Commentary on the clinical management of metabolic syndrome: why a healthy lifestyle is important

BMC Medicine

Michel de Lorgeril¹ 

[1]Laboratoire Cœur et Nutrition, TIMC-IMAG CNRS 5525, Université Joseph Fourier, Faculté de Médecine, 38054 La Tronche, Grenoble, France

关键词: high-density lipoprotein;    hypertension;    diabetes;    insulin resistance;    overweight;    obesity;    triglycerides;    lifestyle;    meta-analysis;    metabolic syndrome;   

Others  :  857299
DOI  :  10.1186/1741-7015-10-139

 received in 2012-10-25, accepted in 2012-11-14,  发布年份 2012

【 摘 要 】

Metabolic syndrome (MS) is associated with an increased risk of type 2 diabetes mellitus and cardiovascular diseases. There is no recognized method to manage MS. Many physicians treat the individual characteristics of MS (high blood pressure, high triglycerides, and so on) instead of the syndrome as a whole, placing particular emphasis on those components that are easily amenable to drug treatment. However, regular physical exercise and a healthy diet have been demonstrated to improve the health of a number of populations, but few studies have assessed their effects in patients with MS. A meta-analysis by Yamaoka and Tango in BMC Medicine found that a lifestyle change program (dietary counseling and encouragement to exercise) resulted in improvements in components of MS and in reducing the proportion of patients with MS. The effects may not be impressive in absolute terms, but the data should be interpreted with the heterogeneity of the included studies in mind. Because of the many adverse side effects of the drugs used to correct individual aspects of MS, this meta-analysis provides strong evidence that lifestyle changes must be the first-line approach to manage MS.

See related article http://www.biomedcentral.com/1741-7015/10/138/abstract webcite

