Effects of lifestyle modification on metabolic syndrome: a systematic review and meta-analysis

BMC Medicine

Toshiro Tango¹  Kazue Yamaoka² 

[1]Center for Medical Statistics, 2-9-6 Higashi Shimbashi, Minato-ku, Tokyo, 105-0021, Japan

[2]Teikyo University, Graduate School of Public Health, Tokyo, Japan

关键词: lifestyle modification;    metabolic syndrome;    randomized controlled trial;    meta-analysis;    Systematic review;   

Others  :  857301
DOI  :  10.1186/1741-7015-10-138

 received in 2012-04-21, accepted in 2012-11-14,  发布年份 2012

【 摘 要 】

Background

To evaluate the effect of lifestyle modifications on metabolic syndrome (MetS) as assessed by its resolution and improved values for its components.

Methods

This was a systematic review and meta-analysis. Searches were performed of MEDLINE and the Cochrane Database from January 1966 to October 2011 to identify randomized controlled trials (RCTs) related to the study objective. The included studies were RCTs restricted to the English language, with a follow-up period of 6 months or more, which reported overall resolution of MetS or values of MetS components (fasting blood glucose, waist circumference, high-density lipoprotein (HDL), triglycerides, and systolic and diastolic blood pressure (SBP, DBP)). Two investigators independently assessed study eligibility. The effect sizes were the relative proportion of patients with resolved MetS and mean differences in MetS component values from baseline to 1-year follow-up in a lifestyle-modification intervention (LMI) group versus a control (conventional lifestyle education or no treatment) group. Meta-analyses were conducted using a random-effects model.

Results

Eleven interventions in eight RCTs were used for the meta-analyses. The relative proportion of patients with resolved MetS in the intervention group was approximately 2.0 (95% CI 1.5 to 2.7) times greater in the intervention group compared with the control group (7 interventions, n = 2.839). LMI (5 interventions, n = 748) significantly reduced mean values for SBP by -6.4 mmHg (95% CI -9.7 to -3.2), DBP by -3.3 mmHg (95% CI -5.2 to -1.4), triglycerides by -12.0 mg/dl (95% CI -22.2 to -1.7), waist circumference by -2.7 cm (95% CI -4.6 to -0.9), and fasting blood glucose by -11.5 mg/dl (95% CI -22.4 to -0.6) (5 interventions), but reductions were not significant for HDL (1.3 mg/dl; 95% CI -0.6 to 3.1).

Conclusions

The LMI was effective in resolving MetS and reducing the severity of related abnormalities (fasting blood glucose, waist circumference, SBP and DBP, and triglycerides) in subjects with MetS.

