Internal and Emergency Medicine

, Volume 3, Issue 2, pp 87–98 | Cite as

Optimizing management of metabolic syndrome to reduce risk: focus on life-style

  • Cristina Bianchi
  • Giuseppe Penno
  • Giuseppe Daniele
  • Luca Benzi
  • Stefano Del Prato
  • Roberto MiccoliEmail author
IM - Review


The prevalence of metabolic syndrome (MS) is increasing all over the world and its incidence is expected to rise in the next years. Although genetic predisposition appears to play an important role in the regulation of metabolic parameters and in particular of body weight, the rapid increase in the prevalence of obesity and MS suggests that ecological factors (social, economic, cultural and physical environment) are promoting those conditions in susceptible individuals. People with MS are at increased risk of type 2 diabetes and cardiovascular disease and therefore they represent a priority target for preventive strategies. Life-style modifications based on healthy diet and increased physical activity are an effective preventing and therapeutic approach. Unfortunately, implementation of life-style modification and maintenance of effects is a difficult task both at personal and social level, thus drug therapy can be taken into account.


Metabolic syndrome Life-style Insulin-resistance Type 2 diabetes Cardiovascular disease 


  1. 1.
    Eckel RH, Grundy SM, Zimmet PZ (2005) The metabolic syndrome. Lancet 365:1415–1428PubMedGoogle Scholar
  2. 2.
    Ford ES (2005) Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome. A summary of the evidence. Diabetes Care 28:1769–1778PubMedGoogle Scholar
  3. 3.
    Lorenzo C, Williams K, Hunt KJ, Haffner SM (2006) Trend in the prevalence of the metabolic syndrome and its impact on cardiovascular disease incidence: the San Antonio Heart Study. Diabetes Care 29:625–630PubMedGoogle Scholar
  4. 4.
    Zhu S, St-Onge MP, Heshka S, Heymsfield SB (2004) Lifestyle behaviors associated with lower risk of having the metabolic syndrome. Metabolism 53:1503–1511PubMedGoogle Scholar
  5. 5.
    Webber LS, Bedimo-Rung AL (2005) The obesity epidemic: incidence and prevalence. J La State Med Soc 157:S3–S11PubMedGoogle Scholar
  6. 6.
    Bouchard C, Tremblay A (1997) Genetic influences on the response of body fat and fat distribution to positive and negative energy balances in human identical twins. J Nutr 127(suppl. 5):943S–947SPubMedGoogle Scholar
  7. 7.
    French SA, Story M, Jeffrey RW (2001) Environmental influences on eating and physical activity. Annu Rev Public Health 22:309–335PubMedGoogle Scholar
  8. 8.
    Schluter G, Lee C (1999) Changing food consumption patterns: their effects on the US food system, 1972–92. Food Rev 22:35–37Google Scholar
  9. 9.
    French SA (2003) Pricing effects on food choices. J Nutr 133:841S–3SPubMedGoogle Scholar
  10. 10.
    Drewnoski A (2003) Fat and sugar: an economic analysis. J Nutr 133:838S–840SGoogle Scholar
  11. 11.
    French SA, Lin BH, Guthrie JF (2003) National trend in soft drink consumption among children and adolescents age 6 to 17 years: prevalence, amounts, and sources, 1977/1978 to 1994/1998. J Am Diet Assoc 103:1326–1331PubMedGoogle Scholar
  12. 12.
    Bowman SA, Gortmaker SL, Ebbeling CB et al (2004) Effects of fast-food consumption on energy intake and diet quality among children in a national household survey. Pediatrics 113:112–118PubMedGoogle Scholar
  13. 13.
    French SA, Story M, Neumark-Sztainer D et al (2001) Fast food restaurant use among adolescents: Associations with nutrient intake, food choices and behavioral and psychosocial variables. Int J Obes Relat Metab Disord 25:1823–1833PubMedGoogle Scholar
  14. 14.
    Jahns L, Siega-Riz AM, Popkin BM (2001) The increasing prevalence of snacking among US children from 1977 to 1996. J Pediatr 138:493–498PubMedGoogle Scholar
  15. 15.
