METABOLIC SYNDROME

RISK FACTORS LINKED TO CARDIO VASCULAR

DISEAESE & 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 problems
- 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

* DM, 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 (male)

Pear shape, Gynoid (female)

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 Trigliseride ≥ 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

1. Weight management
BMI = weight (kg) / height2 (m)

< 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)
2. LOW CALORY DIET

normal healthy adult consume 2000 kcal / day

low calory diet restriction of calory to

1000 kcal / day
protein 65 gram, fat 35 gram
adequat 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, - smal 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
3. 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
4. Behavioral Modification and
Psychological support
1. Focus on method of acquiring new
behavior
2. Self monitoring
3.Guidelines for maintaning weight loss
A study Health Belief Model (HBM)
WEIGHT MANAGEMENT

DIET
PHYSICAL ACTIVITY
BEHAVIORAL MODIFICATION
 METABOLIC SYNDROME
RISK FACTORS & MANAGEMENT
Arsiniati M.Brata-Arbai
Fac of Medicine, Hang Tuah University, Surabaya
Abstract
WHO, 1998:
Metabolic Syndrome (MetS): are cluster of risk factors linked to CVD
Criteria for clinical diagnosis of MetS (Grundy et al , 2005 , from Askandar)
3 out of 5 diagnostic:
1 Abdominal obesity: Men > 90 cm, Women > 80 cm
2. Serum Trigliseride ≥ 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
Management:
* DIET, Low Calori, Low fat
* PHYSICAL ACTIVITY : Aerobic exercises
- walking, - swimming, - becycling
- 20 -30 minutes , 2-3 times a week
* BEHAVIORAL MODIFICATION : Health Bleieve Model