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كتاب المتلازمة الأيضية للدكتور موسى العنزي
 

كتاب المتلازمة الأيضية للدكتور موسى العنزي

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كتاب المتلازمة الأيضية للدكتور موسى العنزي

كتاب المتلازمة الأيضية للدكتور موسى العنزي
استشاري طب الأسرة

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    كتاب المتلازمة الأيضية للدكتور موسى العنزي كتاب المتلازمة الأيضية للدكتور موسى العنزي Document Transcript

    • METABOLIC SYNDROME DR . MOUSA BIN SAMHAN AL ENAZY CONSULTANT PHYSICION OF FAMILY MEDICINE
    • INTRODUCTION Obesity is an important modifiable risk factor for many chronic diseases, including cardiovascular disease (CVD), type 2 diabetes, hypertension, hypercholesterolaemia, certain types of cancer, osteoarthritis, gallbladder disease and mental health problems The traditional CVD risk factors of smoking, hypertension and hypercholesterolaemia have been the main focus of prevention and treatment programs for several decades, with only limited attention given to obesity Recent guidelines show increasing recognition that global risk — integrating a person’s individual risk factors with age, sex and any vascular disease already present — is central to risk factor assessment and management. In recent years, a clustering of risk factors (hyperglycaemia, hypertension, hypertriglyceridaemia, low levels of high-density lipoprotein [HDL] cholesterol, and overweight/obesity) identified as “metabolic syndrome” (MetS) has gained widespread recognition. MetS is strongly associated with an increased risk of type 2 diabetes and CVD. according to US National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria . International Diabetes foundation (IDF) criteria &American heart association criteria .
    • Metabolic Syndrome Also called: Insulin resistance syndrome, Metabolic Syndrome X Metabolic syndrome is a group of conditions that put you at risk for heart disease and diabetes. These conditions are • High blood pressure • High blood sugar levels • High levels of triglycerides, a type of fat, in your blood • Low levels of HDL, the good cholesterol, in your blood • Too much fat around your waist Not all doctors agree on the definition or cause of metabolic syndrome. The cause might be 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. The Role of Diet in Metabolic Syndrome A new study has implicated meat, fried food and, surprisingly, diet soda in the development of metabolic syndrome. More research will now be needed to confirm and explain these intriguing findings. Metabolic syndrome is a cluster of conditions that increases the risk for heart disease and stroke. Doctors consider someone to have metabolic syndrome when they have 3 or more risk factors, which include elevated blood pressure, low HDL (good cholesterol) levels and diabetes or pre-diabetes.
    • Various aspects of diet have been linked to metabolic syndrome in previous studies, but the diet's role in the syndrome's genesis isn't well understood. Dr. Lyn M. Steffen at the University of Minnesota's School of Public Health and her colleagues set out to take a broad look at the relationship between metabolic syndrome and dietary intake. They used data from 9,514 middle-aged adults enrolled in the multicenter Atherosclerosis Risk in Communities (ARIC) study. The study was initiated by NIH's National Heart, Lung and Blood Institute (NHLBI) to investigate the factors that contribute to atherosclerosis (the buildup of cholesterol and fat in the walls of arteries) and the incidence of cardiovascular diseases. ARIC assessed dietary intake, both at the beginning of the study and 6 years later, by using a 66-item food frequency questionnaire. By 9 years later, nearly 40% of the study's participants had developed metabolic syndrome. The new analysis of ARIC data appeared in the February 19, 2008, issue of Circulation. The study found that a Western dietary pattern—characterized by high intakes of refined grains, processed meat, fried foods and red meat—was associated with a greater risk of developing metabolic syndrome. Upon closer analysis, the researchers found that those who ate the most meat were more likely to develop metabolic syndrome. In particular, hamburgers, hot dogs and processed meats were each associated with higher rates of metabolic syndrome. Fried foods were also associated with an increased risk. The researchers didn't find any association, positive or negative, between metabolic syndrome and whole grains, refined grains, nuts, coffee or fruits and vegetables. On the other hand, they found that those who ate more dairy were less likely to develop metabolic syndrome. Strikingly, diet soda was strongly associated with an increased risk for metabolic syndrome, although sweetened beverages such as juices and regular soda were not. Other recent studies have found links between diet soda and metabolic syndrome as well as weight gain. As a possible explanation, findings in rodents suggest that artificial sweeteners may lead to increased intake because they may interfere with the body's ability to properly assess how many calories are in foods. These findings, however intriguing, are not conclusive. Whole grains have been found in previous studies to lower the risk of metabolic syndrome, but this study didn't. Certain foods in themselves may not play a role in causing metabolic syndrome, but rather may serve as markers for other behaviors that do lead to metabolic syndrome. More research into what causes metabolic syndrome will hopefully clear up the confusion.
