Erin Hetrick, MS, RD, LDN

NS 335 UNIT 3Metabolic Syndrome andCardiovascular DiseaseDiet Therapy

Understanding Metabolic Syndrome Metabolic syndrome is not a disease in itself. Instead,

it's a group of risk factors - high blood pressure, high blood sugar, unhealthy cholesterol levels, and abdominal fat.

Obviously, having any one of these risk factors isn't good. But when they're combined, they set the stage for grave problems. These risk factors double your risk of blood vessel and heart disease, which can lead to heart attacks and strokes. They increase your risk of diabetes by five times.

Metabolic syndrome is also becoming more common. But the good news is that it can be controlled, largely with changes to your lifestyle.

(www.webmd.com)

Metabolic Syndrome

According to the American Heart Association and the National Heart, Lung, and Blood Institute, there are five risk factors that make up metabolic syndrome.

Large Waist Size: For men: 40 inches or larger For women: 35 inches or larger

Cholesterol: High Triglycerides Either 150 mg/dL or higher or Using a cholesterol medicine

Cholesterol: Low Good Cholesterol (HDL) Either For men: Less than 40 mg/dL For women: Less than 50 mg/dL or Using a cholesterol medicine

High Blood Pressure Either Having blood pressure of 130/85 mm Hg or greater OR Using a high blood pressure medicine

Blood Sugar: High Fasting Glucose Level 100 mg/dL or higher www.webmd.com

Metabolic Syndrome: The Risk Factors

Some risk factors are: Insulin resistance. Insulin is a hormone that helps your

body use glucose -- a simple sugar made from the food you eat -- as energy. In people with insulin resistance, the insulin doesn't work as well so your body keeps making more and more of it to cope with the rising level of glucose. Eventually, this can lead to diabetes. Insulin resistance is closely connected to having excess weight in the belly.

Obesity -- especially abdominal obesity. Experts say that metabolic syndrome is becoming more common because of rising obesity rates. In addition, having extra fat in the belly -- as opposed to elsewhere in the body -- seems to increase your risk.

Unhealthy lifestyle. Eating a diet high in fats and not getting enough physical activity can play a role.

Hormonal imbalance. Hormones may play a role. For instance, polycystic ovary syndrome (PCOS) -- a condition that affects fertility -- is related to hormonal imbalance and metabolic syndrome. www.webmd.com

What Causes Metabolic Syndrome?

You are older. It's more common as people age. The risk of getting metabolic syndrome rises from 20% in your 40s, to 35% in your 50s, to 45% in your 60s and beyond.

You are prone to blood clots and inflammation. Both are common in people with metabolic syndrome. Your doctor can do blood tests to find out if you have a high risk of clots and inflammation.

You have other medical conditions. Metabolic syndrome is associated with a number of medical conditions. These include polycystic ovary syndrome (PCOS), fatty liver, cholesterol gallstones, and lipodystrophy (which affects fat distribution).

It runs in the family. Even if you are not obese you may have inherited a higher risk. This includes people who have parents or other first-degree relatives with diabetes.

You are South Asian. South Asians seem to have a higher risk of insulin resistance and thus metabolic syndrome. Because of this, the American Heart Association and the National Heart, Lung, and Blood Institute have different recommendations for this group. A waist size above 35" (for men) and 31" (for women) is considered a metabolic syndrome risk factor.

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Metabolic Syndrome: Are You at Risk?

Most of the metabolic syndrome risk factors don't have any symptoms. You usually can't feel high blood pressure or high cholesterol. Often, the only outward sign is packing some extra weight in the belly.

Symptoms of Metabolic Syndrome

The risk factors that make up metabolic syndrome – unhealthy cholesterol levels, high blood pressure, high blood sugar, and excess belly fat -- raise your odds of serious health problems. These include diabetes and blood vessel or heart disease.

Specifically, metabolic syndrome can lead to arteriosclerosis, or "hardening of the arteries." This is when fats, cholesterol, and other substances stick to the sides of the arteries. The arteries then become clogged and brittle. Blood clots form when the arterial walls are damaged. If a blood clot forms, it can cause a heart attack or stroke.

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Metabolic Syndrome: The Link to Serious Health Problems

Heart disease is the leading cause of death in the U.S.

This year 1.2 million Americans will have a heart attack -- 479,000 will die.

This year 700,000 Americans will have a stroke -- 158,000 will die.

65% of all people with diabetes die from heart or blood vessel disease.

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Statistics from the American Heart Association

Metabolic syndrome is a fairly new diagnosis. It's somewhat controversial. Some doctors don't think that it's an important way of looking at a person's health.

At first, some researchers thought that metabolic syndrome was more hazardous than the sum of its parts. They said that the combination of different risk factors was particularly dangerous.

However, recent research has cast doubt on this idea. Having metabolic syndrome may also be a less accurate way of predicting heart disease than was first hoped. www.webmd.com

Metabolic Syndrome:A Debated Condition

How do you treat Metabolic Syndrome?

