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Online Library: Metabolic syndrome

Metabolic syndrome is a combination of medical disorders that, when occurring together, increase the risk of developing cardiovascular disease and diabetes. Metabolic syndrome is also known as metabolic syndrome X, cardiometabolic syndrome, syndrome X or insulin resistance syndrome.

The International Diabetes Federation consensus worldwide definition of the metabolic syndrome (2006):

Central obesity (defined as waist circumference# with ethnicity specific values) AND any two of the following:

  • Raised triglycerides: > 150 mg/dL (1.7 mmol/L), or specific treatment for this lipid abnormality.
  • Reduced HDL cholesterol: < 40 mg/dL (1.03 mmol/L) in males, < 50 mg/dL (1.29 mmol/L) in females, or specific treatment for this lipid abnormality
  • Raised blood pressure: systolic blood pressure > 130 or diastolic blood pressure >85 mm Hg, or treatment of previously diagnosed hypertension.
  • Raised fasting plasma glucose :(FPG)>100 mg/dL (5.6 mmol/L), or previously diagnosed type 2 diabetes. If FPG >5.6 mmol/L or 100 mg/dL, OGTT (oral glucose tolerance test) is strongly recommended but is not necessary to define presence of the Syndrome.

# If BMI is >30 kg/m², central obesity can be assumed and waist circumference does not need to be measured

Is vitamin D status a determining factor for metabolic syndrome? A case-control study

Source: Diabetes, metabolic syndrome and obesity: targets and therapy 2011; 4: 205-12.

Author: Salekzamani S, Neyestani TR, et al

Affiliation: Department of Nutrition Research, National Research Institute and Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract: This study was undertaken to assess vitamin D status in nonmenopausal women with metabolic syndrome (MeS) and to evaluate its possible role in inflammation and other components of MeS. A case-control study was conducted during late fall and winter 2009-10. A total of 375 women with waist circumference (WC) =88 cm were examined to find 100 who met MeS criteria. Of those without MeS, 100 age- and residence area-matched women were selected as a control group. Anthropometric and laboratory evaluations were performed. Waist-to-hip ratio (WHR), body mass index (BMI), homeostatic model of insulin resistance (HOMA-IR) and body fat mass (FM) were also evaluated. Women with MeS had significantly higher BMI, waist circumference (WC) and FM but lower serum osteocalcin than controls. There was no significant difference in serum 25 hydroxyvitamin D (25[OH]D), intact parathyroid hormone (iPTH) or vitamin D status between the two groups. Serum highly sensitive C-reactive protein (hsCRP) concentration was significantly higher in the MeS group, compared to the controls. The difference remained significant even after controlling for BMI, WC and FM. When comparison was made only in those subjects with insulin resistance (HOMA-IR > 2.4), hsCRP was still higher in the MeS group (n = 79) than in the control group (n = 61). When data were categorized according to vitamin D status, in the MeS group significantly higher plasma glucose concentrations were observed in subjects with vitamin D deficiency compared to those with insufficiency or sufficiency. Interestingly, their WC or WHR did not show any significant difference. In stepwise regression analysis, 25(OH)D was the main predictor of both hsCRP and plasma glucose. Vitamin D status may, at least in part, be a determining factor of systemic inflammation and the related metabolic derangements of MeS.

The role of Mediterranean diet in the epidemiology of metabolic syndrome; converting epidemiology to clinical practice

Source: Lipids in health and disease 2005; 4: 7

Author: Panagiotakos DB and Polychronopoulos E

Affiliation: Department of Nutrition and Dietetics, Harokopio University, Athens, Greece