    • High-intensity exercise better at improving metabolic syndrome risk factors Study highlights: • Short bursts of high-intensity exercise, rather than longer spells of moderate-intensity, exercise may improve the health of people with metabolic syndrome. • The findings could have implications for rehabilitation programs. • Once previously sedentary people with metabolic syndrome can comfortably exercise at a moderate intensity, they could consider more vigorous exercise, if they can do it without adverse symptoms, according to American Heart Association spokesperson. DALLAS, July 8 — In a small study, short, vigorous exercise appeared to reduce metabolic risk factors better than longer spells of moderate intensity exercise according to a report in Circulation: Journal of the American Heart Association. Forty-six percent of metabolic syndrome patients who participated in a 4- month, intense aerobic interval training (AIT) program had fewer metabolic syndrome risk factors compared to 37 percent of patients following a moderate training plan. Metabolic syndrome — estimated to affect 24 percent of the U.S. adult population — is a clustering of metabolic risk factors that increase your vulnerability to coronary heart disease, stroke, peripheral vascular diseases and other diseases related to plaque build-ups in artery walls. As defined by the World Health Organization, the risk factors include type 2 diabetes, obesity (body-mass index of 30 or greater), abdominal obesity, high triglycerides, low high-density lipoprotein (HDL) cholesterol, high blood pressure, insulin resistance, glucose intolerance and microalbuminuria.
    • To determine what kind of exercise works best against the metabolic syndrome, researchers divided 32 patients (average age 52) into three groups. One group used a high-intensity aerobic-interval training for four months. Another used a less-intense regimen called “moderate continuous- training” (CME). Another did not exercise. “The current study suggests that exercise in general and AIT in particular is partly or fully able to reverse metabolic syndrome, suggesting that this may be a promising treatment strategy,” said Arnt Erik Tjønna, M.Sc., lead author of the study and a doctoral candidate in clinical medicine at the Norwegian University of Science and Technology in Trondheim, Norway. “Guidelines calling for 30 minutes of exercise of moderate intensity may be too general for this population.” Patients in both exercise groups lost roughly the same weight and waist circumference. Thus, AIT’s ability to cause patients’ hearts to beat faster — and thus absorb and use oxygen — seems to be why patients in this group became healthier than those in the CME group, researchers said. Patients in the AIT group increased their ability to absorb oxygen by 35 percent, while those in the CME increased their ability to absorb oxygen by only 16 percent. “To get good results in maximal oxygen intake, we have to train the heart, because the heart’s pumping capacity seems to be the limiting factor when we talk about maximal oxygen intake in these patients,” Tjønna said. “AIT trained the heart muscles the most and made them pump more oxygen.” This group also outperform the CME group in several other key measures, including endothelial function, blood pressure, insulin sensitivity, fasting glucose, HDL cholesterol and mitochondrial biogenesis (the ability of cells to produce fuel for work). Given the small number of patients studied, a larger study is needed before formally changing guidelines about how to manage the metabolic syndrome through exercise, he said. The American Heart Association and other health organizations recommend that patients with the metabolic syndrome undertake moderate-intensity physical activity, at least 30 minutes on most days of the week. But this study challenges those recommendations. Barry Franklin, Ph.D., an American Heart Association spokesperson and an author of the association’s physical activity guidelines, noted that several recent epidemiological and clinical studies now suggest that if the total energy
    • expenditure of exercise is held constant, exercise performed at a vigorous intensity appears to convey greater cardioprotective benefits than exercise of a moderate intensity. “However, these added benefits must be weighed against the potential for increased musculoskeletal and cardiovascular complications as well as reduced compliance,” said Franklin, co- and director of the William Beaumont Hospital Cardiac Rehab and Exercise Laboratories in Royal Oak, Michigan. “Accordingly, when previously sedentary individuals can comfortably exercise at a moderate intensity, they should consider the goal of more vigorous exercise, provided that it is sustainable and can be achieved without adverse signs or symptoms.” Co-authors are: Sang Jun Lee, Ph.D.; Oivind Rognmo, M.S.; Tomas Stolen, M.S.; Anja Bye, M.S.; Per Magnus Haram, Ph.D.; Jan Pål Loennechen, Ph.D.; Qusay Y. Al-Share, M.S.; Eirik Skogvoll, Ph.D.; Stig A. Slordah, Ph.D.; Ole J. Kemi, Ph.D.; Sonia M. Najjar, Ph.D.; and Ulrik Wisloff, Ph.D. The study was funded by the Norwegian Council of Cardiovascular Disease, the Norwegian Research Council, St. Olav’s University Hospital, Torstein Erbo’s Foundation, the U.S. National Institutes of Health and the U.S. Department of Agriculture. Disclosures for individual authors are available on the manuscript. Statements and conclusions of study authors that are published in the American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect association policy or position. The American Heart Association makes no representation or warranty as to their accuracy or reliability.
