Lifestyle Interventions for Patients With Metabolic Syndrome

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Metabolic syndrome, characterized by abdominal obesity, insulin resistance, hypertension, and hyperlipidemia, raises the risk of serious health problems such as heart disease, stroke, and metabolic dysfunctions. Recent reporting suggests that the global prevalence of metabolic syndrome is anywhere from 12.5% to 31.4%, depending on the diagnosis definition used.1 Estimates for metabolic syndrome in the United States are at more than 30%,2 and studies suggest that 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.4 Between 2017 and 2020, US obesity prevalence was estimated at 41.9%, according to the Centers for Disease Control and Prevention (CDC).5 The CDC also reported in 2022 that about 37.3 million people in the US (11.3% of the US population) have diabetes, with another 96 million US adults reported as prediabetic.6

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.4,7-9 In addition, studies have also indicated potential increased risks of metabolic dysfunctions due to both chronic environmental toxicant exposures and short sleep durations.10,11 Fortunately, clinical trials continue to report the effectiveness of accessible lifestyle-based interventions for the treatment or prevention of metabolic dysfunctions.12-16

Screening for Metabolic Syndrome – The Physical Exam

Early intervention may 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.17,18 Specifically, a simple waist-to-hip ratio may indicate an increased risk for diabetes, heart disease, and other complications.19,20 In the following video, IFM educator Elizabeth Boham, MD, talks about how you can detect metabolic 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.

From Stress to Diet to Movement: Lifestyle Impacts on Metabolic Syndrome

Stress levels, disrupted circadian rhythms, and the health of the gut microbiota can influence metabolic health. A 2018 cross-sectional analysis suggests that the psychosocial stressors associated with shift work may contribute to higher metabolic syndrome incidence.21 In addition, a 2022 meta-analysis indicated a twofold increased risk of developing metabolic syndrome in healthcare shift workers compared to day workers.22 Another recent study suggests that the epidemic of metabolic syndrome is also associated with economic development, lifestyle transition, and dysbiosis of gut microbiota.23 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.24 Additional clinical trials are needed to elucidate the complex interaction between gut microbiome balance and cardiometabolic health.25,26

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.27 A 2023 systematic review investigated how consumption of berries (specifically blueberries, cranberries, and chokeberries) and their phytonutrients may impact inflammatory parameters associated with metabolic syndrome.28 Several of the analyzed clinical trials suggested that berry intake improved lipid profiles and reduced inflammatory biomarkers.28

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.29 Evidence also suggests that regular physical activity, from aerobic exercise to dynamic resistance exercise and combination training, helps improve lipid profiles and reduce metabolic syndrome risk factors.12,13

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. Noubiap JJ, Nansseu JR, Lontchi-Yimagou E, et al. Geographic distribution of metabolic syndrome and its components in the general adult population: a meta-analysis of global data from 28 million individuals. Diabetes Res Clin Pract. 2022;188:109924. doi:1016/j.diabres.2022.109924
  2. Moore JX, Chaudhary N, Akinyemiju T. Metabolic syndrome prevalence by race/ethnicity and sex in the United States, National Health and Nutrition Examination Survey, 1988-2012. Prev Chronic Dis. 2017;14:E24. doi:5888/pcd14.160287
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  15.  Sarsangi P, Salehi-Abargouei A, Ebrahimpour-Koujan S, Esmaillzadeh A. Association between adherence to the Mediterranean diet and risk of type 2 diabetes: an updated systematic review and dose-response meta-analysis of prospective cohort studies. Adv Nutr. 2022;13(5):1787-1798. doi:1093/advances/nmac046
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  28.  Venturi S, Marino M, Cioffi I, et al. Berry dietary interventions in metabolic syndrome: new insights. Nutrients. 2023;15(8):1906. doi:3390/nu15081906
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