1. PBRC 2009 Metabolic Syndrome Pennington Biomedical Research Center Division of Education

2. PBRC 2009 Metabolic Syndrome: Overview Metabolic Syndrome is not a disease, but rather a cluster of disorders of your body’s metabolism, including: o High blood pressure o High insulin levels o Excess body weight o Abnormal cholesterol levels Each of these disorders is by itself a risk factor for other diseases. In combination, however, these disorders dramatically boost the chances of developing potentially life-threatening illnesses, such as diabetes, heart disease or stroke.

3. PBRC 2009 The more components of the syndrome that you have, the greater the risks to your health. Signs and Symptoms

4. PBRC 2009 Metabolic Syndrome The syndrome is closely related to a generalized metabolic disorder called insulin resistance, in which the body can’t use insulin efficiently. Metabolic syndrome has been called many names, including: o Syndrome X o The deadly quartet o Insulin Resistance Syndrome

5. PBRC 2009 Prevalence Affects as many as one in four American adults (25%) For adults over the age of 40, more than 40% are affected. Metabolic syndrome prevalence has increased by 61% over the past decade. Rates differ among races and genders. National Health and Nutrition Examination Survey III, 1988-1994.

6. PBRC 2009 Risk Factors The following factors increase your risk of developing Metabolic Syndrome: Age The prevalence of metabolic syndrome increases with age, affecting less than 10% of people in their 20s and 40% of people in their 60s. Race Metabolic syndrome is generally more common among blacks and Mexican-Americans than among Caucasians. Obesity A body mass index (BMI) greater than 25 increases your risk of metabolic syndrome and abdominal obesity increase the risk of MS. Abdominal obesity refers to having an apple shape rather than a pear. History of diabetes Having a family history of type 2 diabetes or diabetes during pregnancy (gestational diabetes) increases the risk for developing metabolic syndrome. Other diseases A diagnosis of hypertension, cardiovascular disease (CVD) or polycystic ovary syndrome (a hormonal disorder in which a woman’s body produces an excess of male hormones) also increases the risk for metabolic syndrome. Apple Pear

7. PBRC 2009 When is it time to seek medical advice? The presence of one feature of metabolic syndrome, such as high blood pressure, high cholesterol or an apple-shaped body, increases the risk. An individual may already have the condition and not know it. It is important to talk with your doctor about testing for other components of the syndrome and developing a plan to avoid serious diseases.

8. PBRC 2009 Prevention Commit to a healthy diet o A healthy diet includes plenty of fruits and vegetables, choosing lean cuts of white meat and fish over red meat, avoiding processed or deep-fried dinners, and eliminating table salt by experimenting with other herbs and spices. Get moving o It is important to stay active. Get at least 30 minutes of moderately strenuous activity on most days of the week is recommended. Schedule regular check-ups o This includes assessing blood pressure, cholesterol and blood sugar levels annually. Early detection of problems can help with formulating lifestyle modifications. Healthy lifestyle changes can prevent the onset of the syndrome.

9. PBRC 2009 Diagnosing Metabolic Syndrome Waist Circumference o Greater than 35 inches in women and 40 inches in men (abdominal obesity) Triglyceride o Levels of 150 milligrams per deciliter (mg/dl) or higher Blood Pressure o 130/85 millimeters of mercury or higher Fasting blood glucose o Level of 110 mg/dl or higher High-density lipoprotein cholesterol (HDL) o Lower than 50 mg/dl in women and 40 mg/dl for men According to the National Cholesterol Education Program (NCEP), the presence of three or more of the following traits indicates metabolic syndrome:

10. PBRC 2009 Treatment The underlying insulin resistant state is the primary target of therapy. The primary goal of treatment is to prevent: o Type 2 diabetes o Heart attack o Stroke

11. PBRC 2009 Treatment To reduce insulin resistance in overweight and obese individuals, the preferred method is an aggressive regimen of self-care strategies focusing on diet and exercise. It is common for your doctor to routinely monitor the following to ensure that lifestyle modifications are working: o Weight o Blood glucose o Cholesterol o Blood pressure

12. PBRC 2009 Self-care Lose weight o Losing as little as 5 to 10% of your body weight can reduce insulin levels and high blood pressure, thus reducing your risk of diabetes. Exercise o Walking just 30 minutes a day or engaging in other aerobic activities can help prevent the serious diseases associated with MS. Stop smoking o Smoking cigarettes increases insulin resistance and worsens health consequences associated with MS. Eat fiber-rich foods o Whole grains, beans, fruits and vegetables are high in dietary fiber. These are important foods to eat since dietary fiber is known to lower insulin levels. Although metabolic syndrome creates a real risk for developing diabetes, stroke or heart disease, these conditions can be prevented. Insulin resistance can be controlled by the following :

13. PBRC 2009 Weight loss drugs Along with diet and exercise, it may be necessary to prescribe weight loss drugs. Two commonly prescribed weight-loss drugs include sibutramine (Meridia) and orlistat (Xenical). Insulin sensitizers In individuals with diabetes, doctors often prescribe thiazolidinediones and metformin (Glucophage, Glucophage XR) to decrease insulin resistance. These medications may also be useful in improving insulin metabolism in individuals with MS. Treatment Medications to control the syndrome’s individual risk factors include:

14. PBRC 2009 Treatment Aspirin Aspirin is often prescribed to help reduce the risk for a heart attack. Medications to lower blood pressure Major types of medications used to control high blood pressure include diuretics, angiotensin-converting enzymes (ACE) inhibitors, calcium channel blockers and beta blockers. Medications to regulate cholesterol Medications such as niacin, statins and fibrates can help improve cholesterol in the following ways: By reducing the level of low-density lipoprotein (LDL) cholesterol (“bad” cholesterol) By increasing the level of high-density (HDL) cholesterol (“good” cholesterol) By decreasing the level of triglycerides (Another “bad” component of cholesterol) Medications to control the syndrome’s individual risk factors include:

15. PBRC 2009 Division of Education Phillip Brantley, PhD, Director Pennington Biomedical Research Center Claude Bouchard, PhD, Executive Director Heli J. Roy, PhD, RD Shanna Lundy, BS Beth Kalicki Edited: October 2009

16. About Our Company The Pennington Biomedical Research Center is a world-renowned nutrition research center. Mission: To promote healthier lives through research and education in nutrition and preventive medicine. The Pennington Center has several research areas, including: Clinical Obesity Research Experimental Obesity Functional Foods Health and Performance Enhancement Nutrition and Chronic Diseases Nutrition and the Brain Dementia, Alzheimer’s and healthy aging Diet, exercise, weight loss and weight loss maintenance The research fostered in these areas can have a profound impact on healthy living and on the prevention of common chronic diseases, such as heart disease, cancer, diabetes, hypertension and osteoporosis. The Division of Education provides education and information to the scientific community and the public about research findings, training programs and research areas, and coordinates educational events for the public on various health issues. We invite people of all ages and backgrounds to participate in the exciting research studies being conducted at the Pennington Center in Baton Rouge, Louisiana. If you would like to take part, visit the clinical trials web page at www.pbrc.edu or call (225) 763-3000. PBRC 2009

17. Sites Smith S. Metabolic syndrome targets. Current Drug Targets. 2004;3: 431-439. Mayo Clinic: Metabolic syndrome. Available at: http://www.mayoclinic.com. Accessed September 20, 2005.http://www.mayoclinic.com The American Heart Association: Metabolic Syndrome. Available at: http://www.americanheart.org. Accessed September 20, 2005. http://www.americanheart.org