    • • Do you know a healthy body can live up to 120 years? • Why is that even with proper dieting, so many people have died young from organ failure such as heart attack, liver cirrhosis, diabetes, and cancer? • Is there a missing link in health Science? • Do you Know? All food is, at least potentially, a poison, until converted into simple structures.......... • Do you know that to prolong life, we need to complement nutritional health with metabolic health? • What is metabolism? • What cause the metabolic disorder? • Do you know the human red blood cells undergo the process of natural metabolism every 120 days? • Treat the Problem, NOT just the symptoms • How can Enzyme Catalyst help? • Health Digest & Health Today magazine articles: A new answer to prolonging life Let Your Body Perform At Its Peak (Article from HealthToday, APRIL 2005 (Article from HealthDigest, APR/MAY issue) 2005 issue) - Metabolic health—the missing link in - What are Enzymes? prolonging life - Types of Enzyme - What causes metabolic disorder/ syndrome? - Enzyme Benefits - Enzymes cannot function without enzyme - Syndromes common to Enzyme deficiency catalyst - The wonders of fermentation - Enzyme supplements in the market Metabolic Syndrome Health Destroyer
    • The mortality rate for metabolic syndrome is 2.5 times higher that for Non- Metabolic Syndrome. (Highlighted in the American Medical Association and "Chung Hwa Daily" Medical website) As many as 1 in 4 American adults and 40% of adults age 40 or older have metabolic syndrome, an increase of 61% over the last decade. (CNN.COM, metabolic syndrome, march 9, 2004) Bodies deficient in nutrients and overloaded with toxic waste are creating an epidemic in the United States where 65% of Americans are chronically ill and 20% of teenagers are suffering from premature aging. ('Food enzymes For Health & Longevity'by Dr. Edward Howell) The Discovery That Proper Dieting Alone Cannot Prolong Life Scientists have discovered that a healthy body can live up to 120 years! Then why is it that even with proper dieting, so many people have died young from organ failure such as heart attack, liver cirrhosis, diabetes, and cancer? Is There A Missing Link in Health Science? Thanks to molecular biology, scientists can now see minute molecules that form our body called cells & enzymes. Many people cannot enjoy long life because their cells & enzymes fail to work at peak optimal level. This results in metabolic disorder that brings on many fatal illnesses. We now know that to prolong life, we need to complement nutritional health with metabolic health. Nutritional health can be maintained by nutrients from food, but metabolic health can only be preserved by consuming Enzyme Catalyst. Metabolic Health - The Missing Link in Prolonging Life
    • Healthy metabolism is the continual process of breakdown and renewal performed inside cells, as well between cells, that result in growth, energy production, waste elimination, and the control of your bodily functions such as digesting food, distributing food nutrients in the blood, breathing, blinking, walking, talking, etc. What Causes Metabolic Disorder / Syndrome? Cells are power plants that are managed by enzymes. Enzymes are enhanced by Enzyme Catalyst (co-enzymes and co-factors). When certain enzymes become weak or inactive, they will trigger off abnormal cell behaviour, causing one power plant (cell) to shut down after another in a chain reaction that seriously damages your metabolic health thus resulting in chronic diseases such as heart disease, hypertension, diabetes, renal failure, cancer and etc. Treat the Problem, NOT Just the Symptoms When encountering the early symptoms of metabolic disorder, most people will seek fast relief for the symptoms only. Example: antacids for gastric, charcoal pills for gas, etc. This may retard the symptoms for a while, but the problem still remains. The correct way is to follow-up quickly by boosting your enzymatic system with Enzyme Catalyst! Enzymes Cannot Function Without Enzyme Catalyst Co-factors and Co-enzymes (Enzyme Catalyst) are essential for cells to perform at peak optimal level. All metabolism functions that support life, such as bone and tissue formation, blood coagulation and circulation, etc., depend on the well-being of enzymes. And, enzymes will only remain healthy when they are supported by Enzyme Catalyst. The best Enzyme Catalyst is a broad spectrum variety derived from bioactive plant micro-nutrients extracted through the process of fermentation. DR- XENIJI ENZYME CATALYST • DR-XENIJI ~ Metabolism Helper • What Does More Than 1000 Days of Fermentation Do? • More Than 7 Wonders of 1000 Days of Fermentation • Health Benefits of DR-XENIJI • Effectiveness of DR-XENIJI • About Muscovado, Inventor of DR- XENIJI & International Recognition
    • • Testimonials • Q&A with Dr. Shingoro Matsuura DR-XENIJI ~ Metabolism Helper DR-XENIJI is a fermented fruit and vegetable food supplement whose production involves a muscovado base with over 50 kinds of plants including fruits, root vegetables, grains and seaweeds, carefully selected and repeatedly fermented and matured for three years and three months (1185 days). There are a hundred or more manufacturing processes to a finished product and a large number of effective microorganisms have formed special ecological system in a cask and worked during the process of fermenting. DR-XENIJI made in this way is useful for your health maintenance. With increasing concerns about health or wellness among people, various health foods are distributed on the market right now. Therefore, a large number of consumers have required objective evaluation and accurate information of health foods, and also definite guideline on health foods has been required simultaneously. DR-XENIJI is an enzyme catalyst that can help to activate the action of all 3 types of enzymes (digestive, metabolic and food enzymes) to promote healthy metabolism in our body. The uniqueness of DR-XENIJI lies in 3 factors - • More than 1000 days of fermentation • Clinically Proven • Inventor's credentials and worldwide recognitions DR-XENIJI: A Miracle of More than 1000 days AND MORE! What Does More Than 1000 Days of Fermentation Do? • Breaks down plant nutrients from raw complex forms into bioactive fine micro-forms (Enzyme Catalyst) that can be easily absorbed even by an unborn baby. • Creates a host of bioactive micronutrients that will energize the cancer- fighting cells in our body, and lower the risk of cancer. Releases the health-giving goodness of the skin and seeds of fruits. Skin pigments of fruits like grape and apple contain high bio-active energies that reduce the risk of skin cancer. The seeds of fruits are highly beneficial. The rape seed, for example, is one of the most powerful sources of anti-oxidant that fights free radicals, prevents senility, inhibits blood vessel blockages, and actually protects our brain and nervous system!
