The patient presented in this case suffers from metabolic syndrome. The metabolic syndrome is a cluster of health problems that is associated with the presence of obesity and tissues resistance to insulin. The metabolic syndrome is a condition that causes a myriad of problems in the body such that the body becomes incapable of maintaining the circulation of the useful energy molecules such as glucose and lipids in the right quantities in the bloodstream (Huang, 2009). Other associated disorders of metabolic syndrome include high blood pressure and dyslipidemia. The lipid problem is characterized by elevated levels of triglycerides and low concentrations of high-density lipoproteins. The major causes of metabolic syndrome include sedentary lifestyle, obesity, and genetic factors (Huang, 2009). When the problems mentioned above interact with one another, they worsen the health of the body. Ultimately, the set of the health problems becomes severe to lead to serious health consequences. The patient in the case study suffers from metabolic syndrome, and it predisposes her to the risk of cardiovascular disease, coronary artery disease, stroke, and diabetes.
The metabolic syndrome seems not to have a particular cause, and it does not involve a specific organ or system. It appears to arise from the interaction of a myriad of disorders that have different origins. Currently, it is believed that insulin resistance and obesity are the major problems underlying the metabolic syndrome; these two problems can develop independently. If metabolic syndrome remains untreated, it can lead to the development of type 2 diabetes and cardiovascular disease. The condition of insulin resistance is prevalent among the people with obesity, coronary heart disease, and lipid disorders. Insulin resistance is also prevalent among women with the polycystic ovarian syndrome characterized by the absence of menstruation, obesity, and sterility (Kaur, 2014). Metabolic syndrome is primarily caused by the resistance of the body tissues to the insulin. Pancreas is the primary organ that secretes insulin. The insulin affects the functions of the skeletal muscle, the liver, and the adipose tissue. In the skeletal muscle, insulin stimulates the uptake of glucose through the glucose transporter 4. The insulin is also important in stimulating glycogen synthesis and inhibits glycogen breakdown. Also, insulin inhibits gluconeogenesis in the liver and lipolysis in the adipose tissue. Metabolic syndrome interferes with the response of the skeletal muscle, the adipose tissue, and the liver to the effects of insulin (Kaur, 2014). The insulin resistance causes atherogenic dyslipidemia, whereby the impaired insulin signaling promotes lipid breakdown, resulting in increased levels of free fatty acids. The liver uses the free fatty acids to manufacture triglycerides and stabilize the synthesis of Apoprotein B, which is the major lipoprotein in the very-low-density lipoprotein.
The most common symptoms of metabolic syndrome include insulin resistance, abdominal obesity, and fatty liver hepatitis (Kaur, 2014). Obesity, particularly in the abdominal area is linked to insulin resistance that impairs the utilization of peripheral glucose and fatty acid; which often cause type 2 diabetes mellitus. The associated hyperinsulinemia, hyperglycemia, and adipokines may lead to dyslipidemia, vascular inflammation, hypertension, and vascular endothelial dysfunction, all which may exacerbate peripheral insulin resistance (Kaur, 2014). Fat accumulation in the liver also characterizes metabolic syndrome, and it results in the inflammation of the hepatocytes. Furthermore, the condition is also characterized by polycystic ovary syndrome and sleep apnea. Metabolic syndrome also predisposes to depression. Research conducted by Garbarino, & Magnavita (2015) showed that work-related stress can cause higher levels of triglycerides and low level of HDL cholesterol. The high levels of stress proved to be an increased risk factor for developing metabolic syndrome. Therefore, work-related stress can induce metabolic syndrome particularly through its influence on the blood lipid profiles. The woman in the case also suffers from psychological stress due to her incapability to conceive. Lloyd, Smith, & Weinger, (2013). Articulated that psychological distress activates the Hypothalamic-Pituitary-Adrenal Axis that consequently leads to a cascade of endocrine abnormalities, most notably, low sex-steroid levels that antagonize the insulin action.