Lifestyle Changes:Changing Metabolic Syndrome Risk

Some people with metabolic syndrome will also need medicine. Drugs might be needed if lifestyle changes aren't enough to reduce risk factors. Some medicines used are:

High blood pressure medicines,which include medicines such as ACE inhibitors (like Capoten and Vasotec), angiotensin II receptor blockers (like Cozaar and Diovan), diuretics, beta-blockers, and other drugs.

Cholesterol medicines,which include statins (like Crestor, Lescol, Lipitor, Mevacor, Pravachol, and Zocor), niacin (like Niacor, Niaspan, and Nicolar), bile acid resins (like Colestid and Questran), Zetia, and other drugs.

Diabetes medicines, which may be necessary if you have glucose intolerance. Drugs include Glucophage, Actos, and Avandia.

Low-dose aspirin, which can reduce the risks of heart attacks and strokes. It may be especially important for people who are "prothrombotic," or prone to blood clots. www.webmd.com

Medicine and Metabolic Syndrome

One 2005 study published in the Annals of Internal Medicine showed how well lifestyle changes could prevent metabolic syndrome. Researchers looked at more than 3,200 people who already had impaired glucose tolerance, a pre-diabetic state. One group was instructed to make lifestyle changes. They exercised 2.5 hours a week and ate a low- calorie, low-fat diet. After three years, people in the lifestyle group were 41% less likely to have metabolic syndrome than those who got no treatment. The lifestyle changes were also about twice as effective as using a diabetes medicine, Glucophage.

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Prevention Research

Do I have any metabolic syndrome risk factors? Will I need medicine to control them? If so, how will the

medicine help? What are the side effects? Do I need to have blood tests to see if I have a higher risk

of blood clots and inflammation? What is my BMI (body mass index)? Should I lose weight? What's a reasonable weight goal for

me? What changes should I make to my diet? Do I need to take

any special precautions? Should I consider seeing a nutritionist/dietitian to talk

about improving my diet? Do you have suggestions for how I could get more

physical activity? Could any medicines I'm taking be affecting my metabolic

syndrome risk factors? How might my family history affect my risk of getting

metabolic syndrome and having cardiovascular problems? Should I be taking aspirin therapy?

Questions for Patients to ask their Doctors:

AnyQuestions….

Thoughts???

LDL Cholesterol <100 Optimal100-129 Near optimal/above

optimal130-159 Borderline High160-189 High>/= Very High

Lipid Levels

Total Cholesterol<200 Desirable200-239 Borderline High>/= 240 High

HDL Cholesterol<40 Low>/= 60 High Table 16-2

Stanfield

Lipid Levels

Synonyms for “Free”: “free of”, “No”, “Zero”, “Without”, “Trivial Source of”, “Negligible Source of”, “Dietary Insignificant Source of”

Synonyms for “Low”- “Contains a small amount of”, “Low Source of” , “Low in”

Synonyms for “Reduced/Less/Fewer”: “Reduced In”, “Lower”, “Low”

Food Labeling

“Free”Total Calories: Less than 5 calories per

reference servingTotal Fat: Less than 0.5g/reference

servingSaturated Fat: Less than 0.5g/reference

serving, level of trans-fatty acids must be 1% or less of total fat

Cholesterol: Less than 2mg/reference serving; saturated fat must be 2g or less

Sodium: Less than 5mg/reference serving

Food Labeling

“Low”Total Calories: Less than 40 calories/reference

servingTotal Fat: 3g or less/reference serving. Meal

and main dish products: 3g or less per 100g product and 30% or less calories from fat

Saturated Fat: 1g or less/reference serving. Meal and main dishes products: 1g or less per 100g and less than 10% of calories from saturated fat

Cholesterol: 20mg or less/reference serving; saturated fat content must be 2g or less per serving

Sodium: 140mg or less/reference serving; Meal and main dish products” :140mg or less/100g of food

Food Labeling

“Reduced/Less/Fewer”Total Calories: Reduced by at least 25%Total Fat: Reduced by at least 25%Saturated Fat: Reduced by at least 25%Cholesterol: Reduced by at least 25%Sodium: Reduced by at least 25%

Note: “Very Low Sodium” or “Very Low in Sodium” requirements of 35mg or less/reference serving.

Food Labeling

DASH DIET Mild Sodium Restriction (3-5g daily)-Regular diet which omits only salty foods and

use of salt at the table. Salt may be used lightly in cooking; such as ½ of the amount stated in the recipe.

Moderate Sodium Restriction (1g daily)-No more than 2 cups milk daily-No more than 5oz meat per day-One egg may

be substituted for 1oz meat-No Salt in Cooking-Bread and butter beyond 3 servings daily

should be unsalted-No commercial mixes or regular canned

vegetable

Sodium Restricted Diet

Strict Sodium Restriction (500mg Daily)-Used primarily for hospitalized patients-Results in low patient compliance except

in a hospital setting-Continues with Mild and Moderate

Sodium Restrictions, but also no bread or butter that has salt added. No vegetables that are naturally high in sodium content

Sodium Restricted Diet

Severe Sodium Restriction (250mg Daily)

-Substitution of low-sodium milk for regular milk

-Low Sodium water needed (not water filtered with water softeners); distilled water OK

-Many drugs, both prescription and OTC medicines contain high levels of sodium. Patients need to be made aware of these.

Sodium Restricted Diet

Questions ???

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