Role of mediterranean diet in combating the problem of Syndrome x BY : Upasana Research Scholar, Dept. of Home science, BHU,Varanasi - 221005

Introduction Metabolic Syndrome (Met S) is the term linking to the clinical profiles of the some of the major health problems of today. It is a cluster of metabolic abnormalities known to increase heart disease and type II diabetes risk to twice and 5times respectively. These abnormalities include dyslipidaemia, hypertension, hyperglycemia, central obesity and insulin resistance as well as low grade inflammation.

Cont….. Its development is also associated with lifestyle factors which includes smoking, lack of exercise, poor dietary habits and low socio- economic status. The prevalence of Syndrome X also known as metabolic syndrome is increasing rapidly throughout the world and going parallel to the increasing prevalence of obesity and diabetes.

Cont….. Diet is considered as one of the major contributor of metabolic syndrome (Met S). Some studies showed that adherence of Mediterranean diet ( high intake of whole grains, fruits and vegetables, olive oils, fish, low fat dairy products and moderate wine consumption if consumed) has been associated with lower prevalence of suffering with metabolic syndrome (Met S).

Definition of metabolic syndrome 1. According to International Diabetic Federation (IDF) Metabolic syndrome (2006) defined as: Obesity (defined as waist circumference# with ethnicity-specific values) AND any two of the following: Raised triglycerides: > 150 mg/dL (1.7 mmol/L), or specific treatment for this lipid abnormality. Reduced HDL cholesterol: < 40 mg/dL (1.03 mmol/L) in males, < 50 mg/dL (1.29 mmol/L) in females, or specific treatment for this lipid abnormality.

Cont….. Raised blood pressure (BP): systolic BP > 130 or diastolic BP >85 mm Hg, or treatment of previously diagnosed hypertension. Raised fasting plasma glucose (FPG): >100 mg/dL (5.6 mmol/L), or previously diagnosed type 2 diabetes. #If FPG is >5.6 mmol/L or 100 mg/dL, an oral glucose tolerance test is strongly recommended, but is not necessary to define presence of the syndrome. # If BMI is >30 kg/m², central obesity can be assumed and waist circumference does not need to be measured.

Cont….. 2. According to World Health Organization (WHO) , Metabolic syndrome (1999) defined as : The presence of any one of diabetes mellitus, impaired glucose tolerance, impaired fasting glucose or insulin resistance, AND any two of the following: Blood pressure: ≥ 140/90 mmHg. Dyslipidemia: triglycerides (TG): ≥ 1.695 mmol/L and high-density lipoprotein cholesterol (HDL-C) ≤ 0.9 mmol/L (male), ≤ 1.0 mmol/L (female).

Cont….. Central obesity: waist: hip ratio > 0.90 (male); > 0.85 (female), or body mass index > 30 kg/m2 . Microalbuminuria: urinary albumin excretion ratio ≥ 20 µg/min or albumin: creatinine ratio ≥ 30 mg/g. 3. According to American Heart Association (AHA)and which was updated by National Cholesterol Education Program (NCEP), Metabolic syndrome (2004) defined as : Elevated waist circumference: Men — greater than 40 inches (102 cm) Women — greater than 35 inches (88 cm)

Cont….. Elevated triglycerides: Equal to or greater than 150 mg/dL (1.7 mmol/L). Reduced HDL ("good") cholesterol: Men — Less than 40 mg/dL (1.03 mmol/L) Women — Less than 50 mg/dL (1.29 mmol/L). Elevated blood pressure: Equal to or greater than 130/85 mm Hg or use of medication for hypertension. Elevated fasting glucose: Equal to or greater than 100 mg/dL (5.6 mmol/L) or use of medication for hyperglycemia .

Components of metabolic syndrome The components of metabolic syndrome are : Abdominal obesity: This form of obesity most strongly associated with the metabolic syndrome. It presents clinically as increased waist circumference. Atherogenic dyslipidaemia :This manifests in routine lipoprotein analysis by raised triglycerides and low concentrations of HDL cholesterol. A more detailed analysis usually reveals other lipoprotein abnormalities, e.g, increased remnant lipoproteins, elevated apolipoprotein B, small LDL particles , and small HDL particles.

Cont….. Raised blood pressure : It is associated with obesity and commonly occurs in insulin-resistant persons. Thus , hypertension commonly is listed among metabolic risk factors. Insulin resistance _ glucose intolerance : It strongly associates with other metabolic risk factors and correlates univariately with CVD risk. Patients with longstanding insulin resistance frequently manifest glucose intolerance, another emerging risk factor for metabolic syndrome.

