Lifestyle modification for metabolic syndrome: a systematic review.

BACKGROUND All 5 components of metabolic syndrome have been shown to improve with lifestyle and diet modification. New strategies for achieving adherence to meaningful lifestyle change are needed to optimize atherosclerotic cardiovascular risk reduction. We performed a systematic literature review, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework (PRISMA), investigating optimal methods for achieving lifestyle change in metabolic syndrome. METHODS We submitted standardized search terms to the PubMed Central, CINAHL, Web of Science, and Ovid databases. Within those results, we selected randomized controlled trials (RCTs) presenting unique methods of achieving lifestyle change in patients with one or more components of the metabolic syndrome. Data extraction using the population, intervention, comparator, outcome, and risk of bias framework (PICO) was used to compare the following endpoints: prevalence of metabolic syndrome, prevalence of individual metabolic syndrome components, mean number of metabolic syndrome components, and amount of weight loss achieved. RESULTS Twenty-eight RCTs (6372 patients) were included. Eight RCTs demonstrated improvement in metabolic syndrome risk factors after 1 year. Team-based, interactive approaches with high-frequency contact with patients who are motivated made the largest and most lasting impact. Technology was found to be a useful tool in achieving lifestyle change, but ineffective when compared with personal contact. CONCLUSION Patient motivation leading to improved lifestyle adherence is a key factor in achieving reduction in metabolic syndrome components. These elements can be enhanced via frequent encounters with the health care system. Use of technologies such as mobile and Internet-based communication can increase the effectiveness of lifestyle change in metabolic syndrome, but should not replace personal contact as the cornerstone of therapy. Our ability to derive quantitative conclusions is limited by inconsistent outcome measures across studies, low power and homogeneity of individual studies, largely motivated study populations, short follow-up periods, loss to follow-up, and lack of or incomplete blinding.

[1]  K. Kukkonen-Harjula,et al.  Effects of a weight maintenance program with or without exercise on the metabolic syndrome: a randomized trial in obese men. , 2005, Preventive medicine.

[2]  H. Okumura,et al.  Effect of a worksite-based intervention program on metabolic parameters in middle-aged male white-collar workers: a randomized controlled trial. , 2010, Preventive medicine.

[3]  J. Buckley,et al.  Self-management for obesity and cardio-metabolic fitness: Description and evaluation of the lifestyle modification program of a randomised controlled trial , 2008, The international journal of behavioral nutrition and physical activity.

[4]  P. Libby,et al.  Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial , 2012, The Lancet.

[5]  R. Gerber,et al.  Comparison of Methods for Delivering a Lifestyle Modification Program for Obese Patients , 2009, Annals of Internal Medicine.

[6]  T. Toyonaga,et al.  Repeated counselling improves the antidiabetic effects of limited individualized lifestyle guidance in metabolic syndrome: J-STOP-METS final results , 2011, Hypertension Research.

[7]  Donald A Williamson,et al.  Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. , 2009, The New England journal of medicine.

[8]  S. Fowler,et al.  Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. , 2002 .

[9]  Arlen C. Moller,et al.  Multiple behavior changes in diet and activity: a randomized controlled trial using mobile technology. , 2012, Archives of internal medicine.

[10]  D. Moher,et al.  Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement , 2009, BMJ : British Medical Journal.

[11]  E. Ford.  Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. , 2005, Diabetes care.

[12]  E. Feskens,et al.  Prevention of the metabolic syndrome in IGT subjects in a lifestyle intervention: results from the SLIM study. , 2013, Nutrition, metabolism, and cardiovascular diseases : NMCD.

[13]  C. Stefanadis,et al.  Telephone counseling intervention improves dietary habits and metabolic parameters of patients with the metabolic syndrome: a randomized controlled trial. , 2012, The review of diabetic studies : RDS.

[14]  E. Araki,et al.  The effect of group‐based lifestyle interventions on risk factors and insulin resistance in subjects at risk for metabolic syndrome: the Tabaruzaka Study 1 , 2010, Diabetes, obesity & metabolism.

[15]  Alan Bauck,et al.  Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial. , 2008, JAMA.

[16]  M. Morey,et al.  Enhanced Fitness: A Randomized Controlled Trial of the Effects of Home‐Based Physical Activity Counseling on Glycemic Control in Older Adults with Prediabetes Mellitus , 2012, Journal of the American Geriatrics Society.

[17]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement , 2009, BMJ : British Medical Journal.

[18]  S. Grundy.  Point: the metabolic syndrome still lives. , 2005, Clinical chemistry.

