PEP532: Metabolic syndrome and weight loss - PowerPoint PPT Presentation

Title: PEP532: Metabolic syndrome and weight loss


1
PEP532 Metabolic syndrome and weight loss
2
Clustering of risk factors in CVD

• We have dealt with different factors associated
  with CVD individually
• However, it's been recognized that many risk
  factors occur together in people
• Obesity
• Type 2 diabetes
• Hyperlipidemia
• Hypertension
• The observation of the "clustering" pattern of
  these conditions was coined the "metabolic
  syndrome"

3
Metabolic syndrome

• There isn't agreement from different
  organizations on how to define it
• Commonly defined as having 3 or more of below

Fernandez, M.L. The Metabolic Syndrome. Nutrition
Reviews, Vol. 65, No. 6
4
Caution with metabolic syndrome

• In a joint statement between the American
  Diabetes Association and the European Association
  for the Study of Diabetes acknowledge that CVD
  risk factors "cluster", the use of the concept
  "metabolic syndrome" is problematic
• What cut-offs should be used for each factor?
• Is there a single cause of all these (say insulin
  resistance?), or do they happen by coincidence?
• For our purposes, we will use it, however

5
Metabolic syndrome and weight loss

• One common recommendation is weight loss, as a
  part of a lifestyle intervention. Why?

Fernandez, M.L. The Metabolic Syndrome. Nutrition
Reviews, Vol. 65, No. 6
6
Metabolic syndrome and weight loss

• Below are results from a 6-mo program in older
  adults receiving a diet and exercise treatment

significant difference between groups
Villareal, D.T. Effect of lifestyle intervention
on metabolic coronary heart disease risk factors
in obese older adults. Am J Clin Nutr
200684131723.
7
Metabolic syndrome and weight loss

• Were the previous results due to the diet and/or
  exercise or the weight loss?
• Below come from bariatric surgery

Sjöström, L. Lifestyle, Diabetes, and
Cardiovascular Risk Factors 10 Years after
Bariatric Surgery. N Engl J Med 20043512683-93
8
Weight loss benefits does exercise matter?

• In the previous examples, people who lost weight
  demonstrated significant benefits
• This begs the question does exercise matter?
• In two separate studies, groups of men and women
  were either asked to maintain weight (control
  group), lose weight by diet, or lose weight by
  exercise
• Unfortunately, these were the only studies that
  were close to answering the question
• Ross, R. Reduction in Obesity and Related
  Comorbid Conditions after Diet-Induced Weight
  Loss or Exercise-Induced Weight Loss in Men A
  Randomized, Controlled Trial. Ann Intern Med.
  200013392-103
• Ross, R. Exercise-Induced Reduction in Obesity
  and Insulin Resistance in Women a Randomized
  Controlled Trial. Obes Res. 200412789 798.

9
Weight loss benefits does exercise matter?

• Not many studies have investigated whether the
  type of weight loss matters in metabolic syndrome
• Based on the above results, it is possible that
  weight loss is the important variable
• Exercise generally results in greater loss of fat
  mass and less loss of muscle mass

10
What is the driving factor in reducing metabolic
syndrome?

• Weight loss, irrespective of source, has
  beneficial effects on metabolic syndrome
• But, it's not correct to say that surgery is
  "better" than lifestyle interventions

Guigliano. Are there specific treatments for the
metabolic syndrome? Am J Clin Nutr 2008878 11
11
A slight diversion

• This study compared weight loss via surgery and
  lifestyle (people registered with the National
  Weight Control Registry)
• Weight loss and maintenance was equal between
  groups

Bond, D.S. Weight-loss maintenance in successful
weight losers surgical vs non-surgical methods.
International Journal of Obesity (2009) 33,
173180
12
Overall

• Weight loss is an important factor in reducing
  the incidence and treating the diseases that
  occur in the metabolic syndrome
• Programs that implement lifestyle interventions
  (diet and exercise) typically demonstrate
  impressive results
• Lifestyle (diet and exercise) is generally
  considered "first line intervention"
• Adherence to lifestyle interventions continues to
  be a concern
• Is it possible that altering the built
  environment of a community could improve the
  adherence to lifestyle interventions?