MetS Prevention and Control 

• Abdominal obesity and hypertension and low HDL are strong predictors of MS (metabolic syndrome).¹MS identifies people at high risk of diabetes and CVD who are most responsive to lifestyle changes.

• High carbohydrate intake, (particularly high glycemic load) and low physical activity are 2 important contributors to the development of MS among Asian Indians.^2-4

• Lifestyle modifications to achieve a modest weight loss (5%-7%) in overweight individuals could reduce the prevalence of MS and its progression to diabetes. Weight loss requires attention to both energy intake and expenditure. Even small to moderate amounts of physical activity (<7 Kcal/min) is helpful in preventing MS.

• Food items with high glycemic index (eg. refined grains and calorie-sweetened soft drinks) have an adverse effect on the development of MS, whereas modest intakes of animal and vegetable proteins, as well as healthy carbohydrates from fruits and vegetables, have a beneficial effect.⁵

• Ghee, a form of clarified butter, was positively and independently associated with high blood pressure in these children.⁶ Ghee is very high in saturated fat and cholesterol oxide and is used liberally by affluent Indians worldwide.⁶

• Progression of prediabetes to diabetes is high among Asian Indians (18%/y) but can be significantly reduced by both lifestyle modification and metformin.⁷ As the condition progresses, however, drug therapy directed toward the individual risk factors might be required.⁸

• Pioglitazone has significantly favorable effects on HDL particle size, markers of inflammation, and adipokines, and these properties contribute to its antiatherogenic effects.⁹

• Patients with CAD (coronary artery disease) and MS have higher risk of recurrent coronary events and derive incremental benefit from aggressive high-dose statin therapy.¹⁰ It seems reasonable to achieve TC/HDL goal of <4 in people with MS. The Indo US Health summit recommends LDL cholesterol < 100 mg /dL and non-HDL cholesterol <130 mg/dL for Asian Indians without CAD and diabetes. The recommended goal is LDL cholesterol <70 mg/dL and non-HDL cholesterol <100 mg dL for Asian Indians with diabetes or CAD.¹¹ This is by far the simplest and most effective recommendation and is in agreement with the current literature.¹²

• In people with MS, controlling abnormal lipid levels and hypertension to normal levels may prevent up to 50% of major acute coronary events; more importantly, controlling to optimal levels may decrease these events by 80% or more.¹³

• Low fruit and vegetable consumption and high sweetened beverage consumption are independently associated with the prevalence of MS.¹⁴ 

• Compared with serving low-sugar cereals, high-sugar cereals increase children’s total sugar consumption and reduce the overall nutritional quality of their breakfast. Children will consume low-sugar cereals when offered, and they provide a superior breakfast option.¹⁵

Sources

1.Lin YC, Chen JD, Lo SH, Chen PC. Worksite health screening programs for predicting the development of Metabolic Syndrome in middle-aged employees: a five-year follow-up study. BMC Public Health. 2010;10:747.

2. Enas EA. How to Beat the Heart Disease Epidemic among South Asians: A Prevention and Management Guide for Asian Indians and their Doctors. Downers Grove: Advanced Heart Lipid Clinic  USA; 2010.

3. Enas EA, Senthilkumar A, Chennikkara H, Bjurlin MA. Prudent diet and preventive nutrition from pediatrics to geriatrics: current knowledge and practical recommendations. Indian heart journal. Jul-Aug 2003;55(4):310-338.

4. Enas EA, Mohan V, Deepa M, Farooq S, Pazhoor S, Chennikkara H. The metabolic syndrome and dyslipidemia among Asian Indians: a population with high rates of diabetes and premature coronary artery disease. Journal of the cardiometabolic syndrome. Fall 2007;2(4):267-275.

5. Halkjaer J, Tjonneland A, Thomsen BL, Overvad K, Sorensen TI. Intake of macronutrients as predictors of 5-y changes in waist circumference. Am J Clin Nutr. Oct 2006;84(4):789-797.

6. Jafar TH, Islam M, Poulter N, et al. Children in South Asia have higher body mass-adjusted blood pressure levels than white children in the United States: a comparative study. Circulation. Mar 15 2005;111(10):1291-1297.

7. Ramachandran A, Snehalatha C, Mary S, Mukesh B, Bhaskar AD, Vijay V. The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia. Feb 2006;49(2):289-297.

8. Grundy SM. Metabolic syndrome: connecting and reconciling cardiovascular and diabetes worlds. J Am Coll Cardiol. Mar 21 2006;47(6):1093-1100.

9. Szapary PO, Bloedon LT, Samaha FF, et al. Effects of pioglitazone on lipoproteins, inflammatory markers, and adipokines in nondiabetic patients with metabolic syndrome. Arteriosclerosis, thrombosis, and vascular biology. Jan 2006;26(1):182-188.

10. Deedwania  P, Barter P, Carmena R, et al. Reduction of low-density lipoprotein cholesterol in patients with coronary heart disease and metabolic syndrome: analysis of the Treating to New Targets study. Lancet. Sep 9 2006;368(9539):919-928.

11. Enas  EA, Singh V, Gupta R, Patel R, et al. Recommendations of the Second Indo-US Health Summit for the prevention and control of cardiovascular disease among Asian Indians. Indian heart journal. 2009;61:265-74.

12. Enas E A, Senthilkumar. Coronary Artery Disease In Asian Indians: An Update And Review . The Internet Journal of Cardiology 2001

2010;1:avaible at www.The Internet Journal of Cardiology accessed  Dec 1, 2010.

13. Wong ND, Pio JR, Franklin SS, L’Italien GJ, Kamath TV, Williams GR. Preventing coronary events by optimal control of blood pressure and lipids in patients with the metabolic syndrome. Am J Cardiol. Jun 15 2003;91(12):1421-1426.

14. Yoo S, Nicklas T, Baranowski T, et al. Comparison of dietary intakes associated with metabolic syndrome risk factors in young adults: the Bogalusa Heart Study. Am J Clin Nutr. Oct 2004;80(4):841-848.

15. Harris J L, Schwartz MB, Ustjanauskas A, Ohri-Vachaspati P, Brownell KD. Effects of Serving High-Sugar Cereals on Children’s Breakfast-Eating Behavior. Pediatrics. Dec 13 2010.