The metabolic syndrome

Harmon S. Jordan, ScD, Karima A. Kendall, PhD, Linda J. Lux, Roycelynn Mentor-Marcel, PhD, MPH, Laura C. Morgan, MA, Michael G. Trisolini, PhD, MBA, Janusz Wnek, PhD

Jeffrey L. Anderson, MD, FACC, FAHA, Chair , Jonathan L. Halperin, MD, FACC, FAHA, Chair-Elect , Nancy M. Albert, PhD, CCNS, CCRN,

2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society

This review provides the reader with the up-to-date evidence-based basis for prescribing exercise as medicine in the treatment of 26 different diseases: psychiatric diseases (depression, anxiety, stress, schizophrenia); neurological diseases (dementia, Parkinson's disease, multiple sclerosis); metabolic diseases (obesity, hyperlipidemia, metabolic syndrome, polycystic ovarian syndrome, type 2 diabetes, type 1 diabetes); cardiovascular diseases (hypertension, coronary heart disease, heart failure, cerebral apoplexy, and claudication intermittent); pulmonary diseases (chronic obstructive pulmonary disease, asthma, cystic fibrosis); musculo-skeletal disorders (osteoarthritis, osteoporosis, back pain, rheumatoid arthritis); and cancer. The effect of exercise therapy on disease pathogenesis and symptoms are given and the possible mechanisms of action are discussed. We have interpreted the scientific literature and for each disease, we provide the reader with our best advice regarding the optimal type and dose for prescription of exercise.

/pdf/exercise-as-medicine-evidence-for-prescribing-exercise-as-4ap89k53ch.pdf

Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases

Preamble and Transition to ACC/AHA Guidelines to

The goals of the American College of Cardiology (ACC) and the American Heart Association (AHA) are to prevent cardiovascular diseases (CVDs); improve the management …

/pdf/2013-aha-acc-guideline-on-lifestyle-management-to-reduce-4cwv0mif24.pdf

2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk

Loria, Barbara E. Millen, Cathy A. Nonas, F. Xavier Pi-Sunyer, June Stevens, Victor J. Stevens, Karen A. Donato, Frank B. Hu, Van S. Hubbard, John M. Jakicic, Robert F. Kushner, Catherine M. Michael D. Jensen, Donna H. Ryan, Caroline M. Apovian, Jamy D. Ard, Anthony G. Comuzzie, Practice Guidelines and The Obesity Society Report of the American College of Cardiology/American Heart Association Task Force on 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults: A Print ISSN: 0009-7322. Online ISSN: 1524-4539 Copyright © 2013 American Heart Association, Inc. All rights reserved. is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Circulation published online November 12, 2013; Circulation. http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437739.71477.ee.citation World Wide Web at: The online version of this article, along with updated information and services, is located on the http://circ.ahajournals.org/content/suppl/2013/11/07/01.cir.0000437739.71477.ee.DC1.html Data Supplement (unedited) at:

/pdf/2013-aha-acc-tos-guideline-for-the-management-of-overweight-3w1saiwrmy.pdf

2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults

ContextLimited information exists on the interaction between diet and 3-hydroxy-3-methylglutaryl
coenzyme A reductase inhibitors (statins) and the interaction's effect on
serum lipid and lipoprotein levels, insulin sensitivity, and circulating antioxidant
vitamin and provitamin levels.ObjectiveTo evaluate the separate and combined effects of diet and simvastatin
therapy on serum levels of lipids, lipoproteins, antioxidants, and insulin.Design, Setting, and ParticipantsRandomized, controlled crossover trial conducted from August 1997 to
June 1998 in 120 previously untreated hypercholesterolemic men aged 35 to
64 years who were recruited from the community in Turku, southwestern Finland.InterventionsAfter a 4- to 6-week placebo run-in period, participants were randomly
allocated to a habitual diet (n = 60) or dietary treatment group (n = 60),
and each of these groups was further randomized in a double-blind crossover
fashion to receive simvastatin (20 mg/d) or placebo, each for 12 weeks (n
= 30 in each group). The main goals of the dietary treatment were to reduce
energy intake from saturated plus trans-unsaturated
fats to no more than 10% by replacing them partly with monounsaturated and
polyunsaturated fats rich in omega-3 fatty acids and to increase intake of
fruits, vegetables, and dietary fiber.Main Outcome MeasuresChanges in levels of total, low-density lipoprotein (LDL), and high-density
lipoprotein (HDL) cholesterol; triglycerides; apolipoprotein B; insulin; glucose;
and antioxidants at week 12 of each treatment period, compared among the 4
groups.ResultsDietary treatment decreased levels of total cholesterol by 7.6% (P<.001), LDL cholesterol by 10.8% (P<.001), HDL cholesterol by 4.9% (P = .01),
apolipoprotein B by 5.7% (P = .003), serum insulin
by 14.0% (P = .02), and α-tocopherol by 3.5%
(P = .04). Simvastatin decreased levels of total
cholesterol by 20.8%, LDL cholesterol by 29.7%, triglycerides by 13.6%, apolipoprotein
B by 22.4%, α-tocopherol by 16.2%, β-carotene by 19.5%, and ubiquinol-10
by 22.0% (P<.001 for all) and increased levels
of HDL cholesterol by 7.0% (P<.001) and serum
insulin by 13.2% (P = .005). Glucose levels remained
unchanged in all groups. The effects of dietary treatment and simvastatin
were independent and additive.ConclusionsA modified Mediterranean-type diet rich in omega-3 fatty acids efficiently
potentiated the cholesterol-lowering effect of simvastatin, counteracted the
fasting insulin–elevating effect of simvastatin, and, unlike simvastatin,
did not decrease serum levels of β-carotene and ubiquinol-10.

