Running head: METABOLIC SYNDROME
Evidence Based Practice
Critical Appraisal Topic
Metabolic Syndrome
Laura Hoovestol
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METABOLIC SYNDROME
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METABOLIC SYNDROME
Introduction
Metabolic syndrome affects almost 34% of American adults and increases the incidence
of cardiovascular disease, stroke, diabetes and cancer (About Metabolic Syndrome, 2015).
Metabolic syndrome may be diagnosed when three or more of the following are present (About
Metabolic Syndrome, 2015):
-Fasting glucose of 100mg/dL or greater.
-Waist circumference of 40 inches or greater in men and 35 inches or greater in women.
-Triglyceride level of 150mg/dL or greater.
-High Density Lipoprotein (HDL) of less than 40mg/dL in men or less than 50 mg/dL in
women.
-Systolic blood pressure of 130mm Hg or greater, or diastolic blood pressure of 85
mmHg or greater.
The incidence of metabolic syndrome can be decreased by treating hypertension, diabetes,
hyperlipidemia, and with weight loss. Management of weight is the most all-encompassing
treatment for metabolic syndrome, even a weight loss of 10 pounds makes a difference.
Case Scenario:
J.D. is a 35 year old female with a Body Mass Index (BMI) of 35. She works as a
computer technician which leads to a very sedentary work day. During her yearly physical exam
her fasting glucose is 120mg/dL, systolic blood pressure is 160, and HDL is 30mg/dL. Physical
assessment is benign and patient has no complaints. Her primary care provider discusses
metabolic syndrome with her and the plan of care is exercise, weight loss, and a Mediterranean
diet to decrease the factors contributing to metabolic syndrome.
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PICO
In patients with metabolic syndrome, does weight loss compared to no weight loss,
reduce the incidence of metabolic syndrome?
Summary and Appraisal of Key Evidence:
Bischoff et al (2012) study covers a 12 month period in which the participants were
monitored per laboratory results, dietary input, blood pressure, and weight loss. The study
population included men and women ages 18-70 years old with a BMI greater than 30.
Individuals with comorbidities such as bedridden, recent myocardial infarct, pregnant, and
hypothyroidism were excluded. Arterial hypertension, hypercholesterolemia, diabetes and other
metabolic disorders were accepted. Study validity was assured by these measures. A study
weakness was the high incidence of study dropout. 8,296 participants were included in the
study, 42% (3446) did not complete the study. A significant number of study participants
dropped out of the study however there was still a large number whom completed the study.
Upon study conclusion 2/3 achieved a weight loss of greater than 15% and blood pressure
decline similar to pharmacological treatment. All metabolic syndrome markers were decreased
with weight loss (Bischoff et al, 2012).
Melanson et al (2012), determined if weight loss decreased the incidence of metabolic
syndrome in individuals with a BMI between 27-35 during a 12 week period. Study participants
were recruited through newspaper advertisements and screened by telephone. Screening
requirements were as follows; not currently taking prescription medications or over the counter
medications. Subjects were excluded with the following comorbidities; diabetes, uncontrolled
hypertension, orthopedic limitations, eating disorders, pregnancy or lactation, surgical/medical
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conditions, recent weight loss, excess alcohol intake, and serious medical conditions. Study
validity was assured by these measures. A study weakness is the short time span of the study
and participant dropout rate. The study subjects participated in “Weight Watchers”, a
commercially multi-disciplinary weight loss program. The end results were weight loss and
improved markers of metabolic syndrome (Melanson et al, 2012).
Clinical Bottom Line
Metabolic syndrome is a phenomena affecting up to 34% of Americans, it can be
decreased by weight loss. Weight loss is the single most effective means to decreasing factors of
metabolic syndrome. Pharmacological management decreases metabolic syndrome however
healthcare costs associated with this treatment are high. Weight loss and management are the
key to decreasing metabolic syndrome.
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References
About Metabolic Syndrome. (2015, March 19). Retrieved from American Heart Association:
https://www.heart.org/HEARTORG/Conditions/More/MetabolicSyndrome/AboutMetabolic-Syndrome_UCM_301920_Article.jsp
Bischoff, S. C., Damms-Machado, A., Betz, C., Herpertz, S., Legenbauer, T., Low, T., Wechsler,
J. G., Bischoff, G., Austel, A., & Ellrott, T., (2012). Multicenter evaluation of an
interdisciplinary 52-week weight loss program for obesity with regard to body weight,
comorbidities and quality of life. International Journal of Obesity, 36, 614-624.
Melanson, K. J., Summers. A., Nguyen, V., Brosnahan, J., Lowndes, J., Angelopoulos, T. J., &
Rippe, J., M., (2012). Body composition, dietary composition, and components of
metabolic syndrome in overweight and obese adults after a 12-week trial on dietary
treatments focused on portion control, energy density, or glycemic index. Nutritional
Journal, 11(57).