Lifestyle Interventions for Patients With Metabolic Syndrome

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Metabolic syndrome, characterized by abdominal obesity, insulin resistance, hypertension, and hyperlipidemia, is considered a major health hazard1 and has been called one of the grand challenges of our times.2 Research suggests that an increase in high-calorie, low-fiber fast food, an increase in sedentary lifestyles, and a decrease in physical activity have contributed to the rising incidence of metabolic syndrome.1

Patients with metabolic syndrome are five times more likely to develop diabetes.3 In fact, data show that the incidence of metabolic syndrome often parallels the incidence of obesity and type 2 diabetes.1 Between 1988-2010, the average BMI in the US increased by 0.37% per year in both men and women.1 Centers for Disease Control and Prevention (CDC) data published in 2017 found that about 30.2 million adults aged 18 years and older (12.2% of US adults) had type 2 diabetes; the prevalence of prediabetes or metabolic syndrome was about three times more—suggesting that about one third of US adults may have metabolic syndrome.1

In the following video, IFM educator Elizabeth Boham, MD, talks about how you can detect cardiometabolic syndrome in the physical exam:

Elizabeth Boham, MD, MS, RD, is board certified in family medicine and a registered dietitian, with a strong background in nutrition and Functional Medicine.

Learn more about Functional Medicine

Metabolic syndrome isn’t only affected by diet and exercise; stress levels, economics, and the health of the gut microbiota can also play a part. A 2018 cross-sectional analysis suggests that the psychosocial stressors associated with shift work may contribute to higher metabolic syndrome incidence.4 The Whitehall II study, conducted on 10,308 British civil service men and women who were followed for an average of 14 years, revealed that employees under chronic work-related stress had an odds ratio of 2.25 for developing cardiometabolic syndrome compared to those without work-related stress.2 Among women, depressive symptoms, stressful life events, intense anger, and feeling tense increase the likelihood of developing cardiometabolic syndrome.2 Another recent study suggests that the epidemic of metabolic syndrome is also associated with economic development, lifestyle transition, and dysbiosis of gut microbiota.5 However, although researchers can clearly establish a causal relationship between gut microbial profiles and metabolic syndrome in animal experiments, the relationship between them remains controversial in humans.6

Some research suggests that early intervention can help prevent metabolic syndrome, but in order to know when to intervene, you need to know which patients are at risk for the disorder. Before ordering lab tests, the first step in screening for metabolic syndrome can be as simple as conducting a brief physical exam for visceral adiposity and acanthosis nigricans.7-9 Specifically, a simple waist-to-hip ratio may indicate an increased risk for diabetes, heart disease, and other complications.10,11

Dietary interventions have been shown to be effective in helping to prevent or control metabolic syndrome. In 2018, epidemiologic evidence suggested that novel trimethylated (betainized) compounds associated with glucose metabolism in humans are associated with diets rich in whole grains, and they improve insulin resistance and insulin secretion.12 Data from a cross-sectional analysis in adults suggests that a higher quality diet, assessed using the Dietary Approaches to Stop Hypertension (DASH) dietary quality score, is associated with improved adiposity measures and a less insulin-resistant, proinflammatory, pro-thrombotic, and proatherogenic cardiometabolic profile, which may impact central obesity and metabolic syndrome risk.13

Phagocyte-derived myeloperoxidase (MPO) and proinflammatory HDL are associated with metabolic syndrome and increased cardiovascular disease risk. Therapeutic lifestyle changes, such as the adoption of a Mediterranean diet and increased exercise, may decrease this risk.14 A recent study suggests that these therapeutic lifestyle changes improve HDL function by inhibiting MPO-mediated oxidative stress even before appreciable changes in HDL levels.13 Evidence also suggests that aerobic exercise, dynamic resistance exercise, and isometric exercises can lower blood pressure and improve glycemic control.15

What other lifestyle modifications can help patients who struggle with metabolic syndrome? Learn more about tools and strategies to help patients achieve sustainable lifestyle change and improve their well-being through IFM’s new course Lifestyle: The Foundations of Functional Medicine.

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  1. Saklayen MG. The global epidemic of the metabolic syndrome. Curr Hypertens Rep. 2018;20(2):12. doi:1007/s11906-018-0812-z
  2. Mindikoglu AL, Abdulsada MM, Jain A. Intermittent fasting from dawn to sunset for four consecutive weeks induces anticancer serum proteome response and improves metabolic syndrome. Sci Rep. 2020;10(1):18341. doi:1038/s41598-020-73767-w
  3. Wilson PW, D’Agostino RB, Parise H, Sullivan L, Meigs JB. Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation. 2005;112(20):3066-3072. doi:1161/CIRCULATIONAHA.105.539528
  4. Santos AE, Araújo LF, Griep RH, et al. Shift work, job strain, and metabolic syndrome: cross-sectional analysis of ELSA-Brasil. Am J Ind Med. 2018;61(11):911-918. doi:1002/ajim.22910
  5. He Y, Wu W, Wu S, et al. Linking gut microbiota, metabolic syndrome and economic status based on a population-level analysis. Microbiome. 2018;6(1):172. doi:1186/s40168-018-0557-6
  6. Wang PX, Deng XR, Zhang CH, Yuan HJ. Gut microbiota and metabolic syndrome. Chin Med J. 2020;133(7):808-816. doi 1097/cm9.0000000000000696
  7. Shuster A, Patlas M, Pinthus JH, Mourtzakis M. The clinical importance of visceral adiposity: a critical review of methods for visceral adipose tissue analysis. Br J Radiol. 2012;85(1009):1-10. doi:1259/bjr/38447238
  8. Hurt L, Pinto CD, Watson J, Grant M, Gielner J; CDC. Diagnosis and screening for obesity-related conditions among children and teens receiving Medicaid—Maryland, 2005-2010. MMWR Morb Mortal Wkly Rep. 2014;63(14):305-308.
  9. Hesse MB, Young G, Murray RD. Evaluating health risk using a continuous metabolic syndrome score in obese children. J Pediatr Endocrinol Metab. 2016;29(4):451-458. doi:1515/jpem-2015-0271
  10. Löffler-Wirth H, Willscher E, Ahnert P, et al. Novel anthropometry based on 3D-bodyscans applied to a large population based cohort. PLoS One. 2016;11(7):e0159887. doi:1371/journal.pone.0159887
  11. Apple and pear body shapes. Mayo Clinic. Accessed September 27, 2018.
  12. Kärkkäinen O, Lankinen MA, Vitale M, et al. Diets rich in whole grains increase betainized compounds associated with glucose metabolism. Am J Clin Nutr. 2018;108(5):971-979. doi:1093/ajcn/nqy169
  13. Phillips CM, Harrington JM, Perry IJ. Relationship between dietary quality, determined by DASH score, and cardiometabolic health biomarkers: a cross-sectional analysis in adults. Clin Nutr. 2019;38(4):1620-1628. doi:1016/j.clnu.2018.08.028
  14. Mathew AV, Li L, Byun J, et al. Therapeutic lifestyle changes improve HDL function by inhibiting myeloperoxidase-mediated oxidation in patients with metabolic syndrome. Diabetes Care. 2018;41(11):2431-2437. doi:2337/dc18-0049
  15. Lackland DT, Voeks JH. Metabolic syndrome and hypertension: regular exercise as part of lifestyle management. Curr Hypertens Rep. 2014;16(11):492. doi:1007/s11906-014-0492-2

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