    Nielson SJ, Siega-Riz AM, Popkin BM (2002) Trends in food locations and sources among adolescents and young adults. Prev Med 35:107–113Google Scholar
  16. 16.
    Lin BH, Guthrie JF, Frazao E (1999) Nutrient contribution of food away from home. In: Frazao E (ed) America’s eating habits: changes and consequences. US Department of Agriculture, Washington pp 213–242Google Scholar
  17. 17.
    Thompson OM, Ballew C, Resnicow K, Must A, Bandini LG, Cyr H et al (2004) Food purchased away from home as a predictor of change in BMI z-scores among girls. Int J Obes 28:282–289Google Scholar
  18. 18.
    McCrory M, Fuss P, Hays N, Vinken A, Greenberg A, Roberts S (1999) Overeating in America: association between restaurant food consumption and body fatness in healthy men and women ages 19 to 80. Obes Res 7:564–571PubMedGoogle Scholar
  19. 19.
    Satia JA, Galanko J, Siega-Riz AM (2004) Eating at fast-food restaurants is associated with dietary intake, demographic, psychosocial and behavioural factors among African Americans in North Carolina. Pub Health Nutr 7:1089–1096Google Scholar
  20. 20.
    Haines PS, Hungerford DW, Popkin BM, Guilkey DK (1992) Eating patterns and energy and nutrient intakes of US women. J Am Diet Assoc 92:698–704PubMedGoogle Scholar
  21. 21.
    French S, Harnack L, Jeffery R (2000) Fast food restaurant use among women in the Pound of Prevention Study: dietary, behavioral and demographic correlates. Int J Obes Relat Metab Disord 24:1353–1359PubMedGoogle Scholar
  22. 22.
    Pereira MA, Kartashov AI, Ebbeling CB, Van Horn L, Slattery ML, Jacobs DR Jr, Ludwig DS (2005) Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis. Lancet 365:36–42. Erratum in: Lancet 365:1030 (2005)Google Scholar
  23. 23.
    Pereira MA, Kartashov AI, Ebbeling CB, Van Horn L, Slattery ML, Jacobs DR Jr, Ludwig DS (2005) Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis. Lancet 365:36–42. Erratum in: Lancet 365:1030 (2005)Google Scholar
  24. 24.
    van Dam RM, Grievink L, Ocke MC, Feskens EJ (2003) Patterns of food consumption and risk factors for cardiovascular disease in the general Dutch population. Am J Clin Nutr 77:1156–1163PubMedGoogle Scholar
  25. 25.
    Wirfalt E, Hedblad B, Gullberg B, Mattisson I, Andren C, Rosander U et al (2001) Food patterns and components of the metabolic syndrome in men and women: a cross-sectional study within the Malmo Diet and Cancer cohort. Am J Epidemiol 154:1150–1159PubMedGoogle Scholar
  26. 26.
    American Heart Association Nutrition Committee, Lichtenstein AH, Appel LJ, Brands M, Carnethon M, Daniels S, Franch HA, Franklin B, Kris-Etherton P, Harris WS, Howard B, Karanja N, Lefevre M, Rudel L, Sacks F, Van Horn L, Winston M, Wylie-Rosett J (2006) Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation 114:82–96Google Scholar
  27. 27.
    Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, Keinanen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M, Finnish Diabetes Prevention Study Group (2001) Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344:1343–1350PubMedGoogle Scholar
  28. 28.
    Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM, Diabetes Prevention Program Research Group (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346:393–403PubMedGoogle Scholar
  29. 29.
    Parillo M, Rivellese AA, Ciardullo AV, Capaldo B, Giacco A, Genovese S, Riccardi G (1992) A high-monounsaturated-fat/low-carbohydrate diet improves peripheral insulin sensitivity in non-insulin-dependent diabetic patients. Metabolism 41:1373–1378PubMedGoogle Scholar
  30. 30.