Abstract: The metabolic syndrome is a collection of associated conditions such as dyslipidemia, high blood pressure, impaired glucose tolerance, and abdominal fat. It has first been described in 1988, and it is now widely adopted that it is a health situation that promotes atherosclerosis. Each of the associated conditions has an independent effect, but clustering together they become synergistic, making the risk of developing atherosclerosis greater. Moreover, many investigators have shown a direct association between the prevalence of the syndrome with increased risk of cardiovascular disease and diabetes. Because each independent factor of the metabolic syndrome can increase the patient's cardiovascular risk, an integrated, comprehensive approach is indicated for patients with the syndrome. Treatment of metabolic syndrome is primarily based on Therapeutic Lifestyle Change, implementing weight-loss diets and exercise programs to increase physical activity. In this review the authors focus their interest of the effect of diet and exercise on the prevalence of the metabolic syndrome. They particularly study the effect of a traditional diet, the Mediterranean diet, on the components of the syndrome, in relation to exercise. A potential explanation of the beneficial effect of the Mediterranean diet on human health is because it is low in saturated fat, high in monounsaturated fat, mainly from olive oil, high in complex carbohydrates, from legumes, and high in fibre, mostly from vegetables and fruits. The high content of vegetables, fresh fruits, cereals and olive oil, guarantee a high intake of b-carotene, vitamins C and E, polyphenols and various important minerals. These key elements have been suggested to be responsible for the beneficial effect of diet on human health, and especially cardiovascular disease. Conclusion: Dietary approaches to treating and preventing metabolic syndrome vary, but nearly all experts agree that clinical parameters are greatly improved through various dietary changes and body weight control. Whether adoption of Mediterranean diet is a recipe for the metabolic syndrome seems to have a scientific basis; however, it needs further investigation by randomised clinical trials. Nevertheless, health care professionals need to help people understand the benefits from the introduced dietary patterns and support them to adopt these lifestyle characteristics.

Mediterranean diet rich in olive oil and obesity, metabolic syndrome and diabetes mellitus.

Source: Current pharmaceutical design 2011; 17(8) :769-77

Author: Pérez-Martínez P, García-Ríos A, Delgado-Lista J, et al.

Affiliation: Lipid and Atherosclerosis Unit, IMIBIC/Reina Sofia University Hospital/University of Cordoba, CIBER Fisiopatologia Obesidad y Nutricion, Instituto de Salud Carlos III, Spain.

Abstract: After decades of epidemiological, clinical and experimental research, it has become clear that consumption of Mediterranean dietary patterns rich in olive oil has a profound influence on health outcomes, including obesity, metabolic syndrome (MetS) and diabetes mellitus. Traditionally, many beneficial properties associated with this oil have been ascribed to its high oleic acid content. Olive oil, however, is a functional food that, besides having high-monounsaturated (MUFA) content, contains other minor components with biological properties. In this line, phenolic compounds have shown antioxidant and anti-inflammatory properties, prevent lipoperoxidation, induce favorable changes of lipid profile, improve endothelial function, and disclose antithrombotic properties. Research into the pharmacological properties of the minor components of olive oil is very active and could lead to the formulation of functional food and nutraceuticals. Although more data are mandatory the Mediterranean diet rich in olive oil does not contribute to obesity and appears to be a useful tool in the lifestyle management of the MetS. Moreover there is good scientific support for MUFA diets, especially those based on olive oil, as an alternative approach to low-fat diets for the medical nutritional therapy in diabetes. The objective of this review is to present evidence illustrating the relationship between Mediterranean diet, olive oil and metabolic diseases, including obesity, MetS and diabetes mellitus and to discuss potential mechanisms by which this food can help in disease prevention and treatment.

The effect of multivitamin supplementation on mood and stress in healthy older men

Source: Human Psychopharmacology: Clinical and Experimental 2011; 26(8):560–567

Author: Harris E, Kirk J, Rowsell R, et al.

Affiliation: Centre for Human Psychopharmacology, National Institute of Complementary Medicine (NICM) Collaborative Centre for Neurocognition, Swinburne University, Melbourne, Australia.

Abstract: There is a demonstrated association between poor mood and deficiency in several micronutrients. Multivitamin supplements contain a wide range of nutrients, suggesting that they may be effective in improving mood; however, few studies have investigated this potential in randomized, controlled trials. This study investigates the effects of a multivitamin, mineral, and herbal supplement on mood and stress in a group of healthy, older male volunteers. In this randomized, double-blind, placebo-controlled trial, fifty men, aged 50–69?years, supplemented for a period of 8?weeks with a multivitamin formulation that contained vitamins (at levels above recommended daily intakes), minerals, antioxidants, and herbal extracts, or a placebo. They completed a series of mood and stress questionnaires at baseline and post-supplementation. Compared with placebo, there was a significant reduction in the overall score on a depression anxiety and stress scale and an improvement in alertness and general daily functioning in the multivitamin group. Conclusion: Supplementation with a multivitamin, mineral and herbal formulation may be useful in improving alertness and reducing negative mood symptoms and may also improve feelings of general day-to-day well-being.