    • • Releases a broad spectrum of co-enzymes and co-factors so that our body benefits from the full range that enhances the effectiveness of our entire metabolic system instead of just one specific organ. More Than 7 Wonders of 1000 Days of Fermentation 1. DR-XENIJI was initially developed to provide nourishment for pregnant mothers and development of healthy fetus. 2. More than 1000 days of fermentation allows all nutrients from the fruit and vegetables to be fully fermented, hence creating the most Bio-active Board Spectrum co-factor and co-enzyme. The activation of digestive and metabolic processes requires different co-enzyme and co-factors that can be found in DR- XENIJI, the broad spectrum co-factor and co-enzyme. 3. More than 1000 days of fermentation produces bioactive micro-fine nutrients that are in predigested form ready to be absorbed by cells, hence ensuring the effectiveness and efficiency of metabolism in cells. 4. Bioactive micro-fine nutrients are fast absorbed in our body therefore less energy is required for metabolism of food and nutrients, hence reducing the stress levels in the body which leads to improved health. 5. More than 1000 days of fermentation allows the capturing of full spectrum of phytonutrients and energy from all seasons of 52 types of fruits and vegetables together with Muscovado (raw brown sugar). 6. More than 1000 days of fermentation allows fruits and vegetables to ferment naturally. No heating or chemicals are required to sterilize or to quicken the fermentation process, hence all nutrients are preserved. 7. Because it is a broad spectrum co-factor/co-enzyme, it acts as a booster catalyst for metabolic processes in our body, hence it has a positive effects on illnesses related to metabolic disorders.* a.Boosted Activity of NK Cells by 6.5 Folds b.Absorption of Sugar into Bloodstream Curbed by 80% c.Lower Hypertension Causing ACE** Activity Levels by 90% All the above illnesses are related to metabolic processes not being performed at their peak optimal level in the cells. Health Benefits of DR-XENIJI 1. *Increases cancer fighting cells and reduces abnormal cell mutation. Clinical Proof: DR-XENIJI boosted the activity of NK cells (cancer fighting cells) by as much as 6.5 fold within a mere 24 hours. 2. *Inhibits the accumulation of blood sugar in controlling diabetes Clinical Proof: DR-XENIJI inhibits the absorption of blood sugar into the body by as much as 80%. 3. *Regulates cell activity - Stimulates and balances enzyme activity levels in cells: - Heightens up the low enzyme activity level of lethargic people. - Lowers down the high enzyme activity level of renal-hypertension sufferers, normalizing high blood pressure. - Clinical Proof: 50 mg/ml of DR-XENIJI lowers high blood pressure by 90%. (Source of point 1, 2 & 3: refer to (a) below) 4. Increases the fertility rate of couples with low fertility Hundreds of couples with low fertility, some of them have been married for more than 10 years without conceiving had benefited from DR-XENIJI. 5. Improves digestion for better nutrients absorption and utilization
    • 6. Enhances vitality by effectively converting nutrients into energy 7. Improves detoxification and bowel movement thus reducing toxic accumulation Effectiveness of DR-XENIJI Some benefits of improved healthy metabolism Children: Adults: • • Helps Enhances nutrition absorption maintain normal metabolism to • Promote intellectual (brain) regulate cholesterol levels development • Prevent accumulation of excessive fat • Maximizes the metabolism of nutrients • Helps regulate blood glucose uptake for healthy physical growth by the body • Helps normalize renal high blood pressure • Reduce the risk of cancer cell Expectant Mothers: formation • Helps in absorption of nutrients Elders: • Helps in • D optimal and e healthy growth l of the fetus a • Increases energy levels y • Reduces complication of pregnancy aging process • Invigorates and maintains efficiency of body organs Effectiveness • FAST – ACTING: In clinical tests, DR-XENIJI boosted the activity of NK cells (cancer fighting cells) by as much as 6.5 folds within a mere 24 hours. • EASILY ABSORBED BY THE BODY • Completely safe for consumption by anyone – even pregnant mothers and little babies.