Metabolic syndrome has various predictive diagnostic biomarkers. The indicators include measurements of the amount of lipids, cholesterol, urine albumin levels. The American Heart Association and the National Heart, Lung, and Blood Institute illustrate that at least three of the following conditions merit the diagnosis of metabolic syndrome:
Blood pressure exceeding or equal to 130/85 mm Hg
Triglyceride concentrations greater than 150mg/dl
High-Density Cholesterol that is below 40 mg/dl in men and 50 mg/dl in women
Waist circumference that equals to or exceeds 102 cm in men, and 88 cm in women.
Diet Recommendation
It is advisable to the patient to avoid the fatty foods and sugary substances. Under this situation, we well know our patient have a craving for salty and junk food products. These foods are loaded with saturated and trans-fatty acids that enhance insulin resistance.
The patient can replace the saturated and trans-fat diet with healthier dietary fat rich in monounsaturated, polyunsaturated fats, and omega-3 fatty acids. Eating a diet rich in monounsaturated fats other than a diet of highly refined carbohydrates improves the blood HDL cholesterol levels and reduces the levels of the harmful LDL cholesterol.
Research conducted by (Pereira et al., 2009) also shows that the monounsaturated fatty acids have the potential to benefit the levels of insulin and sugar control, hence alleviating the severity of the metabolic syndrome.
The polyunsaturated fatty acids also contain omega-3 fatty acids such as alpha-linolenic acid which are beneficial to the heart. The omega-3 fatty acids found in vegetable oils such corn oil, sunflower oil, and soybean decrease the risk coronary heart disease. Also, the omega-3 fatty acids reduce blood pressure, lower triglyceride, and raise HDL levels, a phenomenon that alleviates the adverse symptoms metabolic syndrome.
Furthermore, I would recommend less-starchy carbohydrate diets such as whole grains, nuts, green leafy vegetable, and legumes instead of fruit juices, refined carbohydrates, and junk foodstuffs. The less starchy diets mentioned above have been shown to have direct and independent beneficial effects on the metabolism of insulin and glucose.
Also, I would strongly recommend a diet rich in potassium, calcium, and magnesium, and minimal sodium to lower the blood pressure.
The patient should also avoid the following triggering foodstuffs
Avoid trans-fat
Avoid highly processed foods
Avoid deep-fried foodstuffs
Avoid salted junk foods
Avoid skipping breakfast
A sample Daily Dietary Plan
Rationale for the above Dietary Plan
The whole grain cereals provide fiber and are slow-releasing foods that will provide calories for an extended period and will prevent the patient from snacking in between the meals. The lunch meal comprising of fresh fruits or fresh vegetable salads contain fiber that would make the patient feel fuller for longer and protect against metabolic syndrome. A supper meal of sardines or mackerel will provide the polyunsaturated fatty acids that will improve the patient’s blood lipid profiles.
Supplements Recommendation
I would recommend fish oil to the patient as an excellent supplement. The fish oils namely, Docosahexanoic Acid and Eicosapentaenoic Acids are proved by the FDA to lower the triglycerides (Smith, 2013).
I would also recommend fibrate supplements which are potent Peroxisomal Proliferator Activator Receptor-alpha agonists. The fibrate supplements would activate the PPAR-alpha to transcribe proteins that are essential for the uptake and metabolism of fatty acids in the skeletal muscle and the liver (Chai, & Choudhury, 2013).
Moreover, fibrates have been shown to activate PPAR-Alpha, which induces the expression of lipoprotein lipase. The lipoprotein lipase enzyme hydrolyzes the circulating lipoproteins rich in triglyceride.
The fibrates’ activation of the PPAR-alpha also represses the expression of Apolipoprotein CIII, thereby boosting the activity of lipoprotein lipase.
The activation of PPAR-alpha by the fibrate supplements would also upregulate the transcription of the principal HDL apolipoproteins such as ApoAI and ApoAII. In this way, the fibrate supplements raise the plasma levels of HDL cholesterol and reduces the levels of the plasma triglycerides (Chai, & Choudhury, 2013).