Effects of fish oil supplementation on markers of the metabolic syndrome.

Source: The journal of pediatrics 2010;157(3):395-400, 400.e1.

Author: Pedersen MH, Mølgaard C, Hellgren LI, Lauritzen L.

Affiliation: Department of Human Nutrition, Copenhagen University, Denmark.

Abstract: This study was conducted to investigate whether fish oil affects cardiovascular risk factors during the adolescent growth spurt. A total of 78 boys age 13-15 years with a mean body fat percentage of 30%+/-9% were randomly assigned to consume fish oil (providing 1.5 g of n-3 long-chain polyunsaturated fatty acid/day) or vegetable oil (control) for 16 weeks. The oils were included in bread. After the intervention, the red blood cell (RBC) content of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were 1.2%+/-0.5% and 6.7%+/-1.6%, respectively, in the those receiving fish oil (FO group), compared with 0.6%+/-0.3% and 4.1%+/-0.9% in the control group. Systolic blood pressure (SBP) was 3.8+/-1.4 mm Hg lower (P<.006) and diastolic blood pressure (DBP) was 2.6+/-1.1 mm Hg lower (P<.01) in the FO group compared with the control group. Plasma triacylglycerol (TAG) concentration and insulin sensitivity were unaffected by either of the treatments. Plasma high-density lipoprotein (HDL) and non-HDL cholesterol were increased by 5% and 7%, respectively, in the FO group, and by 2% and 0% in the control group (P<.01-.02). The changes in RBC EPA content were inversely correlated with the changes in SBP and DBP and directly correlated with the increases in HDL cholesterol and non-HDL cholesterol concentrations. No association was seen between RBC EPA and plasma TAG concentration or insulin sensitivity. Conclusion: Fish oil improves BP in normotensive and normolipidemic slightly overweight adolescent boys.

Effects of myo-inositol supplementation in postmenopausal women with metabolic syndrome: a perspective, randomized, placebo-controlled study

Source: Menopause. 2011 Jan;18(1):102-4.

Author: Giordano D, Corrado F, Santamaria A, Quattrone S, Pintaudi B, Di Benedetto A, D'Anna R

Affiliation: Policlinico Hospital, Reggio di Calabria, Italy.

Abstract: The aim of this study was to evaluate whether myo-inositol, an insulin-sensitizing substance, may improve some features of metabolic syndrome in postmenopausal women. 80 postmenopausal women affected by the metabolic syndrome were enrolled prospectively in the study and treated with diet plus supplementation of myo-inositol (2 g BID* plus diet: intervention group) or with diet plus placebo (control group) for 6 months. They were evaluated at baseline and after 6 months for insulin resistance (homeostasis model assessment ratio [HOMA] insulin resistance), lipid profile, and blood pressure. Myo-inositol plus diet improved systolic and diastolic blood pressure, HOMA index, cholesterol, and triglyceride serum levels with highly significant differences, compared with the groups treated only with diet and placebo. In the group treated with myo-inositol, a decrease in diastolic blood pressure (-11%), HOMA index (-75%), and serum triglycerides (-20%) and an improvement in high-density lipoprotein cholesterol (22%) were shown. Conclusion: Supplementation with myo-inositol may be considered a reliable option in the treatment of metabolic syndrome in postmenopausal women.

* b.i.d. (bis in die) means twice a day

Effects of a healthy Nordic diet on plasma 25-hydroxyvitamin D concentration in subjects with metabolic syndrome: a randomized, placebo-controlled trial (SYSDIET).


Author: Brader L, et al.