【 授权许可】

   
2012 Yamaoka and Tango; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]DeFronzo RA, Ferrannini E: Insulin resistance: a multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidaemia, and atherosclerotic cardiovascular disease. Diabetes Care 1991, 14:173-194.
• [2]Kaplan NM: The deadly quartet. Upper-body obesity, glucose intolerance, hyper- triglyceridemia and hypertension. Arch Intern Med 1989, 149:1514-1520.
• [3]Reaven GM: Role of insulin resistance in human disease. Diabetes 1988, 37:1595-1607.
• [4]Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, Salonen JT: The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002, 288:2709-2716.
• [5]Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) JAMA 2001, 285:2486-2497.
• [6]Balkau B, Charles MA, Drivsholm T, Borch-Johnsen K, Wareham N, Yudkin JS, Morris R, Zavaroni I, van Dam R, Feskins E, Gabriel R, Diet M, Nilsson P, Hedblad B: European Group for the Study of Insulin Resistance (EGIR). Frequency of the WHO metabolic syndrome in European cohorts, and an alternative definition of an insulin resistance syndrome. Diabetes Metabolism 2002, 20:364-376.
• [7]Alberti KG, Zimmet PZ: Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998, 15:539-553.
• [8]Grundy SM, Cleeman JI, Bairey Merz CN, Brewer HB Jr, Clark LT, Hunninghake DB, Pasternak RC, Smith SC Jr, Stone NJ: Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation 2004, 110:227-239.
• [9]Yamaoka K, Tango T: Efficacy of lifestyle education to prevent type 2 diabetes: a meta-analysis of randomized controlled trials. Diabetes Care 2005, 28:2780-2786.
• [10]Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savović J, Schulz KF, Weeks L, Sterne JAC, Cochrane Bias Methods Group, Cochrane Statistical Methods Group: The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011, 18:343.
• [11]Moher D, Liberati A, Tetzlaff J, Altman DG: Preferred Reporting Items for Systematic Reviews and Meta-Analyses the PRISMA statement. BMJ 2009, 339:332-336.
• [12]DerSimonian R, Laird N: Meta-analysis in clinical trials. Controlled Clinical Trials 1986, 7:177-188.
• [13]Warn DE, Thompson SG, Spiegelhalter DJ: Bayesian random effects meta-analysis of trials with binary outcomes: methods for the absolute risk difference and relative risk scales. Stat Med 2002, 21:1601-1623.
• [14]Spector P: An Introduction to S and S-Plus. Duxbury Press, Belmont, CA; 1994.
• [15]Lunn D, Spiegelhalter D, Thomas A, Best N: The BUGS project: evolution, critique and future directions. Stat Med 2009, 28:3049-3067.
• [16]Parikka PI, Laakso M, Eriksson JG, Lakka JG, Lindstrom J, Pletonen M, Aunola S, Kiukaanneimi SA, Uusitupa M, Tuomilehto J: Leisure-time physical activity and the metabolic syndrome in the Finnish Diabetes Prevention Study. Diabetes Care 2010, 33:1610-1617.
• [17]Salvado JS, Ballart JF, Ros E, Gonzalez MAM, Fito M, Estruch R, Corell D, Fiol M, Aros F, Flores G, Lapetra J, Raventos RL, Gutierrez VR, Bullo M, Basora J, Covas MI: Effect of a Mediterranean diet supplemented with nuts on metabolic syndrome status. One-year results of the PREDIMED randomized trial. Arch Intern Med 2008, (168):2449-2458.
• [18]Bo S, Ciccone G, Baldi C, Benini L, Dusio F, Forastiere G, Lucia G, Nuti C, Durazzo M, Cassader M, Gentile L, Pagano G: Effectiveness of a lifestyle intervention on metabolic syndrome. A randomized controlled trial. J Gen Intern Med 2007, 22:1695-1703.
• [19]Orchard TJ, Temprosa M, Goldberg R, Haffner S, Ratner R, Marcovina S, Fowler S, Diabetes Prevention Program Research Group: The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial. Ann Intern Med 2005, 19:611-619.
• [20]Azadbakht L, Mirmiran P, Esmaillzadeh A, Azizi T, Azizi F: Beneficial effects of a dietary approach to stop hypertension eating plan on features of the metabolic syndrome. Diabetes Care 2005, 28:2823-2831.
• [21]Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, D'Armiento M, D'Andrea F, Giugliano D: Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA 2004, 292:1440-1446.
• [22]Watkins LL, Sherwood A, Feinglos M, Hinderliter A, Babyak M, Gullette E, Waugh R, Blumenthal JA: Effects of exercise and weight loss on cardiac risk factors associated with syndrome X. Arch Intern Med 2003, 163:1889-1895.
• [23]Poppitt SD, Keogh GF, Prentice AM, Williams DE, Sonnemans HM, Valk EE, Robinson E, Wareham NJ: Long-term effects of ad libitum low-fat, high-carbohydrate diets on body weight and serum lipids in overweight subjects with metabolic syndrome. Am J Clin Nutr 2002, 75:11-20.
• [24]Carroll S, Dudfield M: What is the relationship between exercise and metabolic abnormalities? A review of the metabolic syndrome. Sports Medicine 2004, 34:371-418.
• [25]Kastrini CM, Milionis HJ, Esposito K, Giugliano D, Goudevenos JA, Panagiotakos DB: The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 532906 individuals. JACC 2007, 30:2937-2931.
• [26]Watanabe M, Yamaoka K, Yokotsuka M, Tango T: Randomized controlled trial of a new dietary education program to prevent type 2 diabetes in a high-risk group of Japanese male workers. Diabetes Care 2003, 26:3209-3214.
• [27]Schwellinus MP, Patel DN, Nossel CJ, Dreyer M, Whitesman S, Dermen EW: Healthy lifestyle interventions in general practice. Part 6: Lifestyle and metabolic syndrome. SA Fam Pract 2009, 51:177-181.