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METABOLIC SYNDROME

RISK FACTORS LINKED TO CARDIO VASCULAR DISEASE

DIETARY MANAGEMENT

Arsiniati M.Brata-Arbai
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 more in men


Pear shape more in women

Waist Circumference (cm)


Male Female
Europids 94 80
South 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 fruit
Mid 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


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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