Affiliation: Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage-Hansens Gade 2, Århus C, Denmark

Abstract: At northern latitudes, vitamin D is not synthesized endogenously during winter, causing low plasma 25-hydroxyvitamin D (25(OH)D) concentrations. Therefore, we evaluated the effects of a healthy Nordic diet based on Nordic nutrition recommendations (NNR) on plasma 25(OH)D and explored its dietary predictors. In a Nordic multi-centre trial, subjects (n = 213) with metabolic syndrome were randomized to a control or a healthy Nordic diet favouring fish (¡Ý300 g/week, including ¡Ý200 g/week fatty fish), whole-grain products, berries, fruits, vegetables, rapeseed oil and low-fat dairy products. Plasma 25(OH)D and parathyroid hormone were analysed before and after 18- to 24-week intervention. At baseline, 45 % had vitamin D inadequacy (<50 nmol/l), whereas 8 % had deficiency (<25 nmol/l). Dietary vitamin D intake was increased by the healthy Nordic diet. The healthy Nordic and the control diet reduced the prevalence of vitamin D inadequacy by 42 % and 19 % respectively, without between-group difference. Compared with control, plasma 25(OH)D and parathyroid hormone were not altered by the healthy Nordic diet. Predictors for 25(OH)D were intake of vitamin D, eicosapentaenoic acids (EPA), docosahexaenoic acids (DHA), vitamin D supplement, plasma EPA and plasma DHA. Nevertheless, only vitamin D intake and season predicted the 25(OH)D changes. Consuming a healthy Nordic diet based on NNR increased vitamin D intake but not plasma 25(OH)D concentration. The reason why fish consumption did not improve vitamin D status might be that many fish are farmed and might contain little vitamin D or that frying fish may result in vitamin D extraction. Additional ways to improve vitamin D status in Nordic countries may be needed.

Vitamin D supplementation affects serum high-sensitivity C-reactive protein, insulin resistance, and biomarkers of oxidative stress in pregnant women.


Author: Asemi Z, Samimi M, Tabassi Z, Shakeri H, Esmaillzadeh A.

Affiliation: Research Center for Biochemistry and Nutrition in Metabolic Diseases, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran.

Abstract: Unfavorable metabolic profiles and oxidative stress in pregnancy are associated with several complications. This study was conducted to determine the effects of vitamin D supplementation on serum concentrations of high-sensitivity C-reactive protein (hs-CRP), metabolic profiles, and biomarkers of oxidative stress in healthy pregnant women. This randomized, double-blind, placebo-controlled clinical trial was conducted in 48 pregnant women aged 18-40 y old at 25 wk of gestation. Participants were randomly assigned to receive either 400 IU/d cholecalciferol supplements (n = 24) or placebo (n = 24) for 9 wk. Fasting blood samples were taken at study baseline and after 9 wk of intervention to quantify serum concentrations of hs-CRP, lipid concentrations, insulin, and biomarkers of oxidative stress. After 9 wk of intervention, the increases in serum 25-hydroxyvitamin D and calcium concentrations were greater in the vitamin D group than in the placebo group. Vitamin D supplementation resulted in a significant decrease in serum hs-CRP and insulin concentrations and a significant increase in the Quantitative Insulin Sensitivity Check Index score, plasma total antioxidant capacity, and total glutathione concentrations compared with placebo. Intake of vitamin D supplements led to a significant decrease in fasting plasma glucose, systolic blood pressure, and diastolic blood pressure compared with placebo. In conclusion, vitamin D supplementation for 9 wk among pregnant women has beneficial effects on metabolic status.

Pycnogenol® supplementation improves health risk factors in subjects with metabolic syndrome.


Author: Belcaro G, Cornelli U, Luzzi R, Cesarone MR, et al.

Affiliation: Irvine3 Labs, Department Biomedical Sciences, CH-PE University.

Abstract: This open, controlled study evaluated the effects of 6 month supplementation with Pycnogenol® maritime pine bark extract on health risk factors in subjects with metabolic syndrome. Pycnogenol® was used with the aim of improving risk factors associated with metabolic syndrome, central obesity, elevated triglycerides (TG), low HDL cholesterol, high blood pressure and fasting blood glucose. Sixty-four subjects (range 45-55 years) presenting with all five risk factors of metabolic syndrome were included, and Pycnogenol® was administered for 6 months. A group of 66 equivalent subjects were followed up as controls. In the 6-month study Pycnogenol® supplementation 150 mg/day decreased waist circumference, TG levels, blood pressure and increased the HDL cholesterol levels in subjects. Pycnogenol lowered fasting glucose from baseline 123 mg/dl to 106.4 after 3 months and to 105.3 at the end of the study. Men's waist circumference decreased with Pycnogenol from 106.2 cm to 98.8 cm and to 98.3 after 3 and 6 months. Women's waist decreased from 90.9 cm to 84.6 cm and to 83.6 cm after 3 and 6 months. Both genders waist circumference reduction was significant as compared to controls at both time points. In addition, plasma free radicals decrease in the Pycnogenol group was more effective than in the control group. In conclusion, this study indicates a role for Pycnogenol® for improving health risk factors in subjects with metabolic syndrome.

