1. Amber Leon Jeanine Mills Erin Prasad Nutrition Assessment and Therapy 1 Winter 2012

2.  http://www.medmovie.com/mmdatabase/Me diaPlayer.aspx?ClientID=89&TopicID=925 http://www.medmovie.com/mmdatabase/Me diaPlayer.aspx?ClientID=89&TopicID=925  A diagnosis of Metabolic Syndrome means that a person is at increased risk for developing ◦ Cardiovascular Disease (2 times as likely) ◦ Type 2 Diabetes Mellitus (5 times as likely) ◦ Stroke

3.  Metabolic syndrome represents the clustering of several risk factors and is not a disease unto itself.  In 1988 Gerald M. Reaven proposed insulin resistance as the underlying factor and named the constellation of abnormalities Syndrome X.  Insulin resistance may underlie the pathogenesis of metabolic syndrome.  Or insulin resistance may result from the increased visceral adipose tissue (VAT)

4.  Fat distribution seems to be related to metabolic function with centrally obese people at higher risk of metabolic syndrome and it’s associated diseases than peripherally obese people.

6.  VAT products that may activate components of the inflammatory pathway and inhibit insulin signaling. ◦ Free fatty acids and their metabolites ◦ Cytokines (ex: tumor necrosis factor alpha) ◦ Adiponectin (hormone released from adipose tissue) decreases, furthering insulin resistance.  VAT is a risk factor for coronary artery disease, dyslipidemia hypertension, stroke, type 2 diabetes and Metabolic Syndrome

7.  3 out of these 5 must be present for diagnosis  Central Obesity  Impaired Glucose Tolerance  Hypertension  Dyslipidemia ◦ Elevated Serum Triglicerides ◦ Lowered HDL Level Additional symptoms include Prothrombotic state high fibrinogen or plasminogen activator inhibitor [-1] in the blood Proinflammatory state elevated high-sensitivity C-reactive protein in the blood

8.  Genetics  Smoking  Sedentary lifestyle  High calorie diet  High-fat diet  Ethnicity

9. For Diagnosis Patient must have 3 out of 5 defining symptoms  Screening/Labs ◦ Waist Circumference  > 40 inches in males  >35 inches in females ◦ Blood Pressure  >140/90  >130/85  if insulin resistance present ◦ Fasting Blood Glucose  > 110mg/dl ◦ Serum Triglycerides  > 150mg/dl ◦ Serum HDL  < 40mg/dl for males  < 50mg/dl for females

10.  To increase mortality and decrease the co-morbidities associated with Metabolic Syndrome.  Weight Reduction ◦ specifically reduction of visceral adipose tissue and decreased waist circumference (waist to hip ratio, Index of Central Obesity)  Maintain normal blood glucose levels  Improve lipid profile (increase HDL, lower triglycerides)  Lower blood pressure  Decrease Systemic Inflammation

11.  Dash Diet ◦ Designed to reduce hypertension ◦ Low sugar ◦ Low fat ◦ High fiber  Carbohydrate Counting/Exchanges ◦ normalization of blood glucose  Fruit and Vegetable intake ◦ May help to lower blood pressure ◦ May help to lose weight ◦ May replace other more refined carbohydrates  Omega 3 Fats ◦ Reduction of inflammation  Refer for and Encourage physical activity ◦ Improved glucose tolerance ◦ Improved blood pressure ◦ Improved lipid profile ◦ Improved cardiovascular fitness and endurance ◦ Improved depression

12.  Calculate calories for weight loss ◦ 7% weight loss has been shown to be enough to reverse a Metabolic Syndrome diagnosis  Protein within AMDR ◦ 10-35% of calories  Fat within AMDR ◦ 20-35% of calories ◦ Emphasis on omega 3 and unsaturated fatty acids  Carbohydrate within AMDR ◦ 45-65% of calories ◦ Emphasis on whole foods sources ◦ Emphasis on maintaining blood sugar levels as close to normal as possible.  Fluids ◦ 35ml/kg or 1ml/kcal

13.  Blood Glucose ◦ Insulin ◦ Oral medications  Sulfonylureas,  Meglitinides  Biguanides  Thiazolidinediones  Alpha-glucosidase inhibitors  DPP-4 inhibitors  Cholesterol ◦ Statins ◦ Bile acid binding resins ◦ Cholesterol absorption inhibitors ◦ Combination cholesterol absorption inhibitor and statin ◦ Fibrates ◦ Niacin ◦ Combination statin and niacin ◦ Omega-3 Fatty Acids  Blood Pressure ◦ Diuretics ◦ Beta-blockers ◦ ACE inhibitors ◦ Angiotensin II receptor blockers ◦ Alpha-2 receptor Agonist ◦ Combined alpha and beta- blockers ◦ Central agonists ◦ Peripheral adrenergic inhibitor ◦ Vasodialoator

14.  Insulin resistance ◦ Chromium polynicotinate, ◦ Maitake mushrooms ◦ Green tea polyphenols ◦ Antioxidants ◦ Alpha lipoic acid ◦ Cinnamon ◦ Oat beta-glucan ◦ Omega 3 fatty acids ◦ Holy Basil  Abnormal blood lipids ◦ Omega-3 fatty acids ◦ Niacin ◦ Oat beta-glucan ◦ Holy Basil  Blood Pressure ◦Garlic ◦Omega-3 fatty acids ◦calcium ◦magnesium ◦vitamin C ◦Miatake Mushrooms  Anti Inflammatory ◦ B-vitamins  B6, B12, Folate ◦ Omega 3 fatty acids ◦ Turmeric ◦ Ginger ◦ Holy Basil

15.  In 2006 The IDF (international diabetes foundation) estimated that 20-25% of the World population has Metabolic Syndrome. ◦ Prevalence is increasing in the adult population worldwide ◦ Prevalence is increasing in the US among children and adolescents  Secondary associated conditions include ◦ Compromised renal function ◦ Polycystic ovary syndrome ◦ Non-alcoholic fatty-liver disease ◦ Non-alcoholic steatohepatitis ◦ Gestational diabetes mellitus ◦ Inflammation ◦ Depression  Metabolic Syndrome is COMPLICATED  The causes and symptoms overlap and contribute to one another.  Pharmacological interventions improve some symptoms while exacerbating others  People with this diagnosis are likely to be overwhelmed and feeling hopeless about their ability to improve their health.  Diet and Exercise lifestyle changes can improve patients health dramatically.