    Garg A, Grundy SM, Unger RH (1992) Comparison of effects of high and low carbohydrate diets on plasma lipoproteins and insulin sensitivity in patients with mild NIDDM. Diabetes 41:1278–1285PubMedGoogle Scholar
  31. 31.
    Obarzanek E, Sacks FM, Vollmer WM, Bray GA, Miller ER 3rd, Lin PH, Karanja NM, Most-Windhauser MM, Moore TJ, Swain JF, Bales CW, Proschan MA, DASH Research Group (2001) Effects on blood lipids of a blood pressure-lowering diet: the Dietary Approaches to Stop Hypertension (DASH) Trial. Am J Clin Nutr 74:80–89PubMedGoogle Scholar
  32. 32.
    Vessby B, Unsitupa M, Hermansen K, Riccardi G, Rivellese AA, Tapsell LC, Nalsen C, Berglund L, Louheranta A, Rasmussen BM, Calvert GD, Maffetone A, Pedersen E, Gustafsson IB, Storlien LH, KANWU Study (2001) Substituting dietary saturated for monounsaturated fat impairs insulin sensitivity in healthy men and women: the KANWU study. Diabetologia 44:312–319PubMedGoogle Scholar
  33. 33.
    Grundy SM, Abate N, Chandalia M (2002) Diet composition and the metabolic syndrome: what is the optimal fat intake? Am J Med 113(Suppl 9B):25S–29SPubMedGoogle Scholar
  34. 34.
    Lopez-Garcia E, Schulze MB, Meigs JB, Manson JE, Rifai N, Stampfer MJ, Willett WC, Hu FB (2005) Consumption of trans fatty acids is related to plasma biomarkers of inflammation and endothelial dysfunction. J Nutr 135:562–566PubMedGoogle Scholar
  35. 35.
    Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, D’Armiento M, D’Andrea F, Giugliano D (2004) Effect of a mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA 292:1440–1446PubMedGoogle Scholar
  36. 36.
    Appel LJ, Sacks FM, Carey VJ, Obarzanek E, Swain JF, Miller ER 3rd, Conlin PR, Erlinger TP, Rosner BA, Laranjo NM, Charleston J, McCarron P, Bishop LM, OmniHeart Collaborative Research Group (2005) Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. JAMA 294:2455–2464PubMedGoogle Scholar
  37. 37.
    Kiechl S, Willeit J, Poewe W, Egger G, Oberhollenzer F, Muggeo M, Bonora E (1996) Insulin sensitivity and regular alcohol consumption: large, prospective, cross sectional population study (Bruneck study). BMJ 313:1040–1044PubMedGoogle Scholar
  38. 38.
    Weickert MO, Mohlig M, Schofl C, Arafat AM, Otto B, Viehoff H, Koebnick C, Kohl A, Spranger J, Pfeiffer AF (2006) Cereal fiber improves whole-body insulin sensitivity in overweight and obese women. Diabetes Care 29:775–780PubMedGoogle Scholar
  39. 39.
    Brown L, Rosner B, Willett WW, Sacks FM (1999) Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J Clin Nutr 69:30–42PubMedGoogle Scholar
  40. 40.
    Parillo M, Giacco R, Ciardullo AV, Rivellese AA, Riccardi G (1996) Does a high-carbohydrate diet have different effects in NIDDM patients treated with diet alone or hypoglycemic drugs? Diabetes Care 19:498–500PubMedGoogle Scholar
  41. 41.
    de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N (1999) Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 99:779–785PubMedGoogle Scholar
  42. 42.
    Psota TL, Gebauer SK, Kris-Etherton P (2006) Dietary omega-3 fatty acid intake and cardiovascular risk. Am J Cardiol 98:3i–18iPubMedGoogle Scholar
  43. 43.
    Balk EM, Lichtenstein AH, Chung M, Kupelnick B, Chew P, Lau J (2006) Effects of omega-3 fatty acids on serum markers of cardiovascular disease risk: a systematic review. Atherosclerosis 189:19–30PubMedGoogle Scholar
  44. 44.
    Giugliano D, Ceriello A, Esposito K (2006) The effects of diet on inflammation: emphasis on the metabolic syndrome. J Am Coll Cardiol 48:677–685PubMedGoogle Scholar
  45. 45.