Effect of green tea (Camellia sinensis) consumption on the components of metabolic syndrome in elderly.


Author: Vieira Senger AE, Schwanke CH, Gomes I, Valle Gottlieb MG.

Affiliation: Biomedical Gerontology Graduate Program, Geriatrics and Gerontology Institute, Pontifical Catholic University of Rio Grande do Sul. Ipiranga Avenue, SaÞo lucas Hospital. Porto Alegre, RS-Brazil.

Abstract: The objective was to evaluate the effect of the consumption of green tea on components of metabolic syndrome (MS) in the elderly. The sample was selected from the Geriatric Service of Hospital São Lucas of Pontifical Catholic University of Rio Grande do Sul. 45 elderly with MS were enrolled and allocated into two groups: green tea group (GTG, n= 24), who drank green tea and control group (CG, n= 21) without intervention. The GTG received sachets of 1.0 g of green tea, and should drink three cups per day for 60 days and the CG was instructed not to make changes in their lifestyle. The diagnostic criteria for MS used were the International Diabetes Federation. The lipidic and glycemic profile, and anthropometric measurements were evaluated before and after intervention. There was a statistically significant weight loss only in GTG. A statistically significant decrease in BMI and waist circumference were observed. The intake of green tea did not change the biochemical parameters. Conclusion: The consumption of green tea was effective in inducing weight loss, reducing BMI and waist circumference in the elderly with metabolic syndrome.

Hypovitaminosis D and metabolic syndrome


Author: Miñambres I, et al.

Affiliation: Departament of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain

Abstract: Metabolic syndrome and hypovitaminosis D are 2 diseases with high prevalence that share several risk factors, while epidemiological evidence shows they are associated. Although the mechanisms involved in this association are not well established, hypovitaminosis D is associated with insulin resistance, decreased insulin secretion and activation of the renin-angiotensin system, mechanisms involved in the pathophysiology of metabolic syndrome. However, the apparent ineffectiveness of vitamin D supplementation on metabolic syndrome components, as well as the limited information about the effect of improving metabolic syndrome components on vitamin D concentrations, does not clarify the direction and the mechanisms involved in the causal relationship between these 2 pathologies. Overall, because of the high prevalence and the epidemiological association between both diseases, hypovitaminosis D could be considered a component of the metabolic syndrome.

Efficacy of food supplement to improve metabolic syndrome parameters in patients affected by moderate to severe psoriasis during anti-TNFá treatment.


Author: Skroza N, et al.

Affiliation: Department of Dermatology "Daniele Innocenzi" Sapienza University of Rome, Polo Pontino, Rome, Italy

Abstract: Psoriasis is a systemic inflammatory immune-mediated skin disease. Recently a relationship with metabolic syndrome in terms of psoriasis severity and response to therapy was observed. The researchers performed an open-label randomized controlled study to evaluate the role of a nutraceutical containing Q10 coenzyme, Krill-oil, lipoic acid, resveratrol, Vitis vinifera seed oil, vitamin E and selenium in addition to Etanercept* therapy for patients affected by psoriasis and metabolic syndrome. Forty patients were enrolled and divided into two arms, one receiving only Etanercept, one other receiving also the neutraceutical. After a period of 3 months (T1) a second evaluation of the considered parameters was performed. At T1 statistically significant differences were detected in HDL cholesterol and triglycerides values both comparing the two arms and in the nutraceutical arm. These results show that the dietary addiction of the nutraceutical to the Etanercept therapy in patients affected by both psoriasis and metabolic syndrome could help to restore the normal lipid profile.