(Journal Article): Diet, Exercise and the Metabolic Syndrome
 
Pitsavos C, Panagiotakos D, Weinem M, Stefanadis C (First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece, d.b.panagiotakos@usa.net )
 
IN: Rev Diabet Stud 2006; 3(3):118-126

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ABSTRACT: The metabolic syndrome is a combination of metabolic disorders, such as dyslipidemia, hypertension, impaired glucose tolerance, compensatory hyperinsulinemia and the tendency to develop fat around the abdomen. Individuals with the metabolic syndrome are at high risk for atherosclerosis and, consequently, cardiovascular disease. However, as a result of several epidemiologic studies and some clinical trials, it has been suggested that people with the metabolic syndrome may benefit from intensive lifestyle modifications including dietary changes and adopting a physically more active lifestyle. In this review we summarize the effects of diet and physical activity on the development of the metabolic syndrome.

TYPE OF PUBLICATION: Review

REFERENCES:

1. Phillips GB. Sex hormones, risk factors and cardiovascular disease. Am J Med 1978. 65:7-11.
2. Reaven GM. Role of insulin resistance in human disease. Diabetes 1988. 37:1595-1607.
3. Grundy SM. Obesity, metabolic syndrome and cardiovascular disease. J Clin Endocrinol Metab 2004. 89:2595-2600.
4. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002. 287:356-359.
5. Das UN. Metabolic syndrome X: an inflammatory condition? Curr Hypertens Rep 2004. 6:66-73.
6. Alberti KG, Zimmet P. 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.
7. 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. Diagnosis and Management of the Metabolic Syndrome. An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005. 112(17):2735-2752.
8. Haffner SM. The metabolic syndrome: inflammation, diabetes mellitus, and cardiovascular disease. Am J Cardiol 2006. 97(2A):3A-11A.
9. Kim SH, Reaven GM. The metabolic syndrome: one step forward, two steps back. Diab Vasc Dis Res 2004. 1:68-75.
10. Alberti KG, Zimmet P, Shaw J; IDF Epidemiology Task Force Consensus Group. The metabolic syndrome - a new worldwide definition. Lancet 2005. 366:1059-1062.
11. 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.
12. Hu G, Qiao Q, Tuomilehto J, Balkau B, Borch-Johnsen K, Pyorala K; DECODE Study Group. Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in non-diabetic European men and women. Arch Intern Med 2004. 164:1066-1076.
13. Ferrannini E, Natali A. Essential hypertension, metabolic disorders, and insulin resistance. Am Heart J 1991. 121:1274-1282.
14. Panagiotakos DB, Pitsavos CH, Chrysohoou C, Skoumas J, Tousoulis D, Toutouza M, Toutouzas PK, Stefanadis C. The Impact of Lifestyle Habits on the Prevalence of the Metabolic Syndrome among Greek adults from the ATTICA study. Am Heart J 2004. 147:106-112.
15. Athyros VG, Ganotakis ES, Elisaf M, Mikhailidis DP. The prevalence of the metabolic syndrome using the National Cholesterol Educational Program and International Diabetes Federation definitions. Curr Med Res Opin 2005. 21:1157-1159.
16. Santos AC, Lopes C, Barros H. Prevalence of metabolic syndrome in the city of Porto. Rev Port Cardiol 2004. 23:45-52.
17. Oh JY, Hong YS, Sung YA, Barrett-Connor E. Prevalence and factor analysis of metabolic syndrome in an urban Korean population. Diabetes Care 2004. 27:2027-2032.
18. Lee WY, Park JS, Noh SY, Rhee EJ, Kim SW, Zimmet PZ. Prevalence of the metabolic syndrome among 40,698 Korean metropolitan subjects. Diabetes Res Clin Pract 2004. 65:143-149.
19. Kannel WB, McGee DL, Gordon T. A general cardiovascular risk profile: The Framingham Study. Am J Cardiol 1976. 38:46-51.
