Metabolic Syndrome : Lifestyle Changes

Metabolic syndrome is a cluster of interconnected disorders that increase the risk of developing various chronic diseases in the long term. The prevalence of metabolic syndrome is significant, affecting approximately one in four adults in the United States (1) and one in five adults in Canada (2). This syndrome is identified when an individual exhibits the following conditions: elevated abdominal adiposity (measured by waist circumference), elevated fasting blood glucose, and dyslipidemia, including low HDL cholesterol levels, elevated triglycerides, and hypertension (2). Historically, visceral obesity was a mandatory criterion, but current definitions require at least three of these five conditions to diagnose the syndrome (3, 4).

Pathophysiology and complications

The primary cause of metabolic syndrome is insulin resistance, where muscles, adipose tissue, and the liver respond less effectively to this hormone that is essential for regulating blood glucose levels. Excess abdominal fat is a major risk factor, increasing free fatty acids in the blood that disrupt lipid balance and glucose uptake by the muscles, leading to increased production of glucose and lipids by the liver and promoting both hyperglycemia and dyslipidemia. Insulin resistance also stimulates the secretion of pro-inflammatory cytokines, causing systemic inflammation (5). Together, these metabolic alterations increase the risks of cardiovascular diseases, type 2 diabetes, certain cancers, neurodegenerative diseases, non-alcoholic fatty liver disease, and all-cause mortality (6).

Lifestyle habits

Physical activity and nutritional therapies

According to the latest recommendations for the prevention and management of metabolic syndrome, several lifestyle factors are key, notably physical activity, weight loss, and diet (7). It is recommended to engage in 30 to 60 minutes per day of physical activity, including a mix of aerobic exercise and muscle-strengthening activities, which can be accumulated in 10-minute intervals (7). Weight loss is another key measure, with an initial goal of reducing body weight by at least 5 to 7% in overweight or obese individuals by combining calorie restriction and exercise (7).

Regarding dietary patterns, the Mediterranean diet is highly recommended for all individuals with metabolic syndrome (7). A 2020 systematic review and meta-analysis of 84 studies found that a Mediterranean diet, with or without weight loss, compared to a control group, had a beneficial impact on waist circumference, body weight, BMI, systolic and diastolic blood pressure, blood glucose, triglycerides, HDL cholesterol, and LDL cholesterol, potentially reducing the long-term risks of developing diabetes and cardiovascular disease (8). Additionally, a meta-analysis of 17 clinical studies comparing low-carbohydrate diets (<40% of energy from carbohydrates) and low-fat diets (<30% of energy from fats) with calorie restriction over 6 months highlighted additional benefits for triglycerides and HDL cholesterol associated with carbohydrate reduction (9). Specific foods such as regular consumption of olive oil, legumes, nuts, whole grains, and fish rich in omega-3 fatty acids, as well as reducing sugary drinks and ultra-processed foods high in fructose, contribute to the health benefits for metabolic health (7). As for dairy products or eggs, there is no evidence supporting the need to limit their consumption (7).

A Canadian pilot study (the CHANGE program) evaluated several of these exercise and nutrition principles in an intervention that included weekly multidisciplinary follow-up (family doctor, nutritionist, and kinesiologist) for the first three months, followed by monthly sessions for the next nine months. The results showed that 19% of participants reversed at least one criterion of metabolic syndrome, while 42% improved their dietary habits and exercise levels, thereby reducing their ten-year risk of heart attack (10). This study demonstrates the importance of multidisciplinary follow-up to significantly improve the health of patient-clients with metabolic syndrome.

Eating patterns

The timing of meals and the frequency of food intake can also play a role in managing metabolic syndrome. Observational data suggest that eating in the morning seems to have a protective effect against metabolic syndrome, while eating late at night is associated with an increased prevalence of this syndrome (11, 12). Furthermore, observational data have shown a significant inverse correlation between meal regularity and insulin resistance, as well as an increase in the number of components of metabolic syndrome (13). On the other hand, a well-planned intermittent fasting approach with regular meals, where the eating window is limited to 8 to 10 hours per day compared to 14 hours, has shown positive effects on metabolic health (14, 15). A nutritionist can provide guidance and help determine the best meal timing for the patient-client based on their situation and preferences.

