Effectiveness of a lifestyle intervention on metabolic syndrome. A randomized controlled trial.

BACKGROUND: Intensive lifestyle intervention significantly reduces the progression to diabetes in high-risk individuals. OBJECTIVE: It is not known whether a program of moderate intervention might effectively reduce metabolic abnormalities in the general population. DESIGN: Two-arm randomized controlled 1-year trial. PATIENTS: Three hundred and thirty-five patients participated from a dysmetabolic population-based cohort of 375 adults aged 45-64 years in northwestern Italy. MEASUREMENTS: We compared the effectiveness of a general recommendation-based program of lifestyle intervention carried out by trained professionals versus standard unstructured information given by family physicians at reducing the prevalence of multiple metabolic and inflammatory abnormalities. RESULTS: At baseline, clinical/anthropometric/laboratory and lifestyle characteristics of the intervention (n = 169) and control (n = 166) groups were not significantly different. The former significantly reduced total/saturated fat intake and increased polyunsaturated fat/fiber intake and exercise level compared to the controls. Weight, waist circumference, high-sensitivity C-reactive protein, and most of the metabolic syndrome components decreased in the intervention group and increased in the controls after 12 months. Lifestyle intervention significantly reduced metabolic syndrome (odds ratio [OR] = 0.28; 95% CI 0.18-0.44), with a 31% (21-41) absolute risk reduction, corresponding to 3.2 (2-5) patients needing to be treated to prevent 1 case after 12 months. The intervention significantly reduced the prevalence of central obesity (OR = 0.33; 0.20-0.56), and hypertriglyceridemia (OR = 0.48; 0.31-0.75) and the incidence of diabetes (OR = 0.23; 0.06-0.85). CONCLUSION: A lifestyle intervention based on general recommendations was effective in reducing multiple metabolic/inflammatory abnormalities. The usual care by family physicians was ineffective at modifying progressive metabolic deterioration in high-risk individuals.

The metabolic syndrome and high C-reactive protein: prevalence and differences by sex in a southern-European population-based cohort.

BACKGROUND: To evaluate the prevalence of the metabolic syndrome (MS) and its components in a population-based cohort, and to analyse the association between gender, environmental conditions, C-reactive protein (CRP), and the syndrome. METHODS: Out of 1877 subjects aged 45-64, who represented all the patients of six family physicians, representative of the sanitary districts of Asti (north-western Italy), 88% accepted to participate in an interview on personal habits, and several clinical and laboratory measurements. RESULTS: The MS (National Cholesterol Education Program criteria) was present in 24% of males and 22% of females. Males had a significantly higher percentage of hyperglycaemia, hypertension, hypertriglyceridemia, whereas females had a higher prevalence of central obesity and low HDL-cholesterol. In a multiple logistic regression model, the MS was significantly associated with increasing age, BMI, and >30 g/day alcohol intake (OR = 1.42; 95% CI 1.27-1.58), and negatively to higher education level (OR = 0.52; 95% CI 0.28-0.99) and moderate exercise (OR = 0.65; 95% CI 0.57-0.76). CRP levels are highly correlated to BMI and the components of the syndrome. The association between CRP and the MS remains significant in women only, in a multivariate analysis, after multiple adjustments (OR = 1.73; 95% CI 1.42-2.11). Higher CRP levels, correlated to smoking and, inversely, to alcohol intake, identify a further 12% of the cohort at higher cardiovascular risk. CONCLUSIONS: The MS affects more than 20% of this middle-aged cohort, but more than 30%, with higher CRP levels are at high cardiovascular risk. Healthier lifestyle habits are inversely associated with the MS and CRP levels, suggesting the need for strategies and their implementation in the general population.