[19]  K. Igarashi,et al.  Effects of exercise in overweight Japanese with multiple cardiovascular risk factors. , 2007, Medicine and science in sports and exercise.

[20]  J. Griffith,et al.  Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. , 2005, JAMA.

[21]  J. Sterne,et al.  The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials , 2011, BMJ : British Medical Journal.

[22]  Y. Wu,et al.  Home-based exercise for middle-aged Chinese at diabetic risk: a randomized controlled trial. , 2011, Preventive medicine.

[23]  J. Kampert,et al.  Comparison of lifestyle and structured interventions to increase physical activity and cardiorespiratory fitness: a randomized trial. , 1999, JAMA.

[24]  W. Riley,et al.  College Smoking-Cessation Using Cell Phone Text Messaging , 2004, Journal of American college health : J of ACH.

[25]  M. Cassader,et al.  Effectiveness of a Lifestyle Intervention on Metabolic Syndrome. A Randomized Controlled Trial , 2007, Journal of General Internal Medicine.

[26]  R. Cox,et al.  Exercise and the metabolic syndrome with weight regain. , 2009, Journal of applied physiology.

[27]  W. Kalender,et al.  Exercise decreases the risk of metabolic syndrome in elderly females. , 2009, Medicine and science in sports and exercise.

[28]  J. Jeon,et al.  Effects of a 6-month lifestyle modification intervention on the cardiometabolic risk factors and health-related qualities of life in women with metabolic syndrome. , 2010, Metabolism: clinical and experimental.

[29]  J. Wylie-Rosett,et al.  Short and long-term lifestyle coaching approaches used to address diverse participant barriers to weight loss and physical activity adherence , 2014, International Journal of Behavioral Nutrition and Physical Activity.

[30]  Claude Lenfant,et al.  Definition of Metabolic Syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on Scientific Issues Related to Definition , 2004, Arteriosclerosis, thrombosis, and vascular biology.

[31]  P. Lavori,et al.  Translating the Diabetes Prevention Program Lifestyle Intervention for Weight Loss into Primary Care a Randomized Trial , 2022 .

[32]  A. Stunkard,et al.  The results of treatment for obesity: a review of the literature and report of a series. , 1959, A.M.A. archives of internal medicine.

[33]  G. Liguori,et al.  Persistent Increase of Prevalence of Metabolic Syndrome Among U.S. Adults: NHANES III to NHANES 1999–2006 , 2010, Diabetes Care.

[34]  Fernando Costa,et al.  Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. , 2005, Circulation.

[35]  Luiz Carlos Bodanese,et al.  Intervenção nutricional e o impacto na adesão ao tratamento em pacientes com síndrome Metabólica , 2011 .

[36]  T. Mizoue,et al.  Effect of Six Months Lifestyle Intervention in Japanese Men with Metabolic Syndrome: Randomized Controlled Trial , 2012, Journal of occupational health.

[37]  Lee-Ing Tsao,et al.  An Internet-based health management platform may effectively reduce the risk factors of metabolic syndrome among career women. , 2013, Taiwanese journal of obstetrics & gynecology.

[38]  V. Franklin,et al.  A randomized controlled trial of Sweet Talk, a text‐messaging system to support young people with diabetes , 2006, Diabetic medicine : a journal of the British Diabetic Association.

[39]  Philip C. Morin,et al.  Weight Loss Success in Metabolic Syndrome by Telephone Interventions: Results from the SHINE Study , 2013, Journal of General Internal Medicine.

[40]  K. Patrick,et al.  A Text Message–Based Intervention for Weight Loss: Randomized Controlled Trial , 2009, Journal of medical Internet research.

[41]  T. Omatsu,et al.  The Metabolic Syndrome as a Predictor of Nonalcoholic Fatty Liver Disease , 2006, Annals of Internal Medicine.

[42]  J. Kassirer,et al.  Losing weight--an ill-fated New Year's resolution. , 1998, The New England journal of medicine.

[43]  J. Rippe,et al.  Body composition, dietary composition, and components of metabolic syndrome in overweight and obese adults after a 12-week trial on dietary treatments focused on portion control, energy density, or glycemic index , 2012, Nutrition Journal.

[44]  D. Jacobs,et al.  Association of 1-y changes in diet pattern with cardiovascular disease risk factors and adipokines: results from the 1-y randomized Oslo Diet and Exercise Study. , 2009, The American journal of clinical nutrition.

[45]  D. Tate,et al.  Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based study , 2006, BMJ : British Medical Journal.