Metabolic Syndrome and Dietary Guidelines for its prevention

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Metabolic Syndrome and Dietary Guidelines for its Prevention Rekha Sharma, R.D. President , Indian Dietetic Association Director, Clinical Nutrition and Dietetics Diabetes Foundation (INDIA) Former Chief Dietician ,AIIMS, New Delhi

[object Object],[object Object],[object Object],[object Object],Rekha Sharma National President , Indian Dietetic Association Director , Clinical Nutrition & Dietetics , Diabetes Foundation

Introduction ,[object Object],[object Object],[object Object]

Prevalence of Obesity ,[object Object],[object Object]

World Health Report Excess weight attributes globally to

Prevalence of CHD ,[object Object],[object Object],[object Object]

Prevalence of Diabetes ,[object Object],[object Object],[object Object],[object Object],[object Object]

Incidence of obesity & related disorders Age Percentage Source Young Women (18 – 25 years) 13.2% Delhi, DST Trial 2000 Urban slum ( 35 years) 40.2% European Journal of Clinical Nutrition (2001) Urban Slum (30-60 years) 28.2% Delhi, 2002 DST Trial Post menopausal (52 years) 62 % Delhi, DBT trial 2006 Hyperlipidemia Cholesterol > 200 mg 47% Diabetes Blood Sugar >126 mg 4 % Osteoporosis (T-score < -2.5) 22% 4,621( >35 years) Overweight Urban Areas 64 % DST trial in 6 cities ,2009 Hypertension >140/90 mm Hg 50% Hyperlipidemia Cholesterol > 200 mg 25% Diabetes Blood Sugar >126 mg% 3 - 14 %

Incidence of obesity& related disorders ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Metabolic Syndrome ,[object Object],[object Object]

Clinical diagnostic criteria for Metabolic Syndrome Risk Factors WHO NCEP, ATP III Asian Indians*/IDF 1.Fasting plasma glucose --- ≥ 100 mg/ dL ≥ 100 mg/ dL ,[object Object],[object Object],[object Object],[object Object],> 102/94 cm - Men > 88/80 cm -Women > 25 kg/m 2 > 0.90 -Men > 0.85 -Women > 102 cm -Men > 88 cm -Women --- > 90 cm -Men > 80 cm -Women > 23 kg/m 2 > 0.9 -Men > 0.8 -Women ,[object Object],[object Object],[object Object],[object Object],> 150 mg/dL < 35 mg/dL -Men < 30 mg/dL -Women ≥ 150 mg/dL < 40 mg/dL -Men < 50 mg/dL -Women ≥ 150 mg/dL < 40 mg/dL -Men < 50 mg/dL -Women 5.Blood pressure *Misra etal JAPI 2009 ≥ 140/ ≥ 90 mmHg ≥ 130/ ≥ 85 mmHg > 130/ > 85 mmHg

Diet, Physical Activity & Risk Factors DIET Obesity Physical activity Hyperlipidemia Diabetes Hypertension Coronary Artery Disease Smoking Stress

Transition in Dietary Habits ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Scientific data shows ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Components of Good Health and Lifestyle that We Can Control ,[object Object],[object Object],[object Object],[object Object]

“ Consensus Dietary Guidelines for Healthy Living and Prevention of Obesity, Metabolic Syndrome, Diabetes, and Related Disorders in Asian Indians” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Energy Recommendations ,[object Object],[object Object],Energy Requirement (Kcal/Kg IBW/day) Activity Obese Normal Underweight Sedentary 20-25 30 35 Moderate 30 35 40 Heavy 35 40 45-50

Carbohydrates and fiber ,[object Object],[object Object],[object Object],[object Object]

Carbohydrates and fiber ,[object Object],[object Object],[object Object],[object Object],[object Object]

Fiber and complex carbohydrates ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Proteins ,[object Object],[object Object],[object Object],[object Object],[object Object]

Fat Recommendations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Fat Recommendations ,[object Object],[object Object],[object Object],[object Object]

Fats Saturated fatty acids (SFA) LDL, Cholesterol Monounsaturated fatty acids (MUFA) (Oleic acid) When substituted for SFA LDL with no VLDL TG Polyunsaturated fatty acids (PUFA) Linoleic acid (LA) n6 LDL (Upto 12 En %) > HDL Alpha Linolenic acid (ALNA) n3 TG LDL Trans fatty acids LDL and HDL (hydrogenation)

Recommended Oils ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Food-Based Guidelines to Ensure Optimal Fat Quality in Asian Indian Diets: ,[object Object],[object Object],[object Object],[object Object],[object Object]

Food-Based Guidelines to Ensure Optimal Fat Quality in Asian Indian Diets: ,[object Object],[object Object],[object Object],[object Object]

Food-Based Guidelines to Ensure Optimal Fat Quality in Asian Indian Diets: ,[object Object],[object Object]

Other Nutrients ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Dietary Guidelines (Food Groups) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Other Dietary Habits ,[object Object],[object Object],[object Object],[object Object],[object Object]

Other Dietary Habits ,[object Object],[object Object],[object Object],[object Object]

Look in to our future ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Realistic approach to diet prescription ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Physical Activity Prescription for Aerobic and Muscle Strengthening Exercises Consensus Statement for Diagnosis of Obesity, Abdominal Obesity and the Metabolic Syndrome for Asian Indians and Recommendations for Physical Activity, Medical and Surgical Management JAPI • VOL. 57 • FEBRUARY 2009 www.japi.org Exercises Moderate intensity Vigorous intensity Type of physical activity Modality Duration Frequency/ days per week Modality Duration/ repetitions Frequency/week Aerobic physical activity Brisk walking, stair climbing, jogging(4-7m/sec), cycling, treadmill and swimming 30 min 5 Football, badminton, basketball, running, rope jumping, dancing 20 min 3 days Muscle strengthening activity Resistance weight training, curls, presses, anti-gravity exercise, isometric exercise Children-Body weight activity (Pull ups) 1-3 sets of 8-12 repetitions targeting major muscle groups 2-3 Resistance training, curls, presses, anti gravity exercise, isometric exercise Children- Body weight activity (Pull ups) >3 sets of >12 repetitions targeting major muscle groups 2-3 days

Conclusion ,[object Object],[object Object],[object Object],[object Object],[object Object]

Conclusion 6 . MUFA is beneficial 7 . Mixed oils should be used to achieve N6/N3 fatty acid ratio (5-10) 8 . Avoid SFA and TFA 9 . Omega 3 should be encouraged 10 . Increased physical activity and Regular exercise is essential

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Metabolic Syndrome and Dietary Guidelines for its prevention

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