November 21, 2016

Metabolic Syndrome

There has been significant advancement in healthcare over the past decades. Despite good research on diet, exercise, genetics, diagnostics, clinical trials with pharmaceuticals and expert clinical medical management there is a steady increase in the chronic non-communicable diseases.

Global Statistics

All over the world there is problem as more and more adults and even children are being diagnosed with non-communicable diseases. The United Nations had a high-level meeting to discuss and declare that there is now an epidemic of non-communicable diseases NCDs. These chronic diseases have emerged as the leading cause of death globally. In 2001 non-communicable diseases accounted for 54% of deaths in low and middle income countries.

In 2008, of the 57 million global deaths, 36 million or 63% were due to NCDs.  The majority of NCD deaths are due to cardiovascular diseases (CVDs), including stroke, heart attack and hypertension, which have emerged as the leading causes of death in most countries of the world.

Without appropriate intervention, projections are that 24 million people will die from cardiovascular disease in 2030. Cancers pose another major threat to global health. It is estimated that approximately 7.6 million persons died from cancer in 2007 as well as in 2008  with over two-thirds of cancer deaths occurring in low and middle income countries. Despite these worrisome figures it is estimated that 80% of deaths from cardiovascular disease and type 2 diabetes and 40% of deaths from cancers are preventable.

 

Global efforts to reverse or halt the increasing trend of the non-communicable diseases

Addressing the Risk Factors

The World Health Organization WHO has focused on reducing four risk factors, namely unhealthy diets, physical inactivity, tobacco use and harmful use of alcohol. These four (4) risky behaviors are responsible for the majority of NCD deaths. It is estimated that 80% of heart disease, stroke and type 2 diabetes and 40% of cancer could be avoided through healthy diets, regular physical activity and avoidance of tobacco use.

The Center for Disease Control CDC has published ‘Strategies to Increase Physical Activity across the Life Course’. The CDC has indicated that less than 48% of all adults meet the 2008 Physical Activity Guidelines. Another finding is that 3 in 10 high school students get at least 60 minutes of physical activity every day www.cdc,gov/physicalactivity/data/facts.html.

Screening, Early diagnosis and treatment of Metabolic Syndrome

Metabolic Syndrome

Metabolic syndrome is a group of conditions that put you at risk for heart disease and diabetes. These conditions are

There is still much debate on the definition or cause of metabolic syndrome. Having 3 or more of the above conditions puts you squarely in the high-risk group.

The health professional community is paying more attention to insulin resistance. This is because of the link between metabolic syndrome and insulin resistance. Insulin is a hormone your body produces to help you turn sugar from food into energy for your body. If you are insulin resistant, too much sugar builds up in your blood, setting the stage for disease.

Now it does not follow that if you have one of these conditions symptoms you have metabolic syndrome. However, any of these conditions increase your risk of serious disease and more than one of these conditions could increase your risk even more.

If you have metabolic syndrome or any of its components, drastic lifestyle changes can delay or even prevent the development of serious health problems.

What are the causes?

Metabolic syndrome is closely linked to overweight and a sedentary lifestyle. There is also a close association between metabolic syndrome and insulin resistance linked to a condition called insulin resistance.

Insulin is a hormone made by your pancreas that helps sugar enter your cells to be used as fuel. It is the food we eat which is broken down to provide the fuel /energy needed at the cellular level. Insulin makes the cell membrane permeable to the hormone insulin.

Insulin resistance individuals are not sensitive to insulin, and so glucose is unable to cross the cell membrane as per normal. This results in the glucose levels in your blood being high. The body responds by secreting more insulin from the pancreas to no avail.

Insulin resistance definition and facts

  • Insulin resistance may be part of the metabolic syndrome, and it has been associated with higher risk of developing heart disease.
  • Insulin resistance precedes the development of type 2 diabetes .
  • The causes of insulin resistance include both genetic (inherited) and lifestyle factors.
  • There are no specific signs and symptoms of insulin resistance.
  • Insulin resistance is associated with other medical conditions, including
    • fatty liver,
    • arteriosclerosis,
    • acanthosis nigerians,
    • Individuals are more likely to have insulin resistance if they have any of several associated medical conditions. They also are more likely to be insulin resistant if obese or of Latino, African-American, Native American, or Asian-American heritage.
    • While there are genetic risk factors, insulin resistance can be managed with diet, exercise, and proper medication.
    • The test for insulin resistance is the measurement of fasting blood glucose and insulin levels.
    • Insulin resistance is treated by lifestyle modifications and in some cases, medications that is maintaining a healthy weight and getting regular exercise.