I would also recommend niacin for treating dyslipidemia. Niacin is an excellent supplement for raising the lowered HDL cholesterol. As compared to other supplements like statins and fibric acid, niacin achieves the greatest increase in plasma HDL cholesterol.
Lifestyle Recommendation
Lifestyle changes are the most healthy lifestyle modification for a patient with elevated levels of triglyceride and low HDL cholesterol.
I would recommend discontinuation of all beverages containing sugar to the patient, particularly the fruit juices that supply fructose, a precursor for fatty acid synthesis (Smith, 2013). The patient should stop the consumption of sugar-based beverages and substitute them with sugar-free beverages or water.
In addition, I would recommend regular exercise to the patient as opposed to the sedentary lifestyle that the patient leads. Instead of participating in the cross country a few times in a year, I would advise the patient to have a scheduled exercise program of at least thrice a week. The acute exercise has adverse effects on the muscle cells because it generates reactive species and inflammatory cytokines as reported by (Berk et al., 2013). Moreover, the intermittent physical exercises cause the contracting skeletal muscles to release myokines like interleukin-6 which has a systemic impact on the metabolism of glucose and lipids.
The significance of regular exercise cannot be underestimated. The regular exercise downregulates the systemic inflammation associated with insulin resistance through homeostatic adaptation (Berk et al., 2013).
Undertaking regular physical exercise will also alleviate the psychological stress of the patient by downregulating the leptin levels, which are implicated in the development of depression.
The exercise will increase the activity of the lipoprotein lipase which breaks down the circulating triglycerides for storage in muscles and adipose tissue (Smith, 2013).
A weight loss program would be beneficial to the patient. Weight loss is essential in that it will help the patient lose intra-abdominal fat and curb liver’s synthesis of triglycerides and VLDL particles. Adopting such positive lifestyles will reduce the triglycerides and the patient will appreciate the benefits of lifestyle change.
Limitations
Dietary interventions and adopting a comprehensive positive lifestyle modification program provide a sustained weight loss if faithfully adhered to. Pharmacotherapy interventions involving the use of supplements can potentiate weight loss, only in conjunction with a comprehensive weight management program. The drug therapy should only be recommended under the guidance of a qualified physician to treat the aspects of the metabolic syndrome that do not improve with therapeutic dietary and lifestyle changes.
References
Berk, M., Williams, L., Jacka, F., O’Neil, A., Pasco, J., & Moylan, S. et al. (2013). So Depression is an Inflammatory Disease, but where does the Inflammation Come from? BMC Medicine, 11(1), 1. http://dx.doi.org/10.1186/1741-7015-11-200
Chai, J. T., & Choudhury, R. P. (2013). Cardiometabolic Interventions – Focus on Transcriptional Regulators. The European Journal of Cardiovascular Medicine, 2(3), 212–218. http://doi.org/10.5083/ejcm.20424884.102
Garbarino, S. & Magnavita, N. (2015). Work Stress and Metabolic Syndrome in Police Officers. A Prospective Study. PLOS ONE, 10(12), e0144318. http://dx.doi.org/10.1371/journal.pone.0144318
Huang, P. L. (2009). A comprehensive Definition for Metabolic Syndrome. Disease Models & Mechanisms, 2(5-6), 231–237. http://doi.org/10.1242/dmm.001180
Kaur, J. (2014). A Comprehensive Review on Metabolic Syndrome. Cardiology Research and Practice, 2014, 943162. http://doi.org/10.1155/2014/943162
Lloyd, C., Smith, J., & Weinger, K. (2013). Stress and diabetes: a review of the links. Diabetes Spectrum, 18(2), 121-127.
Pereira, M. A., Kottke, T. E., Jordan, C., O’Connor, P. J., Pronk, N. P., & Carreón, R. (2009). Preventing and Managing Cardiometabolic Risk: The Logic for Intervention. International journal of environmental research and public health, 6(10), 2568-2584.
Smith, D. (2013). Focus on Cardiometabolic Risk. Consultant, 53(3), 137-144. Retrieved from http://www.consultant360.com/article/dyslipidemia-type-2-diabetes-treatment-strategies
