Amber Leon
Jeanine Mills
Erin Prasad
Nutrition Assessment and Therapy 1
Winter 2012
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http://www.medmovie.com/mmdatabase/Me
diaPlayer.aspx?ClientID=89&TopicID=925
A diagnosis of Metabolic Syndrome means
that a person is at increased risk for
developing
◦ Cardiovascular Disease (2 times as likely)
◦ Type 2 Diabetes Mellitus (5 times as likely)
◦ Stroke
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Metabolic syndrome represents the clustering
of several risk factors and is not a disease
unto itself.
In 1988 Gerald M. Reaven proposed insulin
resistance as the underlying factor and named
the constellation of abnormalities Syndrome X.
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Insulin resistance may underlie the
pathogenesis of metabolic syndrome.
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Or insulin resistance may result from the
increased visceral adipose tissue (VAT)
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Fat distribution seems to be related to
metabolic function with centrally obese
people at higher risk of metabolic syndrome
and it’s associated diseases than peripherally
obese people.
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VAT products that may activate components
of the inflammatory pathway and inhibit
insulin signaling.
◦ Free fatty acids and their metabolites
◦ Cytokines (ex: tumor necrosis factor alpha)
◦ Adiponectin (hormone released from adipose
tissue) decreases, furthering insulin resistance.
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VAT is a risk factor for coronary artery
disease, dyslipidemia hypertension, stroke,
type 2 diabetes and Metabolic Syndrome
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3 out of these 5 must be present for diagnosis
Central Obesity
Impaired Glucose Tolerance
Hypertension
Dyslipidemia
◦ Elevated Serum Triglicerides
◦ Lowered HDL Level
Additional symptoms include
Prothrombotic state
high fibrinogen or plasminogen activator inhibitor [-1] in the blood
• Proinflammatory state
elevated high-sensitivity C-reactive protein in the blood
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Genetics
Smoking
Sedentary lifestyle
High calorie diet
High-fat diet
Ethnicity
For Diagnosis Patient must have 3 out of 5 defining symptoms
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Screening/Labs
◦ Waist Circumference
 > 40 inches in males
 >35 inches in females
◦ Blood Pressure
 >140/90
 >130/85
 if insulin resistance present
◦ Fasting Blood Glucose
 > 110mg/dl
◦ Serum Triglycerides
 > 150mg/dl
◦ Serum HDL
 < 40mg/dl for males
 < 50mg/dl for females
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To increase mortality and decrease the co-morbidities
associated with Metabolic Syndrome.
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Weight Reduction
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Maintain normal blood glucose levels
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Improve lipid profile (increase HDL, lower triglycerides)
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Lower blood pressure
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Decrease Systemic Inflammation
◦ specifically reduction of visceral adipose tissue and decreased
waist circumference (waist to hip ratio, Index of Central Obesity)
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Dash Diet
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Carbohydrate Counting/Exchanges
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May help to lower blood pressure
May help to lose weight
May replace other more refined carbohydrates
Omega 3 Fats
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normalization of blood glucose
Fruit and Vegetable intake
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Designed to reduce hypertension
Low sugar
Low fat
High fiber
Reduction of inflammation
Refer for and Encourage physical activity
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Improved glucose tolerance
Improved blood pressure
Improved lipid profile
Improved cardiovascular fitness and endurance
Improved depression
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Calculate calories for weight loss
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Protein within AMDR
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Fat within AMDR
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Carbohydrate within AMDR
◦ 7% weight loss has been shown to be enough to reverse a Metabolic Syndrome
diagnosis
◦ 10-35% of calories
◦ 20-35% of calories
◦ Emphasis on omega 3 and unsaturated fatty acids
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45-65% of calories
Emphasis on whole foods sources
Emphasis on maintaining blood sugar levels as close to normal as
possible.
Fluids
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35ml/kg or 1ml/kcal
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Blood Glucose
◦ Insulin
◦ Oral medications
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Sulfonylureas,
Meglitinides
Biguanides
Thiazolidinediones
Alpha-glucosidase inhibitors
DPP-4 inhibitors
Cholesterol
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Statins
Bile acid binding resins
Cholesterol absorption inhibitors
Combination cholesterol
absorption inhibitor and statin
Fibrates
Niacin
Combination statin and niacin
Omega-3 Fatty Acids
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Blood Pressure
Diuretics
Beta-blockers
ACE inhibitors
Angiotensin II receptor blockers
Alpha-2 receptor Agonist
Combined alpha and betablockers
◦ Central agonists
◦ Peripheral adrenergic inhibitor
◦ Vasodialoator
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Insulin resistance
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Chromium polynicotinate,
Maitake mushrooms
Green tea polyphenols
Antioxidants
Alpha lipoic acid
Cinnamon
Oat beta-glucan
Omega 3 fatty acids
Holy Basil
Abnormal blood lipids
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Omega-3 fatty acids
Niacin
Oat beta-glucan
Holy Basil
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Blood Pressure
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Garlic
Omega-3 fatty acids
calcium
magnesium
vitamin C
Miatake Mushrooms
Anti Inflammatory
◦ B-vitamins
 B6, B12, Folate
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Omega 3 fatty acids
Turmeric
Ginger
Holy Basil
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In 2006 The IDF (international diabetes foundation) estimated that 20-25% of the
World population has Metabolic Syndrome.
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Secondary associated conditions include
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Prevalence is increasing in the adult population worldwide
Prevalence is increasing in the US among children and adolescents
Compromised renal function
Polycystic ovary syndrome
Non-alcoholic fatty-liver disease
Non-alcoholic steatohepatitis
Gestational diabetes mellitus
Inflammation
Depression
Metabolic Syndrome is COMPLICATED
The causes and symptoms overlap and contribute to one another.
Pharmacological interventions improve some symptoms while exacerbating others
People with this diagnosis are likely to be overwhelmed and feeling hopeless
about their ability to improve their health.
Diet and Exercise lifestyle changes can improve patients health dramatically.