Common Risk Factors

People who have metabolic syndrome typically have apple-shaped bodies, meaning they have larger waists and carry a lot of weight around their abdomens. A pear-shaped body has weight around your hips and a narrower waist. This does not increase your risk of diabetes, heart disease and other complications of metabolic syndrome.

The following factors increase your chances of having metabolic syndrome:

  • Age: Risk of metabolic syndrome increases as we age.
  • Race: Mexican-Americans appear to be at greater risk of developing metabolic syndrome.
  • Obesity: Excessive body weight, especially around the waist, increases the risk of metabolic syndrome.
  • Diabetes: Gestational diabetes (diabetes in pregnancy) or if you have a family history of type 2 diabetes increases the risk of metabolic syndrome.
  • Diseases which may be precursors to metabolic syndrome: Cardiovascular disease, fatty liver disease (not related to alcohol) or polycystic ovary syndrome.

What are the symptoms?

Most of the disorders associated with metabolic syndrome have no symptoms, although a large waist circumference is a visible sign. If your blood sugar is very high, you might have signs and symptoms of diabetes — including increased thirst and urination, fatigue, and blurred vision.

How is it diagnosed?

Several organizations have criteria for diagnosing metabolic syndrome. According to guidelines used by the National Institutes of Health, you have metabolic syndrome if you have three or more of these traits or are taking medication to control them:

  • Large waist circumference

Large waistline that measures at least 35 inches (89 centimeters) for women and 40 inches (102 centimeters) for men

  • High triglyceride level

High triglycerides 150 mg/dL, or 1.7 millimoles per liter (mmol/L), or higher of this type of fat found in blood

  • Reduced high-density lipoprotein (HDL) cholesterol

Low blood levels of less than 40 mg/dL (1.04 mmol/L) in men or less than 50 mg/dL (1.3 mmol/L) in women of this “good” cholesterol

  • Increased blood pressure

BP readings of 130/85 mm Hg or higher

  • Elevated fasting blood sugar

Blood glucose levels of 100 mg/dL (5.6 mmol/L) or higher

 

A review of selective research on metabolic syndromeES Ford, WH Giles, WH Dietz – Jama, 2002 – jama.jamanetwork.com

  1. Determined the prevalence of the metabolic syndrome among US adults:   findings from the third National Health and Nutrition Examination Survey. They analysed data on 8814 men and women aged 20 years or older from the Third National Health and Nutrition survey.

    1. K Alberti, RH Eckel, SM Grundy, PZ Zimmet Circulation, 2009 – Am Heart Assoc contributed to harmonizing the metabolic syndrome definition. A joint interim statement of the international diabetes federation task force on epidemiology and prevention; national heart, lung was issued. They reviewed a cluster of risk factors for cardiovascular disease and type 2 diabetes mellitus, which occur together more often than by chance alone, have become known as the metabolic syndrome. The risk factors include raised blood pressure, dyslipidemia, raised blood sugar and cholesterol.
    2. SM Grundy, HB Brewer, JI Cleeman, SC Smith… – Circulation, 2004 – Am Heart Assoc established atherogenic dyslipidemia 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.
    3. SM Grundy, JI Cleeman, SR Daniels, KA Donato – Circulation, 2005 – Am Heart Assoc made a contribution to the Diagnosis and management of the metabolic syndrome in an American Heart Association/National Heart, Lung, and Blood Institute scientific statement

     

    1. The American Heart Association (AHA) and the National Heart, Lung, and Blood Institute (NHLBI) is intended to provide up-to-date guidance for professionals on the Cardiovascular morbidity and mortality associated with the metabolic syndrome
    2. BO Isomaa, P Almgren, T Tuomi, B Forsén- Diabetes, 2001 – Am Diabetes Assoc, estimated the prevalence of and the cardiovascular risk associated with the metabolic syndrome using the new definition proposed by the World Health Organization (WHO). This study involved a total of 4,483 subjects aged 35–70

    7.   HM Lakka, DE Laaksonen, TA Lakka… – Jama, 2002 – archderm.jamanetwork.com. This study examined The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men

    8.   C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events an 8-year follow-up of 14 719 initially healthy American women

    1. PM Ridker, JE Buring, NR Cook, N Rifai – Circulation, 2003 – Am Heart Assoc. The metabolic syndrome study describes a high-risk population having 3 or more of the following clinical characteristics: upper-body obesity, hypertriglyceridemia, low HDL, hypertension, and abnormal glucose.