https://jamanetwork.com/journals/jama/articlepdf/194614/joc11554.pdf

Effects of Diet and Simvastatin on Serum Lipids, Insulin, and Antioxidants in Hypercholesterolemic Men: A Randomized Controlled Trial

Aim: The aim of this study was to investigate the role of skeletal muscle fibre type in the regulation of glucose metabolism in middle-aged obese subjects with impaired glucose tolerance (IGT) during a 2-year exercise anddietary intervention. Methods: Muscle biopsies (musculus vastus lateralis) were taken from 22 subjects belonging to the intervention group of the Finnish Diabetes Prevention Study [1]. According to their myosin heavy chain (MHC) profile at the baseline, the subjects were divided into two groups: IGT s l o w (n = 10) with a high proportion of MHC I isoforms and IGT f a s t (n = 12) with a high proportion of MHC II isoforms in the vastus lateralis muscle. The intervention consisted of dietary counselling, strength and power training and/or aerobic exercise. The amount of exercise was the same in both groups; the exercise frequency was 5.1 ′ 2.7h/week in the IGT s l o w and 5.1 ′ 2.8 h/week in the IGT f a s t group. Results: Fasting glucose (p < 0.05), 2-h glucose (p<0.05), fasting insulin (p < 0.05), haemoglobin A1c (HbA 1 c ) (p<0.01) and insulin resistance (p < 0.05) [homeostasis model assessment for insulin resistance (HOMA-IR)] decreased in the IGT f a s t group, whereas only the 2-h glucose and HbA 1 c concentrations decreased in the IGT s l o w group. The amount of the glycogen synthase kinase-3-αβ (GSK-3-αβ) decreased in the IGT f a s t group (p<0.05). Exercise training increased the lactate dehydrogenase (LDH) (p < 0.01), LDH-1 (p < 0.05) and citrate synthase (CS) (p < 0.05) activities in the vastus lateralis muscle in the IGT s l o w group, but only the CS activity (p<0.05) in the IGT f a s t group. Conclusions: The glucose metabolism improved both in the IGT s l o w and IGT f a s t group during the 2-year exercise and dietary intervention. The change was more prominent in the IGT f a s t group than in the IGT s l o w group, associated with the decrease of the GSK-αβ protein expression in skeletal muscle. The exercise training improved both glycolytic and oxidative capacity in the vastus lateralis muscle. The glycolytic capacity improved in the IGT s l o w group and the oxidative capacity in both groups.

Role of skeletal muscle-fibre type in regulation of glucose metabolism in middle-aged subjects with impaired glucose tolerance during a long-term exercise and dietary intervention.

Exercise and dietary intervention: effects on human muscle metabolism in middle-aged IGT subjects

Effects of exercise and dietary intervention on human skeletal muscle metabolism in middle-aged IGT persons

OBJECTIVE —To assess the prevalence of the metabolic syndrome (MetS) in two independent Finnish study cohorts. RESEARCH DESIGN AND METHODS —The prevalence of the MetS by modified World Health Organization criteria was analyzed in different categories of glucose tolerance in a cross-sectional, population-based sample of 2,049 individuals (FINRISK) aged 45–64 years and in 522 participants of the Finnish Diabetes Prevention Study (DPS) with impaired glucose tolerance (IGT). RESULTS —In the FINRISK cohort, the MetS was present in 38.8% of the men and 22.2% of the women. The prevalence was 14.4 and 10.1% in subjects with normal glucose tolerance, 74.0 and 52.2% in subjects with impaired fasting glucose, 84.8 and 65.4% in subjects with IGT, and 91.5 and 82.7% in subjects with type 2 diabetes in men and women, respectively. Among women, the prevalence of the MetS increased with increasing age. In the DPS cohort, the MetS was present in 78.4% of the men and 72.2% of the women with IGT. CONCLUSIONS —The MetS was extremely common in middle-aged subjects The high prevalence in men was mostly due to their high waist-to-hip ratio. The prevalence of the MetS increased in both sexes with deterioration in glucose regulation. Approximately 75% of the subjects with IGT had the MetS. Because the syndrome includes the major risk factors for atherosclerotic vascular diseases and is the major antecedent for type 2 diabetes, concerted preventive action should be targeted to control all the features of the MetS.

https://care.diabetesjournals.org/content/diacare/27/9/2135.full.pdf

Prevalence of the Metabolic Syndrome and Its Components: Findings from a Finnish general population sample and the Diabetes Prevention Study cohort

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