20. Keys A, Menotti A, Karvonen MJ, Aravanis C, Blackburn H, Buzina R, Djordjevic BS, Dontas AS, Fidanza F, Keys MH, et al. The diet and 15-year death rate in the Seven Countries Study. Am J Epidemiol 1986. 124:903-915.
21. Trichopoulou A, Kouris-Blazos A, Wahlqvist M, Trichopoulos D. Diet and overall survival in elderly people. Br Med J 1995. 311:1457-1460.
22. Trichopoulou A. , Lagiou P. Healthy traditional Mediterranean diet - An expression of culture, history and lifestyle. Nutr Rev 1997. 55:383-389.
23. Knapp HW. Dietary fatty acids in human thrombosis and homeostasis. Am J Clin Nutr 1997. 65:1687S-1698S.
24. 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.
25. Panagiotakos DB, Pitsavos C, Chrysohoou C, Tzioumis K, Papaioannou I, Stefanadis C, Toutouzas PK. The Association of Mediterranean Diet with Lower Risk of Acute Coronary Syndromes, in Hypertensive Subjects. Int J Cardiol 2002. 19:141-147.
26. Martinez-Gonzalez MA, Fernandez-Jarne E, Serrano-Martinez M. Mediterranean diet and reduction in the risk of a first acute myocardial infarction: an operational healthy dietary score. Eur J Nutr 2002. 41:153-160.
27. World Health Organization Study Group. Diet, Nutrition, and the Prevention of Chronic Diseases. World Health Organization, Geneva, Switzerland 2003. Technical Report Series, 916.
28. Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 2003. 348:2599-2608.
29. Chrysohoou C, Panagiotakos DB, Pitsavos C, Das UN, Stefanadis C. Adherence to the Mediterranean diet attenuates inflammation and coagulation process, in healthy adults: the ATTICA study. J Am Col Cardiol 2004. 44:152-158.
30. Anderson CA, Miller ER 3rd. Dietary recommendations for obese patients with chronic kidney disease. Adv Chronic Kidney Dis 2006. 13(4):394-402.
31. Schroder H, Marrugat J, Vila J, Covas MI, Elosua R. Adherence to the traditional Mediterranean diet is inversely associated with body mass index and obesity in a Spanish population. J Nutr 2004. 134:3355-3361.
32. American College of Sports Medicine. Position statement on proper and improper weight loss programs. 1983. 15:9-13.
33. Leon A S, Connett J, Jacobs DR. Leisure-time physical activity levels and risk of coronary heart disease and death: the Multiple Risk Factor Intervention Trial. JAMA 1987. 258:2388-2395.
34. Pekkanen J, Marti B, Nissinen A. Reduction of premature mortality by high physical activity: a 20-year follow-up of middle-aged Finnish men. Lancet 1987. 255:1473-1477.
35. Pate RR, Pratt M, Blair SN, Haskell WL. Physical activity and public health. JAMA 1995. 273:402-407.
36. Ford ES, DeStefano F. Risk factors for mortality from all causes and from coronary heart disease among persons with diabetes. Findings from the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. Am J Epidemiol 1991. 133:1220-1230.
37. Kohl HW, Villegas JA, Gordon NF, Blair SN. Cardiorespiratory fitness, glycemic status and mortality risk in men. Diabetes Care 1992. 15:184-192.
38. Wei M, Gibbons LW, Kampert JB. Low cardiorespiratory fitness and physical inactivity as predictors of mortality in men with type 2 diabetes. Ann Intern Med 2000. 132:605-611.
39. Hu FB, Stampfer MJ, Solomon C. Physical activity and risks for cardiovascular events in diabetic women. Ann Intern Med 2001. 134:96-105.
40. Batty GD, Shipley MJ, Marmot M, Smith GD. Physical activity and cause-specific mortality in men with type 2 diabetes/impaired glucose tolerance: evidence from the Whitehall study. Diabet Med 2002. 19:580-588.
41. Tanasescu M, Leitzmann MF, Rimm EB, Hu FB. Physical activity in relation to cardiovascular disease and total mortality among men with type 2 diabetes. Circulation 2003. 107:2435-2439.
42. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, Keinanen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M, Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001. 344(18):1343-1350.
43. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM, Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Eng J Med 2002. 346(6):393-403.
44. Pitsavos C, Panagiotakos DB, Chrysohoou C, Kavouras S, Stefanadis C. The associations between physical activity, inflammation, and coagulation markers, in people with metabolic syndrome: the ATTICA study. Eur J Cardiovasc Prev Rehabil 2005. 12:151-158.
45. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. Physical Activity and Health: a Report of the Surgeon General. Atlanta, GA, 1996.
46. Jakicic JM, Winters C, Lang W, Wing RR. Effects of intermittent exercise and use of home exercise equipment on adherence, weight loss, and fitness in overweight women. JAMA 1999. 282:1554-1560.
47. Kokkinos PF, Narayan P, Colleran JA, Pittaras A, Notargiacomo L, Reda D, Papademetriou V. Effects Of Regular Exercise On Blood Pressure And Left Ventricular Hypertrophy In African-American Men With Severe Hypertension. N Engl J Med 1995. 333:1462-1467.
48. Burt VL, Whelton P, Roccella EJ. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988-1991. Hypertension 1995. 25(3):305-313.
49. Eaton CB, Lapane KL, Garber CE. Physical activity physical fitness and coronary heart disease risk factors. Med Sci Sports Exerc 1995. 27:340-346.
50. Hsieh SD, Yoshinaga H, Muto T, Sakurai Y. Regular physical activity and coronary risk factors in Japanese men. Circulation 1998. 97:661-665.
51. Bijnen FC, Feskens EJ, Caspersen CJ. Physical activity and cardiovascular risk factors among elderly men in Finland, Italy and the Netherlands. Am J Epidemiol 1996. 143:553-561.
52. Ford ES. Does exercise reduce inflammation? Physical activity and C-reactive protein among U.S. adults. Epidemiology 2002. 13:561-568.
53. King DE, Carek P, Mainous AG 3rd, Pearson WS. Inflammatory Markers and Exercise: Differences Related to Exercise Type. Med Sci Sports Exerc 2003. 35:575-581.
54. Abramson JL, Vaccarino V. Relationship between physical activity and inflammation among apparently healthy middle-aged and older US adults. Arch Intern Med 2002. 162:1286-1292.
55. MacAuley D, McCrum EE, Stott G, Evans AE, McRoberts B, Boreham CA, Sweeney K, Trinick TR. Physical activity, physical fitness, blood pressure, and fibrinogen in the Northern Ireland health and activity survey. J Epidemiol Community Health 1996. 50:258-263.
56. Danesh J, Collins R, Appleby P. Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. JAMA 1998. 279:1477-1482.
57. Panagiotakos DB, Pitsavos C, Chrysohoou C, Kavouras S, Stefanadis C. The associations between leisure-time physical activity and inflammatory and coagulation markers related to cardiovascular disease: the ATTICA Study. Prev Med 2004. 40(4):432-437.
58. Koh KK. Inflammatory markers and the metabolic syndrome. J Am Coll Cardiol 2005. 46:1978-1985.
59. Roberts CK, Barnard RJ. Effects of exercise and diet on chronic disease. J Appl Physiol 2005. 98:3-30.
60. Stone N, Saxon D. Approach to treatment of the patient with metabolic syndrome. Lifestyle therapy. Am J Cardiol 2005. 22:15E-21E.
61. Haffner S. Diabetes and the metabolic syndrome. When is it best to intervene to prevent? Atherosclerosis 2006. 7:S3-S10.
62. Eriksson KF, Lindgarde F. No excess 12-year mortality in men with impaired glucose tolerance who participated in the Malmo Preventive Trial with diet and exercise. Diabetologia 1998. 41(9):1010-1016.
63. Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, Hu ZX, Lin J, Xiao JZ, Cao HB, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 1997. 20(4):537-544.
64. Wein P, Beischer N, Harris C, Permezel M. A trial of simple versus intensified dietary modification for prevention of progression to diabetes mellitus in women with impaired glucose tolerance. Aust N Z J Obstet Gynaecol 1999. 39(2):162-166.