How is it treated?

Once the risk factors have been established in an individual ( abdominal girth, raised cholesterol, triglycerides, high blood sugar and elevated blood pressure), there must be an aggressive approach to manage each clinical indicator until they are within normal ranges.

Tips for personal lifestyle changes to reduce, prevent and reverse metabolic syndrome

  1. Physical activity and regular exercise reduces the risk of overweight. Practical initiatives to overcome sedentarism include walking around more during the day. 10,000 steps are the recommended goals. If you are not very mobile and flexible consult with a health coach and fitness instructor who will do an assessment and make the appropriate recommendation which may include water exercise.
  2. Consult a nutritionist for advice on a healthy eating plan. Cultural and personal preferences are taken into consideration. Nutritionists are encouraging us to eat more vegetables, legumes and fiber. Heathy fats and oils as well as omega rich food should be part of our daily diet. Consult a nutritionist for advice on a healthy eating plan. To lose weight the dietitian will reduce the calorie intake. A food diary helps with the transformation needed for healthier eating.
  3. Consult your physician about being screened for chronic non-communicable diseases including cancers. Risks you may have and family history of disease will help to determine how often you should be screened especially for diabetes and cardiovascular diseases.
  4. Persons diagnosed with cardiovascular or respiratory diseases must discuss with the doctor whether they are well enough to engage in certain types of physical activity.
  5. Smoking cessation is strongly recommended for smokers.
  6. Limiting intake of alcoholic beverages is encouraged.

Common Complications

Having metabolic syndrome can increase the risk of developing:

  • Diabetes: Failure to reduce excess weight can lead to insulin resistance. If this is not detected early the unchecked glucose levels could eventually lead to diabetes.
  • Cardiovascular disease: High cholesterol and high blood pressure can contribute atherosclerosis (a build-up of plaques in your arteries). These plaques harden and narrow the arteries thus reducing the blood flow to sensitive organs such as the brain and the heart. This is what predisposes us to a stroke or heart attack.

Individuals diagnosed with metabolic syndrome or insulin resistance are advised to undergo serious lifestyle changes. It is never too late to start a Health and Fitness program. The benefits will boost the health and wellness of the entire body systems and mental well-being.

Role and Responsibility of State Agencies

Each individual has a personal responsibility to improve and maintain good health by eating healthy, keeping physically active and avoiding addictive habits such as smoking and excessive drinking of alcohol. Governments all over the role have been impacted by the spiralling cost of healthcare especially for persons living with the chronic diseases of diabetes and cardiovascular diseases. The call to action has also been spurred by the staggering costs of pharmaceuticals and diagnostics. Governments and non-government organizations can work together to stem the rising cost of healthcare by investing more time, energy and resources into Preventative Public Health actions.

The main role and responsibility of state agencies is two-fold i.e.

  1. Developing Public Policies and Legislation

Public policy is a declared set of objectives relating to the health, wellbeing and morals of the population. The objectives cover laws, regulatory measures, courses of action and funding provisions. Important areas for policies to safeguard the health of the population include food security and food safety. Tobacco control and alcohol policies serve to regulate the cultivation, importation, distribution and sale of these addictive products.

  1. Creating supportive environment

The provision by the state of safe, green spaces to walk ride and conduct recreational activities to support citizens who wish to be physically active. Parks, walking trails and bike lanes are infrastructural investments made by metropolitan city managers. Another feature of creating a supportive is encouraging workplace wellness programs so employees have access to healthy meals, opportunities to exercise, help with smoking cessation and excessive drinking issues.

