll and Mike Dudfield, (2004)systematic review 25 RCT’s Reviewed

Insulin sensitivity improves by 60%Reduction in body weight 8% (without calorie restriction)Reduction in incidence of DM by 41-58%Reduction in 3mmHg of SBP/DBP by 3-9% weight lossRecommendation: CLINICAL TRIALS NEEDED IN ETHINIC MINORITY POPULATIONS SUCH AS INDIANS

Katzmarzyk P. T et al.,(2003). HERITAGE Family Study 20 wk of aerobic exercise training

Overall reduction in prevalence of MetS reduced from 16.9 to 11.8 %

Rennie K. L et al., (2003) 5153 white European participants moderate and vigorous physical leisure-time activities

Reduced BMI and increased cardiovascular fitness.Reduction in cluster of risk factors.

RESEARCH STUDIES

Kerry J. Stewart et al., (2005) 51 men and 53 women with MetS. 6 months exercise

Increased aerobic and muscle fitness, lean mass, and HDL and reduced total and abdominal fat. Diastolic BP was reduced .

Orchard TJ, Temprosa M, Goldberg R, et al(2005)3234 participants150 minutes of exercise per week

3 year follow up.Incidence of the metabolic syndrome was reduced by 41% in the lifestyle intervention group and by 17% in the metformin group

Christos Pistavos et al.,(2006)Systematic review of 13 studies on effect of exercise on MetS

Decreased risk of CHD mortalityReduced risk of developing DMEx shown to modify blood lipid profilesImprovements difficult to maintain

Tjonnas AE, Lee SJ, Rogonmo O, et al(2008)Aerobic interval training vs. continuous moderate exercise 32 patients

Increase of 25% in HDL levels, improvement in insulin sensitivity, aerobic capacity in interval training group.

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

EFFICACY OF INTERVAL TRAINING IN IMPROVING CARDIOVASCULAR FITNESS IN MetSAjin Jayan Thomas

Comparison of pre and post six minute walk Distances of the interval training

and the conventional groups

RESULTSAll 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 6MWDPostive correlation of height with 6MWDWeight had no correlation with 6MWD

PREVENTIONPublic Education about Metabolic syndromeScreening for at risk individuals:

Family historyBlood Sugar / Hgb A1C, Lipids, Blood pressureSmoking/Tobacco useActivity Level / Dietary habits

Exercise prescriptionDietary advice

HELP PREVENT INDIA FROM BECOMING CARDIOVASCULAR DISEASE CAPITAL OF

THE WORLD

TAKE HOME MESSAGE………………

RESOURCES

09769441388ajinjt_physio@yahoo.c

om

THANK YOU