Dietary management of insulin resistance and the metabolic syndrome
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Corresponding author David J.A. Jenkins, MD, PhD Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, 61 Queen St. East, Toronto, Ontario, M5C 2T2, Canada. E-mail: [email protected] Current Cardiovascular Risk Reports 2007, 1:24 –31 Current Medicine Group LLC ISSN 1932-9520 Copyright © 2007 by Current Medicine Group LLC
Strategies are being developed to reduce the incidence of diabetes and other associated chronic diseases, including heart disease and many common cancers. Part of the strategy has been to define at-risk groups, especially those with the metabolic syndrome. Perhaps the most readily useable classification is that of National Cholesterol Education Program Adult Treatment Panel III criteria. The ultimate goal has been to increase exercise and reduce body weight. Diets with different macronutrient profiles have been proposed, all of which appear useful if compliance is maintained but may differ somewhat in the spectrum of benefits they confer. Newer drugs have appeared that also may confer benefit metabolically (peroxisome proliferatoractivated receptor agonists) or by central mechanisms (cannabinoid antagonists). The changes will likely have to be metabolic and societal and include not only the food industry but also modes of transportation and urban planning.
Introduction This review presents the definitions of the metabolic syndrome as the chief harbinger of obesity and its sequelae and briefly outlines societal, dietary, and pharmacologic treatment options and strategies. We assess the often disparate dietary approaches used to induce weight loss, including some popular diets, correct the underlying cause of insulin resistance, and modify individual risk factor components. We also discuss the overarching effects of exercise and end the article with a general diet and lifestyle recommendation. This review covers 2003 to the present.
The Metabolic Syndrome Although the need for the term metabolic syndrome has been questioned [1], it has proved to be a useful reminder of a constellation of genetically determined and often environmentally modified risk factors that are commonly associated with chronic diseases, including diabetes, coronary heart disease (CHD), and certain cancers [2]. For this reason and because of the heightened risk for cardiovascular disease (CVD) found in people with metabolic syndrome, the National Cholesterol Education Program, Adult Treatment Panel III (NCEP ATPIII) embedded treatment of the metabolic syndrome within the guidelines for CHD risk factor reduction [3]. Headed by Grundy et al. [4••], the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) has explained the reasoning behind the addition to the guidelines and supplied a comprehensive overview. The basic modalities in the ATPIII definition are given in Table 1 and relate to intra-abdominal fat (waist circumference), glycemic control (blood glucose), hypertension, and dyslipidemia (low high-density lipoprotein cholesterol [HDL-C] and high triglycerides [TG]). Ot
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