Benefits of engaging a health coach to achieve healthy lifestyle goals

Person diagnosed with metabolic syndrome are usually given advice on lifestyle changes that they will need to made in order to decrease their risk of developing the complications of diabetes and heart-related diseases. Unhealthy diets, inactivity, smoking and excessive use of alcohol over time contribute to the top leading causes of illnesses and are also major contributors to early death.

Chronic diseases may be defined as diseases that have a prolonged course, that does not resolve spontaneously, and for which a complete cure is rarely achieved. Globally there is a move to address the lifestyle practices which when modified can improve health and quality of life. The top leading cause of illness, disability and premature death are cardiovascular diseases, diabetes mellitus, cancers and chronic respiratory disease.

 

Behavior Change

Doctors, nurses and health providers in general tell their patients to reduce salt and sugar intake, exercise, quit smoking and reduce stress without offering specific advice on how to transform their daily habits and by extension their lifestyle. There is a greater chance of success when they are referral to health professionals who are trained transformational coaches who can support them through appropriate behavior changes to restore health.

Behavior change intervention programs must be specific and unique for the patients’ needs. The programs are designed to modify and transform behavior to achieve better health outcomes. Many actually know what needs to be done but the will and commitment to do the work needed to achieve the health goals is where the assistance is needed. Breaking the cycle of poor eating habits can be very difficult and frustrating to attempt on your own.

 

The health coach is trained to assist you to explore many options to overcome a sabotaging/risky habit. By so doing there is a better chance of committing to the program. It has been suggested to work on one or a coupe changes at a time. An example of this is increasing fiber and vegetables daily by adding a salad to a meal. This is less dramatic than trying all at once to eat unfamiliar foods and supplements. Health coaching is exploring practical sustainable healthy habits using evidence-based recommendations and practices to overcome attitudes and behavior which sabotage health.

Finding the right health coach for you

The ideal coach is a professional who:

  • Is non-judgmental about your weight, smoking, eating choices, drinking and other risky behavior
  • Engenders trust and rapport is effortless
  • Demonstrates a sincere interest and commitment to assist you to attain the agreed goals
  • Is inclusive in the development of the health goals and activities
  • Suggests evidence-based approaches to modify behavior

 

Your personal health coaches must remain client-centered and be aware of what is practical and workable for your belief system and lifestyle.

When shopping for a personal health coach check the directory, or ask your health-care professional about health coaches who can assist you to achieve and maintain your health goals.

Some coaches require you to sign an agreement to fulfil the goals you have set for yourself as a demonstration of your commitment to improve your health and wellbeing. The coach will reserve the right to opt out of the arrangement if the client is not living up to the agreed plan.

References

  1. What is Metabolic Syndrome? Available at: nhlbi.nih.gov/health/health-topics/topics/ms. Accessed November 14, 2016
  2. Overview-Metabolic Syndrome. Available at: mayoclinic.org/diseases-conditions/metabolic-syndrome/home/ovc. Accessed November 12, 2016.
  3. What is metabolic Syndrome. Available at: webmd.com/heart/metabolic-syndrome/metabolic-syndrome-what-is-it. Accessed November 14, 2016
  4. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey, ES Ford, WH Giles, WH Dietz – Jama, 2002 – jama.jamanetwork.com
  5. Harmonizing the metabolic syndrome, a joint statement of the international diabetes federation task force on epidemiology and prevention; national heart, lung, K Alberti, RH Eckel, SM Grundy, PZ Zimmet Circulation, 2009 – Am Heart Assoc
  6. Definition of metabolic syndrome report to the National Heart, Lung, and blood Institute/ American Heart Association Conference on scientific issues, SM Grundy, HB Brewer, JI Cleeman, SC Smith… – Circulation, 2004 – Am Heart Assoc
  7. The American Heart Association (AHA) and the National Heart, Lung, and Blood Institute (NHLBI)
  8. Cardiovascular morbidity and mortality associated with metabolic syndrome, BO Isomaa, P Almgren, T Tuomi, B Forsén- Diabetes, 2001 – Am Diabetes Assoc
  9. The metabolic syndrome and total cardiovascular disease mortality in middle-aged men, HM Lakka, DE Laaksonen, TA Lakka… – Jama, 2002 – archderm.jamanetwork.com.
  10. C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events, PM Ridker, JE Buring, NR Cook, N Rifai – Circulation, 2003 – Am Heart Assoc.

 

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