METABOLIC SYNDROME

RISK FACTORS LINKED TO CARDIO VASCULAR DISEASE

DIETARY MANAGEMENT

Arsiniati M.Brata-ArbaiEmail: arsiniati2006@yahoo.co.idHP 0818522463

Cardio Vascular Disease (CVD)

- disease of the heart & blood vesels - disease of the arteries of the heart is called: coronary heart diseaese (CHD) - atherosclerosis hardening of the arteries root forms of CVD

CHD - is a major public health problem - a contrubutor to mortality and morbidity in westernised countries as well as in countries undergoing economic transition (Yogiantoro, 2005). Prevalence of CVD - USA 61 million men & women - Indonesia CVD main cause of death ranked 1972 11 1986 3 1992 1

METABOLIC SYNDROME (THE METS)

WHO, 1998: Metabolic Syndrome (MetS): are cluster of risk factors linked to CVD

ATP ( Adult Treatment Panel) III, 2001 : 1. Abdominal obesity (central obesity) 2. Atherogenic dislipidemia 3. Raised blood pressure 4. Insuline resistance 5. Proinflammatory state 6. Protrombic state

Beyond these components, individuals with MetS are suspectable to other conditions

7. Vascular abnormalities 8. Hyperuricaemia 9. Adrenal incidentaloma (increase cortisol secretion) 10.Fatty liver ( fatty disposition) (Askandar, 2005)

OBESITY a state in which an excess of fat accumulate Grade I : Their overweight does not affected their health, they are able to lead their normal life Grade II : reduced exercise tolerance, shorteness of breath on exertion

At increase risk of of one or more of the disorders *

Grade III - these are pathetic patients - their activities are restricted by their enormous mass - have serious psychological disturbances - suffering from many of of the disorders * - life expectation is low

* Diabetes Mellitus, hypertension,gall blader disease, fatty liver, gout, pulmonary disorders,osteoarthritis,hernias, varicouse veins, dermatitis.

Abdominal obesity (central obesity) Elevated waist circumference

Obesity: Apple shape , Android ( more in men) Pear shape , Gynoid ( more in women) Waist Circumference (cm) Male Female Europids 94 80South Asian 90 80

CRITERIA FOR CLINICAL DIAGNOSIS OF METS (Grundy et al , 2005)

3 out of 5 diagnostic: 1.Abdominal obesity: Men > 90 cm Women > 80 cm 2. Serum Trigliceride 150 mg/dl 3. Serum HDL Cholesterol: Men < 40 mg/dl Women < 50 mg/dl 4. Blood pressure 130 / 85 5. Fasting Glucose 110 mg/dl

THERAPEUTIC INTERVENTION FOR METS Weight management BMI = weight (kg) / height (m2) < 18.5 underweight 18.5 24.9 healthy/low health risk > 25 overweight/ increase risk of disease > 30 obese (class 1) increase risk of disease > 35 obese (class II) higher risk of disease > 40 extremely or morbidly obese (class III) (Sareen, 2005)

I. Dietary approach

normal healthy adult consume 2000 kcal / day

- Very low Calorie Diet 800 kcal/day - Moderateay Low calorie Balanced Diet 1000 kcal / day protein 65 gram, fat 35 gram adequate in all other nutrients

Sample of daily menu

Breakfast: - small glass unsweetened fruit juice - 1 egg boiled/scrambled or grill bacon - 20 gram unsweeted cereal or 120 poridge with milk or - 20 gram bread with butter - coffee or tea without sugar with milk Mid morning: coffee or tea no sugar , milk from allowance

Midday meal: - clear soup, - 2 slied of bread - 60 gram chicken or tuna, - small salad / vegetable - 1 serving of fruitMid afternoon : coffee or tea no sugar Evening meal : - 60 gram chicken or tuna, - 2 small boiled potatoes - salad / vegetable

Allowances: - 300 ml skim milk - 15 gram butter

These group of food contain 1. 175 kcal, 4 gram protein, 40 gram carbohydrate 100 gram of rice , 70 gram of white bread 210 gram potatoes

2. 50 kcal, 7 gram of protein ,2 gram fat 40 gram chicken, 40 gram meat 35 gram fish, 15 gram salty fish

3. 75 kcal,7 gram protein, 5 gram fat 55 gram chicken egg, 50 gram duck egg

II PHYSICAL ACTIVITY Physical activity provides the advantages of - cardio vascular condition - insuline sensitivity. - mantaning muscle mass - bone density Aerobic exercises - walking - swimming - bycycling 20 minutes several times a week

Aerobic exercises - walking - swimming - bycycling 20 minutes several times a week

III. Behavioral Modification and Psychological support

1. Focus on method of acquiring new behavior 2. Self monitoring 3. Guidelines for maintaning weight loss

CONCLUSSION

METS MANAGEMENT: 1.DIET 2. PHYSICAL ACTIVITY 3.BEHAVIORAL MODIFICATION

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