Metabolic Syndrome and the 2006 Revision of AHA Lifestyle & Dietary Guidelines

Metabolic Syndrome, also known as “Cardio-metabolic Syndrome” or “Syndrome X,” refers to a constellation of medical conditions that are still poorly understood. In fact, there has been some disagreement within the clinical and research medical communities as to whether Metabolic Syndrome actually exists as a distinct entity or is merely a “renaming” of previously identified risk factors relating to cardiovascular disease (CVD) and Type II Diabetes Mellitus (DM II).Although the relationships between obesity, DM II, and CVD had been well-documented for the better part of the 20^th century, it was in 1988 that Reaven first proposed insulin resistance as the underlying factor and named the constellation of abnormalities Syndrome X.

In 2005, The Adult Treatment Panel III of the United States National Cholesterol Education Program defined the diagnosis of Metabolic Syndrome (their preferred terminology) as three or more of the following five findings:

Increased waist circumference (�102 cm in men and �88 cm in women), indicating central obesity
Elevated triglycerides (�150 mg/dL)
Decreased HDL cholesterol (<40 mg> Blood pressure above 130/85 or active treatment for hypertension
Fasting glucose levels above 100 mg/dL or active treatment for hyperglycemia

As noted above, the causes of metabolic syndrome are extremely complex and poorly understood. However, the majority of patients diagnosed with this condition tend to be older, obese, and have at least some degree of insulin resistance. There is some continuing debate within the medical community regarding whether obesity or insulin resistance causes metabolic syndrome or is a byproduct of a more far-reaching metabolic cause.

Although purely coincidental to the discussions regarding Metabolic Syndrome, the American Heart Association (AHA) has announced a revision to its guidelines relating to the prevention of heart disease. The new guidelines, recently published in the journal Circulation, are intended as guidance for both healthy adults and children over the age of 2 (guidelines specific to children can be found by following the link in the “References” section, below). Highlights of the new guidelines include:

The recognition that a healthy diet is a part of the broader healthy lifestyle category.

The new guidelines encourage :

A diet rich in fruit and vegetables as well as whole-grain, high-fiber foods;
Eating fish, especially oily fish, at least 2 times a week;
Reducing the intake of food and drinks with added sugar;
Preparing foods with little or no salt;
Consuming alcohol only in moderation; and
Limiting saturated fat intake to < 7% of energy, trans fat to < 1% of energy, and cholesterol to < 300 mg/day.

In an interview conducted by online medical education provider Medscape, lead author Alice Lichtenstein stated that “… previous recommendations stressed a healthy dietary pattern; the new ones broaden that concept to include the importance of a healthy lifestyle pattern. The two go together – they should be inseparable.”

The inclusion of “healthy environment” as a part of the new healthy lifestyle recommendation. The attributes of a “healthy environment” including
Complete abstinence involving all types of tobacco products;
Limiting consumption of “fast foods” whenever practical;
Reducing the size of food servings;
Avoiding, or at least substantially reducing, fried foods and,
A regular exercise program.

If you read the above sections on metabolic syndrome and the new AHA guidelines carefully, you will notice that they are very similar. In fact, the guidelines could easily be interpreted as a treatment plan addressed to combat metabolic syndrome itself rather than a suggested course of changes to prevent heart disease.

By simply following the AHA guidelines, you have taken the crucial first steps in reducing your risks regarding CVD. For help regarding the medical treatment of elevated lipid levels in the bloodstream and/or high blood pressure, your health care provider will be happy to order the appropriate laboratory tests and to prescribe the appropriate medications.

References

Davis, Stephen. Evolving Treatments for Cardiometabolic Syndromes. J Managed Care Medicine 2006; Vol. 9 No. 2. 17-23 (Full Text).

gSS, et al. Dietary recommendations for children and adolescents: a guide for practitioners: consensus statement from the American Heart Association. Circulation; 2005; 112:2061-2075 (Full Text).

Grundy, SM, et al. Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005; 112:2735-2752 (Full Text or Executive Summary). Krauss, RM, et al. AHA Dietary Guidelines, Revision 2000: A Statement for Health care Professionals from the Nutrition Committee of the American Heart Association. Circulation; 2000; 102:2284(Full Text).

Lichtenstein AH, et al. Diet and Lifestyle Recommendations Revision 2006: A Scientific Statement from the American Heart Association Nutrition Committee. Circulation; 2006; 114:82-96 (Full Text).

National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 3143-3421 (Full Text)

Reaven, GM. Banting Lecture 1988. Role of insulin resistance in human disease. Diabetes 1988; 37:1595-607 (Abstract).

Disclaimer

The information presented in this article and its included links is of an informational nature only and is not intended as a recommendation of any changes in the reader’s health care program. Before making any changes in diet, medications, or other treatments the reader is strongly advised to consult with their health care provider.