    • New Guidelines for Diagnosis and Management of Metabolic Syndrome CME News Author: Laurie Barclay, MD CME Author: Désirée Lie, MD, MSEd Disclosures To earn CME credit, read the news brief along with the CME information that follows and answer the test questions. Release Date: September 13, 2005; Valid for credit through September 13, 2006 This activity has expired. CME in this activity indicates that it was developed according to ACCME guidelines and was certified for credit by an accredited CME provider. Medscape cannot attest to the timeliness of expired CME activities. Sept. 13, 2005 — The American Heart Association (AHA) and the National Heart, Lung, and Blood Institute (NHLBI) have issued guidelines for the diagnosis and management of the metabolic syndrome. The executive summary, a synopsis of the full scientific statement explaining the new guidelines, is published in the Sept. 12 Rapid Access issue of Circulation. "The metabolic syndrome has received increased attention in the past few years," write Scott M. Grundy, MD, panel chair, and colleagues from the AHA and the NHLBI. "It consists of multiple, interrelated risk factors of metabolic origin that appear to directly promote the development of atherosclerotic cardiovascular disease (ASCVD). This constellation of metabolic risk factors is strongly associated with type 2 diabetes mellitus [DM] or the risk for this condition." The panel found that the metabolic syndrome is a complex disorder, with no single factor as the cause. However, the most important risk factors were abdominal obesity and insulin resistance. Other
    • metabolic risk factors are atherogenic dyslipidemia (elevated triglyceride levels and apolipoprotein B, small low-density lipoprotein cholesterol [LDL-C] particles, and low high-density lipoprotein HDL cholesterol [HDL-C] concentrations), high blood pressure (BP), high plasma glucose levels, a prothrombotic state, and a proinflammatory state. Other conditions that may promote the metabolic syndrome include sedentary lifestyle, aging, hormonal imbalance, and genetic or ethnic predisposition. Prospective population studies suggest that the metabolic syndrome is associated with approximately a twofold increase in relative risk for ASCVD, and a fivefold increase in risk for developing diabetes. "The presence of the syndrome is associated with increased long-term risk for both ASCVD and type 2 diabetes mellitus, and thus requires attention in clinical practice," the authors write. "Lifestyle interventions deserve prime consideration for risk reduction across a lifetime; these interventions include weight control, increased physical activity, and a diet designed to reduce the risk for ASCVD." Goals for lifestyle intervention for abdominal obesity are to reduce body weight by 7% to 10% during the first year of treatment and continued weight loss thereafter to achieve desirable weight (body mass index, < 25 kg/m2) and waist circumference of less than 40 in. for men and less than 35 in. for women. Recommended physical activity is of moderate intensity for 30 to 60 minutes five to seven days a week. Diet should reduce intakes of saturated fat (< 7% of total calories), trans fat, cholesterol levels (< 200 mg/day), and total fat (25% - 35% of total calories). Most dietary fat should be unsaturated, and simple sugars should be limited. Other overall conclusions of the panel were that the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria for clinical diagnosis of the metabolic syndrome were robust and clinically useful, and they recommended maintaining the NCEP-ATP III criteria with minor modifications. The NCEP-ATP III definition requires defined abnormalities in any three of five clinical measures: waist circumference, elevated triglyceride levels, HDL-C levels, BP, and fasting glucose level. Modifications recommended by the panel include adjustment of waist circumference to lower thresholds when individuals or ethnic groups are prone to insulin resistance; considering triglyceride levels, HDL-C levels, and BP to be abnormal when drug treatment is prescribed; clarifying that elevated BP refers to a level exceeding the threshold for either systolic or diastolic pressure; and lowering the threshold for elevated fasting glucose level from 110 to 100 mg per dL. For patients with the metabolic syndrome who have a relatively high 10-year risk for ASCVD, the guidelines state that drug therapy of both major and metabolic risk factors can help lower risk. They suggest using pharmacotherapy according to present recommendations by the AHA, NHLBI, and American Diabetes Association (ADA) for individual risk factors, but not specifically to reduce risk for type 2 DM independent of treatments to prevent ASCVD. The panel described specific treatment of metabolic risk factors for prevention of ASCVD or treatment of type 2 DM, including treatment of atherogenic dyslipidemia, hypertension, elevated glucose levels, prothrombotic state, and proinflammatory state. "Additional research is required both to better understand the underlying pathophysiology of the metabolic syndrome and to identify new targets for therapy," the panel concludes. Members of the writing group disclose various financial arrangements with NHLBI, AHA, Cincinnati Children's Hospital Medical Center, Pfizer, Astra-Zeneca, Abbott Laboratories, University of Colorado Health Sciences, William Beaumont Hospital, Pfizer, University of Texas, Southwestern Medical Center, GlaxoSmithKline, Merck, KOS Department of Veterans Affairs, Reynolds, National Institutes of Health, Sanofi, Children's Hospital Oakland Research Institute, Bristol-Myers Squibb, University of North Carolina Medical School, Johnson & Johnson, Medtronic, Intuitive Surgery, Saint Luke's Hospital of Kansas City, CV Therapeutics, CV Outcomes, Outcomes Instruments, Inc., University of Washington, Emory University, Atlanta VA Medical Center, Kidney Foundation, Amcyte, Diamedica, Inc., Aventis, Diamedica, Inc., Kowa Research Institute, Mankind Corp., Novartis, Sanyko, Sanofi-Synthelabo, Sanofi Aventis, Takeda, Hartford Hospital, Schering-Plough, Bristol-Myers Squibb, and/or Reliant. Circulation. Posted online Sept. 12, 2005.
