Lifestyle Factors that Improve Metabolic Syndrome Components

Citation:

Grundy SM, Hansen B et.al. 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. Circulation. 2004;109:551-556.

 
Study Design:
Consensus Statement
Class:
R - Click here for explanation of classification scheme.
Quality Rating:
Negative NEGATIVE: See Quality Criteria Checklist below.
Research Purpose:
To summarize the second conference devoted to clinical management of the metabolic syndrome. The following issues were considered: 1)pathogenesis and presentation of the metabolic syndrome 2) management of underlying risk factors 3) management of metabolic risk factors, and 4) unresolved issues and research challenges.
Inclusion Criteria:
N/A
Exclusion Criteria:
N/A
Description of Study Protocol:

Recruitment

 

Design

 

Blinding used (if applicable)

 

Intervention (if applicable)

 

Statistical Analysis

 

Data Collection Summary:

Timing of Measurements

 

N/A

Dependent Variables

  • Variable 1: brief description (how measured?)
  • Variable 2: brief description (how measured?)
  • etc

Independent Variables

 

Control Variables

 

Description of Actual Data Sample:

N/A

Initial N: (e.g., 731 (298 males, 433 females))

Attrition (final N):

Age:

Ethnicity:

Other relevant demographics:

Anthropometrics (e.g., were groups same or different on important measures)

Location:

 

Summary of Results:

Identified 3 potential etiologic categories: obesity, insulin resistance and constellation of independent risk factors

Management of Underlying Risk Factors
-the risk factors that promote the development of the MS are overweight/obesity, physical inactivity, and an atherogenic diet.
-first line of therapy should be lifestyle modification (weight loss and physical activity)

Management of overweight and obesity
-Reduce caloric intake and increased physical activity: 
    -Crash diets/extreme diets don't work. More effective and healthful for long-term weight loss 
        and 500 to 1000 calorie/day restrictions
    -Realistic goal is to reduce body weight by 7-10% over 6-12 months
    -Long-term maintenance is best achieved when regular exercise is included in the weight 
        loss regimen
    -Emphasis should be given to eating habits, social support, stress management and regular 
        exercise.


Management of physical inactivity
    -Daily minimum of 30 minutes of moderate-intensity physical activity, increasing the level 
        (1 hour/day) appears to be more beneficial, especially for weight control
    -To help initiate activity, suggestions to start with 10-15 bouts of activity

Dietary Modification
    -Diet composition consistent with general dietary recommendations: low intake of SF, trans-
        fat and cholesterol; reduced consumption of simple sugars; increased intake of fruits and 
        vegetables, and whole grains.
    -Further research needed to see if MS pts will benefit from a shift to more unsaturated fatty 
        acids and less carbohydrates

Variables

Treatment Group

Measures and confidence intervals

Control group

Measures and confidence intervals

Statistical Significance of Group Difference

Dep var 1

Mean, CI.

e.g., 4.5±2.2

Mean, CI.

e.g., 1.5±2.0

Stat signif difference between groups

e.g., p=.002

Dep var 2

 

 

 

etc

 

 

 

 

Other Findings

 

Author Conclusion:

Lifestyle modification leading to weight reduction and increased physical activity represents first-line clinical therapy. Smoking cessation is paramount. A realistic goal for weight loss is to reduce body weight by 7-10% over 6 months to 1 year. Weight reduction should be combined with a daily minimum of 30 minutes of moderate-intensity activity. Nutritional therapy calls for a low intake of SF, trans-fatty acids and cholesterol; reduced consumption of simple sugars; and increased fruits and vegetables and whole grains. Extremes in intakes of either carbohydrate or fats should be avoided.

Funding Source:
Reviewer Comments:

Many limitations due to the nature of the paper.

Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? Yes
 
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? No
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? No
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? No
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? No
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? No
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? No
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? No
  10. Was bias due to the review's funding or sponsorship unlikely? Yes