The Metabolic Syndrome

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The Metabolic Syndrome

• Jim Mann
• Professor in Human Nutrition Medicine
• Director, Edgar National Centre for Diabetes
  Research
• University of Otago

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Diagnostic Criteria

• NCEP,ATPIII,2001
• Three or more of
• Central obesity waist 102 (M), 88 (F)
• Hypertriglyceridaemia
• Triglyceride ? 1.7
• Low HDL
• Hypertension
• - Blood pressure135/85 or
• Treatment
• Fasting glucose 6.1

• WHO,1999
• Hyperglycaemia or
• Insulin resistance plus 2
• or more of
• Obesity W/H0.9 (M), 0.85(F) or BMI30
• Dyslipidaemia TG?1.7 or HDL

• Hypertension
• - Blood pressure 140/90mmHg
• Microalbuminuria
• Albumin excretion 20µg/min

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Proposed IDF Criteria 2005 (a)

• Central Obesity
• Waist circumference (ethnic specific)
• Plus two (2) of the following
• Raised triglyceride (1.7 mmol/l)
• Reduced HDL (
• (mmol/l,F)
• Raised blood pressure (130systolic or 85
• 
  diastolic)
• Fasting glucose 5.6 mmol/l
• Diagnosed T2DM
• Treated hypertension
• Treated dyslipidaemia

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Proposed IDF Criteria (b)

• Ethnic specific values for waist circumference

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Other metabolic abnormalities associated with
insulin resistance

• - Predominance of small dense LDL
• - Increased uric acid and gout
• - Increased plasminogen activator inhibitor
  (PAI - 1)
• - NASH
• - Endothelial dysfunction
• - Increased proinflammatory cytokines
• - Increased homocysteine

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Figure 1 Prevalence of the metabolic syndrome
from ATPIII definition
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Unadjusted Kaplan-Meier Hazard Curves
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OR (95 CI) for IRS by categories of weight
gained from age 20 to age at examination
Everson et al 1998
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KANWU Study, Vessby 2001
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Rare/Never 1-3/mo 1/wk 2-4/wk 5/wk
Insulin sensitivity
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IDF 2005 RECOMMENDATIONS FOR TREATMENT

• Primary intervention Healthy lifestyle
• ? moderate calorie restriction (5-10
  weight loss)
• ? moderate increase in physical
  activity
• ? change in dietary composition
• Secondary intervention
• Atherogenic dyslipidaemia
• ? lower TG, ApoB non HDL
  cholesterol
• ? raise HDL - C
• ? reduce LDL - C
• By use of fibrates statins
• (achieve ATP - III criteria)

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IDF 2005 RECOMMENDATIONS FOR TREATMENT (2)

• Elevated blood pressure
• ? Introduce BP Rx if 140/90 or 130/80
  with diabetes
• ACE Inhibitors and ARBs especially
  useful
• Insulin Resistance Hyperglycaemia
• Metformin (DPP)
• Acarbose
• Orlistat
• Thiazolidinediones

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DPS GOALS

• Weight reduction 5
• Moderate intensity
• physical activity 30 m/day
• Dietary fat
• Dietary Sat fat
• Dietary fibre 15 g/1000
  kcal

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Finnish Diabetes Prevention Study Proportion
of subjects without diabetes during trial
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Finnish Diabetes Prevention StudyIncidence of
diabetes during follow-up
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Other metabolic abnormalities associated with
insulin resistance

• - Predominance of small dense LDL
• - Increased uric acid and gout
• - Increased plasminogen activator inhibitor
  (PAI - 1)
• - NASH
• - Endothelial dysfunction
• - Increased proinflammatory cytokines
• - Increased homocysteine

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Treating the Metabolic Syndrome
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Age-standardised prevalence of glucose metabolism
disorders
Standardised to WHO world population
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New Zealand Medical Journal, 2004, 1171208U
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Physical activity and dietary practices
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Ngati Healthy Strategies

• Health promotion
• Community education and individual follow up
• Structural strategy

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Health Promotion

• Travelling roadshow
• Local radio
• Poster campaign
• Involvement of local celebrities - e.g. East
  Coast Rugby team
• TANE approach

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Get Hooked on water!
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Low fat milk
Builds strong bones
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Trim the fat
Lean meats build lean machines
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Wholegrain
breads cereals
Head shoulders above the rest
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Community education and follow up of high risk
individuals

• Physical activity classes rubba lavas
• Food and cookery demonstrations
• Collecting kai (seafood)
• TANE approach
• Individual follow up of high risk individuals

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Structural Strategy

• Aims to involve all activities of the Runanga
• East Coast schools Kohanga
• Get hooked on water
• Ngati Healthy lunch boxes
• Water only drink permitted
• Gardens in schools
• Retail food outlets
• Ngati Healthy display
• Ngati Healthy mealpacks
• Ngati Healthy menu
  and recipe books

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