    • Learning Objectives for This Educational Activity Upon completion of this activity, participants will be able to: • Describe modifications to the updated NCEP-ATP III criteria for the metabolic syndrome by the AHA and NHLBI writing group. • Compare the similarities and differences in diagnosis and management of the metabolic syndrome by the International Diabetes Federation (IDF) vs the updated NCEP-ATP III reports. Clinical Context The metabolic syndrome consists of multiple, interrelated risk factors that promote the development of ASCVD, and the constellation strongly is associated with type 2 DM or the risk for type 2 DM, according to the current authors. Prospective population studies show a twofold increased risk for ASCVD events in patients with the metabolic syndrome and a fivefold risk of developing type 2 DM with relatively high long-term risks for both conditions. The NCEP-ATP III proposed a simple set of diagnostic criteria based on clinical measures that have been widely used in clinical and epidemiologic studies, according to this report. This executive summary is a synopsis of a full scientific statement from the AHA and the NHLBI writing group that is intended to provide up-to-date guidance for professionals on the diagnosis and management of the metabolic syndrome in adults. Study Highlights • The NCEP-ATP III criteria for the metabolic syndrome are based on the presence of 3 or more of the following: increased waist circumference, elevated triglyceride levels, BP, fasting glucose level, and reduced HDL-C levels. • Increased waist circumference is not a required criterion for diagnosing the metabolic syndrome in the NCEP-ATP III criteria. • The AHA and NHLBI writing group affirms the overall utility and validity of the NCEP-ATP III criteria and proposed that they should continue to be used with modifications. • The recommended modifications are (1) adjustment of waist circumference to lower thresholds when individuals or ethnic groups are prone to insulin resistance, (2) allowing triglyceride and HDL-C levels and BP to be counted as abnormal when a person is prescribed drug treatment for these conditions, (3) clarifying that elevated BP is defined as an elevation of either systolic or diastolic BP, and (4) reducing the threshold for elevated glucose level from 110 mg per dL or higher to 100 mg per dL or higher in accordance with the ADA revised definition of impaired fasting glucose (IFG). • The IDF has proposed clinical criteria similar to those of the NCEP-ATP III with identical thresholds for triglyceride and HDL-C levels, BP, and plasma glucose. • The IDF criteria are different in that the waist circumference thresholds are adjusted to different ethnic groups. • The IDF criteria require that increased waist circumference be an element of the metabolic syndrome because abdominal obesity reflects both concepts of obesity and insulin resistance. • In the U.S. population, updated NCEP-ATP III and IDF criteria identify essentially the same people as having the metabolic syndrome. • Clinical Management of Metabolic Syndrome: o Recommendations for management of the metabolic syndrome are virtually identical in the updated NCEP-ATP III and IDF reports. o First-line recommendations for reducing ASCVD risk include smoking cessation, reducing LDL-C levels, BP, and glucose levels to recommended goals. o Long-term risks are of high priority in management. o Lifestyle interventions include weight loss in obese subjects, increased physical activity, and dietary modification. o Recommendations for drug therapy follow those of the AHA, NHLBI, and ADA. o For dyslipidemia, the 10-year risks for ASCVD are defined by four risk categories of elevated LDL-C levels: high risk (> 20%), moderately high risk (10% - 20% with 2 or more risk factors), moderate risk (< 10% with 2 or more risk factors), and lower risk (< 10% with 0 - 1 risk factor). o Risk stratification is used for target LDL-C levels.
    • o LDL-lowering standard drugs include statins, ezetimibe, and bile-acid sequestrants. Other drugs that promote moderate reduction are nicotinic acid and fibrates, which are considered to be secondary drugs. o If the triglyceride level is higher than 500 mg per dL, then lowering the triglyceride level to 500 mg per dL or less takes primacy over LDL-C lowering. o After LDL-C and non HDL-C goals are achieved, a tertiary target is raising HDL-C level. No specific goals for raising HDL-C levels are specified. o BP management follows the Joint National Committee 7 guidelines. Individuals with prehypertension should use lifestyle modification, whereas those with higher BPs should use drug therapy. In the presence of renal disease or type 2 DM, the goal of BP reduction should be less than 130/80 mm Hg. o Subjects with IFG should practice lifestyle change, especially weight reduction and increased physical activity. Drug therapies are not recommended. o In patients with ASCVD in whom aspirin is contraindicated, clopidogrel should be considered. Pearls for Practice • The AHA and NHLBI recommends modifications to the NCEP-ATP III criteria as follows: (1) adjustment of waist circumference to lower thresholds when individuals or ethnic groups are prone to insulin resistance, (2) allowing triglyceride and HDL-C levels and BP to be counted as abnormal when a person is prescribed drug treatment for these conditions, (3) clarifying that elevated BP is defined as an elevation of either systolic or diastolic BP, and (4) reducing the threshold for elevated glucose level from 110 mg per dL or higher to 100 mg per dL or higher in accordance with the ADA revised definition of IFG. • The NCEP-ATP III and IDF have similar management guidelines for the metabolic syndrome but differ in that the IDF requires increased waist circumference to be a criterion for diagnosis and adjusts the definition of increased waist circumference to ethnicity. About News CME News CME is designed to keep physicians and other healthcare professionals abreast of current research and related clinical developments that are likely to affect practice, as reported by the Medscape Medical News group. Send comments or questions about this program to mailto:%20cmenews@medscape.net. Medscape Medical News 2005. © 2005 Medscape Legal Disclaimer The material presented here does not necessarily reflect the views of Medscape or companies that support educational programming on www.medscape.com. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.