    Hu FB, Li TY, Colditz GA, Willett WC, Manson JE (2003) Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. JAMA 289:1785–1791PubMedGoogle Scholar
  46. 46.
    Henriksen EJ (2002) Invited review: Effects of acute exercise and exercise training on insulin resistance. J Appl Physiol 93:788–796PubMedGoogle Scholar
  47. 47.
    Whelton SP, Chin A, Xin X, He J (2002) Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med 136:493–503PubMedGoogle Scholar
  48. 48.
    Thompson PD, Rader DJ (2001) Does exercise increase HDL cholesterol in those who need it the most? Arterioscler Thromb Vasc Biol 21:1097–1098PubMedGoogle Scholar
  49. 49.
    Huttunen JK, Lansimies E, Voutilainen E, Ehnholm C, Hietanen E, Penttila I, Siitonen O, Rauramaa R (1979) Effect of moderate physical exercise on serum lipoproteins. A controlled clinical trial with special reference to serum high-density lipoproteins. Circulation 60:1220–1229PubMedGoogle Scholar
  50. 50.
    Hu FB, Willett WC, Li T, Stampfer MJ, Colditz GA, Manson JE (2004) Adiposity as compared with physical activity in predicting mortality among women. N Engl J Med 351(26):2694–703PubMedGoogle Scholar
  51. 51.
    Hu G, Jousilahti P, Borodulin K, Barengo NC, Lakka TA, Nissinen A, Tuomilehto J (2006) Occupational, commuting, leisure-time physical activity in relation to coronary heart disease among middle-aged Finnish men and women. Atherosclerosis 2006 (Epub ahead of print) PMID:16979645Google Scholar
  52. 52.
    Handy SL, Boarnet MG, Ewing R, Killingsworth RE (2002) How the built environment affects physical activity: Views from urban planning. Am J Prev Med 23:64–73PubMedGoogle Scholar
  53. 53.
    Saelens BE, Sallis JF, Frank LD (2003) Environmental correlates of walking and cycling: findings from the transportation, urban design, and planning literatures. Ann Behav Med 25:80–91PubMedGoogle Scholar
  54. 54.
    Burgeson CR, Wechsler H, Brener ND, Young JC, Spain CG (2001) Physical education and activity: Results from the School Health Policies and Programs Study 2000. J Sch Health 71:279–293PubMedCrossRefGoogle Scholar
  55. 55.
    Powell LM, Slater S, Chaloupka FJ (2004) The relationship between community physical activity settings and race, ethnicity and socioeconomic status. Evid Based Prev Med 1:135–144Google Scholar
  56. 56.
    Gorely T, Marshall SJ, Biddle SJH (2004) Couch kids: Correlates of television viewing among youth. Int J Behav Med 11:152–163PubMedGoogle Scholar
  57. 57.
    Carroll S, Dudfield M (2004) What is the relationship between exercise and metabolic abnormalities? A review of the metabolic syndrome. Sports Med 34:371– 418PubMedGoogle Scholar
  58. 58.
    Eriksson J, Taimela S, Koivisto VA (1997) Exercise and the metabolic syndrome. Diabetologia 40:125–135PubMedGoogle Scholar
  59. 59.
    Ford ES, Kohl HW 3rd, Mokdad AH, Ajani UA (2005) Sedentary behavior, physical activity, and the metabolic syndrome among U.S. adults. Obes Res 13:608–614PubMedCrossRefGoogle Scholar
  60. 60.
    Bertrais S, Beyeme-Ondoua JP, Czernichow S, Galan P, Hercberg S, Oppert JM (2005) Sedentary behaviors, physical activity, and metabolic syndrome in middle-aged French subjects. Obes Res 13:936–944PubMedGoogle Scholar
  61. 61.
    Stat bite: Trends in cigarette smoking among adults, 1965–2001. J Natl Cancer Inst (2004);96:506Google Scholar
  62. 62.