The microbiome

An emerging body of research highlights the importance of the microbiota in managing inflammatory markers in individuals with metabolic syndrome. For example, short-chain fatty acids like butyrate, produced by the fermentation of dietary fibres by the gut microbiota, may help improve certain clinical features of the syndrome as well as inflammatory biomarkers. Animal studies suggest that these fatty acids could promote a better lipid profile, improved blood glucose levels, reduced body weight, and a better insulin response in models of metabolic syndrome (16). In human participants, a randomized controlled crossover study found that probiotics (a strain of Lactobacillus) had promising effects in modulating the microbiota and inflammatory biomarkers when combined with a hypocaloric diet and physical activity (17). However, clinical trial results remain mixed and further research is needed to confirm the benefits of microbiota changes related to the management of metabolic syndrome.

Metabolic syndrome is a condition that requires a multidisciplinary approach for effective management. At TeamNutrition, we are committed to providing personalized expertise and support to our patient-clients, helping them effectively manage metabolic health in the long term. To learn more about managing metabolic syndrome and to consult with one of our specialist nutritionists, please visit our website or contact us directly.

References

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3. Alberti, K. G., Eckel, R. H., Grundy, S. M., Zimmet, P. Z., Cleeman, J. I., Donato, K. A., ... & Smith Jr, S. C. (2009). Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; national heart, lung, and blood institute; American heart association; world heart federation; international atherosclerosis society; and international association for the study of obesity. Circulation, 120(16), 1640-1645.
4. Alberti, K. G. (2005). IDF Epidemiology Task Force Consensus Group: The metabolic syndrome: a new worldwide definition. Lancet, 366, 1059-1062.
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6. Cleveland Clinic. (2023). Metabolic Syndrome. Retrieved from https://my.clevelandclinic.org/health/diseases/10783-metabolic-syndrome
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9. Willems, A. E. M., Sura-de Jong, M., van Beek, A. P., Nederhof, E., & van Dijk, G. (2021). Effects of macronutrient intake in obesity: a meta-analysis of low-carbohydrate and low-fat diets on markers of the metabolic syndrome. Nutrition reviews, 79(4), 429–444.
10. Jeejeebhoy, K., Dhaliwal, R., Heyland, D. K., Leung, R., Day, A. G., Brauer, P., ... & Klein, D. (2017). Family physician-led, team-based, lifestyle intervention in patients with metabolic syndrome: results of a multicentre feasibility project. Canadian Medical Association Open Access Journal, 5(1), E229-E236.
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13. Sierra‐Johnson, J., Undén, A. L., Linestrand, M., Rosell, M., Sjogren, P., Kolak, M., ... & Hellénius, M. L. (2008). Eating meals irregularly: a novel environmental risk factor for the metabolic syndrome. Obesity, 16(6), 1302-1307.
14. Wilkinson, M. J., Manoogian, E. N., Zadourian, A., Lo, H., Fakhouri, S., Shoghi, A., ... & Taub, P. R. (2020). Ten-hour time-restricted eating reduces weight, blood pressure, and atherogenic lipids in patients with metabolic syndrome. Cell metabolism, 31(1), 92-104.
15. He, M., Wang, J., Liang, Q., Li, M., Guo, H., Wang, Y., Deji, C., Sui, J., Wang, Y. W., Liu, Y., Zheng, Y., Qian, B., Chen, H., Ma, M., Su, S., Geng, H., Zhou, W. X., Guo, X., Zhu, W. Z., Zhang, M., … Shi, B. (2022). Time-restricted eating with or without low-carbohydrate diet reduces visceral fat and improves metabolic syndrome: A randomized trial. Cell reports. Medicine, 3(10), 100777
16. Gao, Z., Yin, J., Zhang, J., Ward, R. E., Martin, R. J., Lefevre, M., ... & Ye, J. (2009). Butyrate improves insulin sensitivity and increases energy expenditure in mice. Diabetes, 58(7), 1509-1517.
17. Tenorio-Jiménez, C., Martínez-Ramírez, M. J., Del Castillo-Codes, I., Arraiza-Irigoyen, C., Tercero-Lozano, M., Camacho, J., ... & Gómez-Llorente, C. (2019). Lactobacillus reuteri V3401 reduces inflammatory biomarkers and modifies the gastrointestinal microbiome in adults with metabolic syndrome: the PROSIR study. Nutrients, 11(8), 1761.