    • Diabetes epidemic expands: Blame "metabolic syndrome"? Seems like the diabetes epidemic just won't quit. Type 2 diabetes affects almost 10 percent of American adults, and 1.5 million people get the diagnosis every year. Globally, 200 million are expected to have this grave condition by 2010... National Cancer Institute Diabetes is a blood-sugar disorder related to the hormone insulin, which cells need to remove sugar from the blood. A high level of blood sugar damages small blood vessels, like those in the heart, kidney and eye. The two forms of diabetes kill about 250,000 Americans per year, and cost more than $130 billion. Diabetes is the major cause of kidney failure, limb amputation, and vision loss in American adults. Diabetes at least doubles the risk of heart disease. DIABETES TYPE 1 AND 2 Type 1: Causes: autoimmune, genetic, and environmental factors. Insulin required daily. Includes 5 to 10 percent of diagnosed diabetics in United States. Symptoms: increased thirst, urination and hunger, weight loss, blurred vision, extreme fatigue. Type 2: Risk factors: age, obesity, family history, physical inactivity, and certain ethnicities. About 80 percent are overweight or obese. Symptoms: fatigue, frequent urination, increased thirst and hunger, weight loss, blurred vision, and slow healing of wounds. Some people have no symptoms.
    • The explosion of diabetes mostly concerns type 2 (which used to be called "adult- onset diabetes," but now also strikes some kids). Unlike type 1, type 2 does not appear suddenly, but now seems to be the end of a process that begins with a condition called "metabolic syndrome." In other words, type 2 diabetes is the culmination of a group of common conditions, including high blood pressure, abdominal obesity and abnormal blood levels of several fats. As the body stops responding to insulin, beta cells in the pancreas are forced to crank out more of the hormone. Type 2 does not appear until they wear out, says Richard Bergman, professor of medicine, endocrinology, diabetes and metabolism at the University of Southern California. "Metabolic syndrome leads to the need for more insulin secretion, but if the beta cells do not fail, you do not have diabetes." U.S. INCIDENCE OF DIABETES (BOTH TYPES) From 1980 to 2005, diabetes diagnoses grew 124 percent, to 7.4 per 1000 people. The parallel increase in both lines shows that the rise is not due to an aging population. Notice the lines spiking in the 1990s? Graph: CDC Bergman adds that almost all of the genes known to affect type 2 diabetes "are related to beta cell function," and this helps explain the pattern of disease seen in the population: Some ethnic groups, particularly Asians, African Americans and American Indians, "are not as equipped to compensate for a degree of insulin
    • resistance, and as they become more obese, get more visceral fat, they become more at risk for type 2." Other factors implicated in metabolic syndrome and diabetes include growing obesity, a surge in high-fat fast-foods, a sedentary lifestyle, and perhaps the rising use of high-fructose corn syrup over the last 30 years or so. A simplified view of the role of metabolic syndrome in disease Cross my heart? Metabolic syndrome also plays a major role in cardiovascular disease, and is actually as harmful to the heart as smoking two packs of cigarettes a day, says Francisco Lopez-Jimenez, a cardiologist at the Mayo Clinic in Rochester, Minn. Even as doctors dispute the significance and exact definition of metabolic syndrome, Lopez- Jimenez finds it useful. "It's still controversial as a new diagnosis... because every single component has a name already: hypertension, obesity, abnormal cholesterol."
    • Skeptics raise an obvious question, he admits: "What is the value of creating a new diagnosis, when everybody already has a name for these things, and the treatment is still the same?" But by unifying measurements that may seem trivial in isolation, metabolic syndrome makes a difference to patients, Lopez-Jimenez says. "If the blood sugar is a bit high, the waist circumference slightly abnormal, it would very likely qualify for metabolic syndrome, but without that term, they would not leave the office with clear sense of the risk for diabetes or cardiovascular disease. If they see everything as only mildly abnormal, they would not have a strong enough motivation to change behavior." Diabetics have many of the common risk factors Graph: CDC As a preventive cardiologist, Lopez- Jimenez stresses that metabolic syndrome is a risk factor for heart attack and stroke, not just diabetes. "Every component of metabolic syndrome has been linked to cardiovascular disease. Although some people develop heart disease without diabetes, in many cases diabetes is the intermediate point between the metabolic syndrome and heart disease." The strong links among metabolic syndrome, cardiovascular disease and diabetes are not fully understood, says Lopez-Jimenez. "The approach has been that high blood sugar is the bad guy, but it's probably beyond that, because several studies have failed to show significant reductions in cardiovascular events just by controlling blood sugar. People with diabetes have a constellation of abnormalities. Patients with type 2 have very high insulin levels, and that in itself can affect the cardiovascular system, making the kidneys absorb more salt, making the blood pressure go up, and changing the metabolism of cholesterol." High insulin "by itself can be linked to several measures" of hardening of the arteries. (We promise to revisit this subject...) What is metabolic syndrome? Metabolic syndrome (AKA insulin resistance syndrome, X syndrome, diabesity), is linked to cardiovascular disease and type 2 diabetes. One common definition comes from the National Cholesterol Education Program, which includes: Abdominal obesity: waist circumference above 35 inches (female) or 40 inches (male); Low level of high-density lipoprotein (HDL, or "good cholesterol");