    Office on Smoking, Health, Division of Adolescent and School Health National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (2002) Trends in cigarette smoking among high school students–United States, 1991–2001. J Sch Health 72:226–228Google Scholar
  63. 63.
    Rohrmann S, Becker N, Kroke A, Boeing H (2003) Trends in cigarette smoking in the German centers of the European Prospective Investigation into Cancer, Nutrition (EPIC): the influence of the educational level. Prev Med 36:448–454PubMedGoogle Scholar
  64. 64.
    Giskes K, Kunst AE, Benach J, Borrell C, Costa G, Dahl E et al (2005) Trends in smoking behaviour between 1985 and 2000 in nine European countries by education. J Epidemiol Community Health 59:395–401PubMedGoogle Scholar
  65. 65.
    Dzien A, Dzien-Bischinger C, Hoppichler F, Lechleitner M (2004) The metabolic syndrome as a link between smoking and cardiovascular disease. Diabetes Obes Metab 6:127–132PubMedGoogle Scholar
  66. 66.
    Park YW, Zhu S, Palaniappan L, Heshka S, Carnethon MR, Heymsfield SB (2003) The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988–1994. Arch Intern Med 163:427–436PubMedGoogle Scholar
  67. 67.
    Lee WY, Jung CH, Park JS, Rhee EJ, Kim SW (2005) Effects of smoking, alcohol, exercise, education, and family history on the metabolic syndrome as defined by the ATP III. Diabetes Res Clin Pract 67:70–77PubMedGoogle Scholar
  68. 68.
    Frati AC, Iniestra F, Ariza CR (1996) Acute effect of cigarette smoking on glucose tolerance and other cardiovascular risk factors. Diabetes Care 19:112–118PubMedGoogle Scholar
  69. 69.
    Oh SW, Yoon YS, Lee ES, Kim WK, Park C, Lee S et al (2005) Association between cigarette smoking and metabolic syndrome: the Korea National Health and Nutrition Examination Survey (Brief Report). Diabetes Care 28:2064–2066PubMedGoogle Scholar
  70. 70.
    Laaksonen DE, Lakka HM, Niskanen LK, Kaplan GA, Salonen JT, Lakka TA (2002) Metabolic syndrome and development of diabetes mellitus: application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study. Am J Epidemiol 156:1070–1077PubMedGoogle Scholar
  71. 71.
    Stern MP, Williams K, Gonzalez-Villalpando C, Hunt KJ, Haffner SM (2004) Does the metabolic syndrome improve identification of individuals at risk of type 2 diabetes and/or cardiovascular disease? Diabetes Care 27:2676–2681PubMedGoogle Scholar
  72. 72.
    Miccoli R on behalf of the GENFIEV Study Group (2006) Relationship between insulin-resistance, metabolic syndrome and altered glucose tolerance. The GENFIEV Study. Diabetologia 49(Suppl 1):742Google Scholar
  73. 73.
    Ford ES (2005) Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. Diabetes Care 28:1769–1778PubMedGoogle Scholar
  74. 74.
    Grundy SM (2002) Obesity, metabolic syndrome, and coronary atherosclerosis. Circulation 105:2696–2698PubMedGoogle Scholar
  75. 75.
    Ridker PM, Buring JE, Cook NR, Rifai N (2003) C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14 719 initially healthy American women. Circulation 107:391–397PubMedGoogle Scholar
  76. 76.
    Creager MA, Luscher TF, Cosentino F, Beckman JA (2003) Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part I. Circulation 108:1527–1532PubMedGoogle Scholar
  77. 77.
    Ninomiya JK, L’Italien G, Criqui MH, Whyte JL, Gamst A, Chen RS (2003) Association of the metabolic syndrome with history of myocardial infarction and stroke in the Third National Health and Nutrition Examination Survey. Circulation 109:42–46PubMedGoogle Scholar
  78. 78.
    Lakka HM, Laaksonen DE, Lakka TA et al (2002) The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 288:2709–2716PubMedGoogle Scholar
  79. 79.