【 授权许可】

   
2012 de Lorgeril; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, Spertus JA, Costa F, for the American Heart Association and National Heart, Lung, and Blood Institute: Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Circulation 2005, 112:2735-2752.
• [2]Wilson PWF, D'Agostino RB, Parise H, Sullivan L, Meigs JB: Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation 2005, 112:3066-3072.
• [3]Reaven GM: Role of insulin resistance in human disease. Diabetes 1988, 37:1595-1607.
• [4]Barter P: Raising HDL-C can be achieved by both lifestyle changes and pharmacological means. Introduction. Atheroscler Suppl 2011, 12:265-266.
• [5]Kastelein JJ, van Leuven SI, Burgess L, Evans GW, Kuivenhoven JA, Barter PJ, Revkin JH, Grobbee DE, Riley WA, Shear CL, Duggan WT, Bots ML, RADIANCE 1 Investigators: Effect of torcetrapib on carotid atherosclerosis in familial hypercholesterolemia. N Engl J Med 2007, 356:1620-1630.
• [6]Barter PJ, Caulfield M, Eriksson M, Grundy SM, Kastelein JJ, Komajda M, Lopez-Sendon J, Mosca L, Tardif JC, Waters DD, Shear CL, Revkin JH, Buhr KA, Fisher MR, Tall AR, Brewer B, ILLUMINATE Investigators: Effects of torcetrapib in patients at high risk for coronary events. N Engl J Med 2007, 357:2109-2122.
• [7]Grundy SM, Hansen B, Smith SC Jr, Cleeman JI, Kahn RA: Clinical management of metabolic syndrome: report of the American Heart Association/National Heart, Lung, and Blood Institute/American Diabetes Association conference on scientific issues related to management. Arterioscler Thromb Vasc Biol 2004, 24:e19-24.
• [8]de Lorgeril M, Salen P: New insights into the health effects of dietary saturated and omega-6 and omega-3 polyunsaturated fatty acids. BMC Med 2012, 10:50. BioMed Central Full Text
• [9]Tortosa A, Bes-Rastrollo M, Sanchez-Villegas A, Basterra-Gortari FJ, Nuñez-Cordoba JM, Martinez-Gonzalez MA: Mediterranean diet inversely associated with the incidence of metabolic syndrome: the SUN prospective cohort. Diabetes Care 2007, 30:2957-2959.
• [10]Azadbakht L, Mirmiran P, Esmaillzadeh A, Azizi T, Azizi F: Beneficial effects of a dietary approaches to stop hypertension eating plan on features of the metabolic syndrome. Diabetes Care 2005, 28:2823-2831.
• [11]McKeown NM, Meigs JB, Liu S, Saltzmann E, Wilson PW, Jacques PF: Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care 2004, 27:538-546.
• [12]Fogli-Cawley JJ, Dwyer JT, Saltzman E, McCullough ML, Troy LM, Meigs JB, Jacques PF: The 2005 dietary guidelines for Americans and risk of the metabolic syndrome. Am J Clin Nutr 2007, 86:1193-1201.
• [13]Aubin HJ, Farley A, Lycett D, Lahmek P, Aveyard P: Weight gain in smokers after quitting cigarettes: meta-analysis. BMJ 2012, 345:e4439.
• [14]Luo J, Rossouw J, Tong E, Giovino GA, Lee C, Chen C, Ockene JK, Qi L, Margolis KL: Smoking cessation, weight gain, and risk of type 2 diabetes mellitus among postmenopausal women. Arch Intern Med 2012, 172:438-440.
• [15]Hoffman KB, Kraus C, Dimbil M, Golomb BA: A survey of the FDA's AERS database regarding muscle and tendon adverse events linked to the statin drug class. PLoS One 2012, 7:e42866.
• [16]Cham S, Evans MA, Denenberg JO, Golomb BA: Statin-associated muscle-related adverse effects: a case series of 354 patients. Pharmacotherapy. 2010, 30:541-553.
• [17]Koh KK, Quon MJ, Han SH, Lee Y, Kim SJ, Shin EK: Atorvastatin causes insulin resistance and increases ambient glycemia in hypercholesterolemic patients. J Am Coll Cardiol 2010, 55:1209-1216.
• [18]Culver AL, Ockene IS, Balasubramanian R, Olendzki BC, Sepavich DM, Wactawski-Wende J, Manson JE, Qiao Y, Liu S, Merriam PA, Rahilly-Tierny C, Thomas F, Berger JS, Ockene JK, Curb JD, Ma Y: Statin use and risk of diabetes mellitus in postmenopausal women in the Women's Health Initiative. Arch Intern Med 2012, 172:144-152.
• [19]Opie LH, Yellon DM, Gersh BJ: Controversies in the cardiovascular management of type 2 diabetes. Heart 2011, 97:6-14.
• [20]Kuperstein R, Sasson Z: Effects of antihypertensive therapy on glucose and insulin metabolism and on left ventricular mass: a randomized, double-blind, controlled study of 21 obese hypertensives. Circulation 2000, 102:1802-1806.
• [21]Weidmann P, Ferrier C, Saxenhofer H, Uehlinger DE, Trost BN: Serum lipoproteins during treatment with antihypertensive drugs. Drugs 1988, 35:118-134.
• [22]Lardinois CK, Neuman SL: The effects of antihypertensive agents on serum lipids and lipoproteins. Arch Intern Med 1988, 148:1280-1288.
• [23]Wartburton DE, Nicol CW, Bredin SS: Health benefits of physical activity: the evidence. CMAJ 2006, 174:801-809.
• [24]Barengo NC, Hu G, Lakka TA, Pekkarinen H, Nissinen A, Tuomilehto J: Low physical activity as a predictor for total and cardiovascular disease mortality in middle-aged men and women in Finland. Eur Heart J 2004, 25:2204-2211.
• [25]Wen CP, Wai JP, Tsai MK: Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet 2011, 378:1244-1253.
• [26]de Lorgeril M, Renaud S, Mamelle N, Salen P, Martin JL, Monjaud I, Guidollet J, Touboul P, Delaye J: Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet 1994, 343:1454-1459.
• [27]de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N: Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999, 99:779-785.
• [28]Smutok MA, Reece C, Kokkinos PF: Aerobic versus strength training for risk factor intervention in middle-aged men at high risk for coronary heart disease. Metabolism 1993, 42:177-184.
• [29]Pratley RE, Hagberg JM, Dengel DR, Rogus EM, Muller DC, Goldberg AP: Aerobic exercise training-induced reductions in abdominal fat and glucose-stimulated insulin responses in middle-age and older men. J Am Geriatr Soc 2000, 48:1055-1061.
• [30]Blumenthal JA, Sherwood A, Gullette EC: Exercise and weight loss reduce blood pressure in men and women with mild hypertension. Arch Intern Med 2000, 160:1947-1958.
• [31]Dengel DR, Hagberg JM, Pratley RE, Rogus EM, Goldberg AP: Improvements in blood pressure, glucose metabolism, and lipoprotein lipids after aerobic exercise plus weight loss in obese, hypertensive middle-aged men. Metabolism 1998, 47:1075-1082.
• [32]Tuomilehto J, Lindstrom J, Eriksson JG: Prevention of type 2 diabetes by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001, 344:1343-1350.
• [33]Yamaoka K, Tango T: Effects of lifestyle modification on metabolic syndrome: a systematic review and meta-analysis. BMC Med, in press.