    • Elevated fasting glucose test; Insulin resistance (the body does not respond properly to the hormone); and High blood pressure (over 130/80). Metabolic syndrome may be grim, but it's not all gloom and doom, especially if you can control your weight and activity. So let's get moving: Want to reverse metabolic syndrome? There are 1 2 3 pages in this feature plus a bibliography and credits page Megan Anderson, project assistant; Terry Devitt, editor; S.V. Medaris, designer/illustrator; David Tenenbaum, feature writer; Amy Toburen, content development executive
    • ©2008, University of Wisconsin, Board of Regents
    • Metabolic syndrome is a collection of heart disease risk factors that increase your chance of developing heart disease, stroke and diabetes. The percentage of people with metabolic syndrome increases with age, affecting more than 40 percent over the age of 60. Populations particularly at risk include Mexican Americans (32 percent), African-American males (26 percent) and African-American females (57 percent). Metabolic syndrome is diagnosed when a person has at least three of the following heart disease risk factors (a person can develop any one of these fi ve risk factors by itself, but they tend to occur together): • A waistline of 40 inches or more for men and 35 inches or more for women • A blood pressure of 130/85 mm Hg or higher or are on blood pressure medications • A triglyceride level above 150 mg/dl • A fasting blood glucose (sugar) level greater than 100 mg/dl or are on glucose lowering medications • A “good cholesterol” (HDL) less than 40 mg/dl (men) or under 50 mg/dl (women) Another cause of metabolic syndrome may be related to “insulin resistance”. Consistently high levels of insulin and glucose are linked to many harmful changes in the body, including: • Damage to the lining of arteries, a key step toward the development of heart disease or stroke. • Changes in the kidneys’ ability to remove salt, leading to high blood pressure, heart disease and stroke. • An increase in triglyceride levels, resulting in an increased risk of developing cardiovascular disease. • An increased risk of blood clot formation, which can block arteries and cause heart attacks and strokes. • A slowing of insulin production, which can signal the start of type 2 diabetes. Since physical inactivity and excess weight are the main underlying contributors to the development of metabolic syndrome, getting more exercise and losing weight can help reduce or prevent the complications associated with this condition. Your doctor may also prescribe medications to manage some of your underlying problems. To reduce your risk: • Lose weight: Moderate weight loss, in the range of 5 percent to 10 percent of body weight, can help restore your body’s ability to recognize insulin and greatly reduce the chance that the syndrome will evolve into a .more serious illness
    • The Metabolic Syndrome S ince cardiovascular (heart and blood vessel) disease is the leading cause of death for adults in developed countries, many medical studies focus on treating or preventing heart disease and stroke. The metabolic syndrome, a collection of unhealthy body measurements and abnormal laboratory test results, may identify persons at high risk for developing cardiovascular disease. Aggressive lifestyle modification and possible use of medications to treat the conditions that make up the metabolic syndrome may reduce a person’s chances of developing heart disease or stroke. The metabolic syndrome has also been called syndrome X or insulin resistance syndrome. The February 15, 2006, issue of JAMA includes an article about the metabolic syndrome. DEFINITION OF THE METABOLIC SYNDROME FOR MORE INFORMATION • National Heart, Lung, and Blood Institute www.nhlbi.nih.gov • American Heart Association www.americanheart.org • American Diabetes Association www.diabetes.org INFORM YOURSELF To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s Web site at www.jama.com. Many are available in English and Spanish. A Patient Page on coronary artery disease was published in the November 24, 2004, issue; and one on weight gain and diabetes was published in the August 25, 2004,
    • issue. Janet M. Torpy, MD, Writer Cassio Lynm, MA, Illustrator Richard M. Glass, MD, Editor 850 JAMA, February 15, 2006—Vol 295, No. 7 Sources: National Heart, Lung, and Blood Institute; American Heart Association; National Cholesterol Education Program; American Diabetes Association The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 203/259-8724. • Abdominal (waist) circumference greater than 40 inches for men or 35 inches for women • High blood pressure (hypertension) • Hyperglycemia (fasting blood sugar more than 110 mg/dL) • Elevated triglycerides (a type of fat in the bloodstream) • Low levels of high-density lipoprotein, also known as HDL or “good cholesterol” Having at least 3 of the above measurements means that an individual has metabolic syndrome and is at risk for developing type 2 diabetes, coronary heart disease, heart attack, or stroke. TREATING THE METABOLIC SYNDROME Lifestyle modifications include weight loss, regular exercise, stopping smoking, and reducing dietary fat intake. Losing just 10% of excess body weight lowers blood pressure and improves insulin resistance. Some persons may be able to treat high blood pressure and hyperglycemia by altering their lifestyle alone. In many individuals, lifestyle modification is not adequate, and medications must be used to decrease blood pressure, lower triglycerides, and increase the level of HDL. Because these problems are often linked, treating one aspect of the metabolic syndrome may help the other issues. For example, regular exercise can help you lose weight, reduce blood pressure, and manage hyperglycemia and insulin resistance. Combining healthful eating with a regular exercise program is the cornerstone of treating the metabolic syndrome and reducing risk for heart disease, stroke, diabetes, and other medical problems. PREVENTION • Exercise regularly throughout your life. • Encourage children to have daily physical activity and make healthful food choices. • Eat a healthful, balanced diet low in saturated fats and high in nutrient-rich fruits and vegetables. • Do not smoke. • Recognize that you may have a genetic (inherited) predisposition for diabetes, heart disease, and the metabolic syndrome. • Have regular medical check-ups and initiate early treatment for high blood pressure. Downloaded from www.jama.com by guest on October 28, 2008