Cont….. Proinflammatory state: It is recognized by elevations of C-reactive protein (CRP), is commonly present in persons with metabolic syndrome. One cause is obesity, because excess adipose tissue releases inflammatory cytokines that may elicit higher CRP levels. Prothrombotic state : It is characterized by increased plasma plasminogen activator inhibitor (PAI)-1 and fibrinogen, also associates with the metabolic syndrome.

Risk factors for metabolic syndrome Obesity Lack of exercise Age A stressful life Race Diabetes Other diseases Ic syndrome

Epidemiology of metabolic syndrome MS is a complex web of metabolic factors that are associated with a 2-fold risk of CVD and a 5-fold risk of diabetes. Individuals with MS have a 30%–40% probability of developing diabetes and/or CVD within 20 years, depending on the number of components present . In the United States (US), the prevalence of the MS in the adult population was estimated to be more than 25%. Similarly, the prevalence of MS in 7 European countries was approximately 23%.

Cont….. It was estimated that 20%–25% of South Asians have developed MS and many more may be prone to it . Epidemiologists in India and international agencies such as the world health organization (WHO) have been sounding an alarm on the rapidly rising burden of CVD for the past 15 years. It is estimated that by 2020, CVD will be the largest cause of disability and death in India, with 2.6 million Indians predicted to die due to CVD . The metabolic syndrome (MS) is a multiplex risk factor for atherosclerotic cardiovascular disease (ASCVD).

mediterranean diet The MD was first presented by Ancel Keys in the 1960s. The characteristics of healthy mediterranean diet are: It maximizes natural whole foods and minimizes highly processed ones . Small amounts of red meat . Less than four eggs per week. Low to moderate amounts of poultry and fish . Daily fresh fruit . Seasonal locally grown foods with minimal processing.

Cont….. Concentrated sugars only a few times per week . Wine in low to moderate amounts, and usually taken at mealtimes . Milk products (mainly cheese and yogurt) in low to moderate amounts Olive oil as the predominant fat . Abundance of foods from plants: vegetables, fruits, beans, potatoes, nuts, seeds, breads and other whole grain products . Naturally low in saturated fat, trans fats, and cholesterol .

Cont….. Naturally high in fiber, phytonutrients, vitamins (e.g., folate), antioxidants, and minerals (especially when compared with concentrated, refined starches and sugars in a modern Western diet) . Naturally high in monounsaturated and polyunsaturated fats, particularly as a replacement for saturated fats.

Figure 1. Effects of the Mediterranean diet on the parameters of metabolic syndrome (MetS).

Individual components of Mediterranean diet and their effects on parameters of MetS Components of mediterranean diets Effects on parameters of Metabolic Syndrome N-3 fatty acid or fish consumption Decrease in plasma triglycerides level, decrease in platelets aggregation, lowers heart rate and decrease blood pressure. Olive oil Lowers blood pressure, reduces plasma glucose, improves the cholesterol/HDL ratio and endothelial function. Low fat dairy products Lowers insulin resistance and lowers waist circumference. Low glycemic index and increased protein intake Reduces central obesity

Cont….. Components of mediterranean diets Moderate wine consumption Decreases the risk of Heart diseases. Whole grains Lowers plasma glucose, improve insulin sensitivity and increases adiponectin concentration. Fruits and vegetables Decreases plasma triglycerides level and blood pressure as well as decreases concentration of CRP. Nuts Decreases plasma cholesterol and triglycerides level, decreases waist circumference and ameliorate hypertension.

vital steps to follow and what to avoid in case of MetS diagnosis Exercise regularly may help you to lose the fat around your waist area . Eliminate high fructose corn syrup and all the other artificial sweeteners. Cut MSG, Aspartame (NutraSweet), Sucralose (Splenda) off your diet . Use an anti-inflammatory diet and supplements to reduce the free  radicals and the signs of chronic inflammation .

Cont….. Take at least 2 grams omega-3 capsules per day (fish oil, flaxseed oil, cod liver oil etc) . Use aged garlic extract to lower bad cholesterol levels . Take advantage of natural antioxidants in fruits and vegetables. Use antioxidants/vitamins to prevent cholesterol oxidation and nerve damage. Add plenty of soluble fiber to your diet to lower your  blood sugar. Avoid eating foods high in absorbable iron (in red meat and others).

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