Metabolic Syndrome

Clinical manifestation of metabolic syndrome

• Hyperglycaemia

• Insulin resistance

• Hypertriglyceridemia

• Reduced HDL cholesterol

• Abdominal obesity

• High waist:hip ratio

• High BP

• Increased plasminogen activator inhibitor (PAI1)

• Microalbuminuria

• High uric acid

• High coagulation factors

• High leptin/insulin levels

Metabolic syndrome is associated with…

Higher risk of T2DM, CVD, stroke and myocardial infarction, cacner (liver, bladder, colorectal, pancreatic), kidney disease

What is the most widely used diagnostic criteria and describe

NCEP ATP III (2012)

Any 3 from the below

• Waist circumference >102cm (M) >88cm (F)

• Fasting >5.6 mmol/L or treatment for elevated glucose or T2DM

• TG >1.7 mmol/L or TG treatment

• HDL <1.03 mmol/L (M) or <1.29 mmol/L (F) or treatment

• Systolic BP >130 mmHg or Diastolic >85 mmHg or HTN ± treatment

Explain pathophysiological treatment

• Seperate treatment for each component

• Slow progression to T2DM/CVD

• First line treatment of diet and physical activity

• Treat abdominal obesity

• Treat insulin resistance

• Treat other risk factors

Pharmacological treatment of obesity

• Orlistat (Xenical)

• Phentermide (Duromine)

• Liraglutide (Saxenda or Victoza)

• Naltrexone-Bupropion (Contrave)

Pharmacological treatment of insulin resistance

Metformin

Thiazolidnediones/Glitazone

Improves glycaemic control which has effects on other components of MS

DPP found reduced incidence of T2DM after metformin in those at high risk

Pharmacological treatment of atherogeneci dyslipidaemia

• Statins

• Fibrates

• Reduce risk of CV events through lowering LDL, increasing HDL, lowering TGs

Pharmacological treatment of hypertension

• ACE inhibitors

• ARB

• Reduce BP by recuing angiotensin

• Reducing production of aldosterone involved in fluid retention in the kidneys

Pharmacological treatment of prothrombotic state

• Low dose aspirin

• Antiplatelet drugs

Pharmacological treatment of pro-inflammatory state

• Statins, fibrates and thiazolidinediones reduce CRP

• Weight loss to reduce cytokines & acute phase reactants

Goals of MNT

1. Address underlying causes of metabolic syndrome > adiposity & insulin resistance - weight loss & physical activity

2. Address additional risk factors - atherogenic dyslipidaemia, hypertension, dysglycaemia, prothrombotic state, proinflammatory state

Weight loss for recommendations

• Loss of 5-10% of BW, can lead to reductions in BP, improved insulin resistance & glycaemia, triglyceride, total cholesterol

• Improves adipokines & inflammation markers (e.g. adiponectin, tumor, necrosis factor alpha)

• Reduced risk of T2DM & CVD

Physical activity recommendations

Set SMART goals

FIIT (most days, moderate, 30 min/day, liked)

Physcial activity benefits

Reduction in insulin resistance & CVD risk

Fat recommendations

Aim for 20-35% total energy

Type of fat important (saturated <7%, trans <1% and include MUFA&PUFA)

Improved fat profile benefits

Lower cholesterol

Lower LDL

Higher HDL

Lower TGs

Carbohydrate recommendations

• Include low GI complex carbs

• Soluble & insoluble fibre

• Antioxidants, polyphenols and phytochemicals in wholegrains, fruit, vegetables, nuts and seeds

• Reduce simple/added sugars to <10% energy intake

• Limit or moderate alcohol intake

Nutrition Counselling

Overall quantity & quality of foods (swpas, pattern, macro distribution)

Cooking methods (grilling, steaming, boiling, baking over frying)

Takeaways and convenience foods

Mood, food, stress & emotional eating