    Klein BE, Klein R, Lee KE (2002) Components of the metabolic syndrome and risk of cardiovascular disease and diabetes in Beaver Dam. Diabetes Care 25:1790–1794PubMedGoogle Scholar
  80. 80.
    Isomaa B, Almgren P, Tuomi T et al (2001) Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 24:683–689PubMedGoogle Scholar
  81. 81.
    Levantesi G, Macchia A, Marfisi R et al (2005) Metabolic syndrome and risk of cardiovascular events after myocardial infarction. J Am Coll Cardiol 46:277–283PubMedGoogle Scholar
  82. 82.
    Gorter PM, Olijhoek JK, van der Graaf Y et al (2004) Prevalence of the metabolic syndrome in patients with coronary heart disease, cerebrovascular disease, peripheral arterial disease or abdominal aortic aneurysm. Atherosclerosis 173:363–369PubMedGoogle Scholar
  83. 83.
    Bonora E, Targher G, Formentini G et al (2004) The Metabolic Syndrome is an independent predictor of cardiovascular disease in Type 2 diabetic subjects. Prospective data from the Verona Diabetes Complications Study. Diabet Med 21:52–58PubMedGoogle Scholar
  84. 84.
    Isomaa B, Henricsson M, Almgren P, Tuomi T, Taskinen MR, Groop L (2001) The metabolic syndrome influences the risk of chronic complications in patients with type II diabetes. Diabetologia 44:1148–1154PubMedGoogle Scholar
  85. 85.
    Bianchi C, Penno G, Malloggi L et al (2008) Non-traditional markers of atherosclerosis potentiate the risk of coronary heart disease in patients with type 2 diabetes and metabolic syndrome. Nutr Metab Cardiovasc Dis 18:31–38PubMedGoogle Scholar
  86. 86.
    Despres JP, Lemieux I (2006) Abdominal obesity and metabolic syndrome. Nature 444:881–887PubMedGoogle Scholar
  87. 87.
    Nathan DM, Buse JB, Davidson MB, Heine RJ, Holman RR, Sherwin R, Zinman B (2006) Management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 29(8):1963–1972PubMedGoogle Scholar
  88. 88.
    Wilson PWF, Grundy SM (2003) The metabolic syndrome: practical guide to origins and treatment: part I. Circulation 108:1422–1425PubMedGoogle Scholar
  89. 89.
    Poobalan A, Aucott L, Smith WC et al (2004) Effects of weight loss in overweight/obese individuals and long-term lipid outcomes – a systematic review. Obes Rev 5:43–50PubMedGoogle Scholar
  90. 90.
    Leon AS, Sanchez OA (2001) Response of blood lipids to exercise training alone or combined with dietary intervention. Med Sci Sports Exerc 33:S502–S515PubMedGoogle Scholar
  91. 91.
    Byberg L, Zethelius B, McKeigue PM et al (2001) Changes in physical activity are associated with changes in metabolic cardiovascular risk factors. Diabetologia 44:2134–2139PubMedGoogle Scholar
  92. 92.
    Wilund KR, Colvin PL, Phares D et al (2002) The effect of endurance exercise training on plasma lipoprotein AI and lipoprotein AI: AII concentrations in sedentary adults. Metabolism 51:1053–60PubMedGoogle Scholar
  93. 93.
    Kraus WE, Houmard JA, Duscha BD et al (2002) Effects of the amount and intensity of exercise on plasma lipoproteins. N Engl J Med 347:1483–1492PubMedGoogle Scholar
  94. 94.
    Moreau KL, Degarmo R, Langley J et al (2001) Increasing daily walking lowers blood pressure in postmenopausal women. Med Sci Sports Exerc 33:1825–1831PubMedGoogle Scholar
  95. 95.
    Arciero PJ, Vukovich MD, Holloszy JO et al (1999) Comparison of short-term diet and exercise on insulin action in individuals with abnormal glucose tolerance. J Appl Physiol 86:1930–1935PubMedGoogle Scholar
  96. 96.
    DiPietro L, Seeman TE, Stachenfeld NS et al (1998) Moderate-intensity earobic training improves glucose tolerance in aging independent of abdominal adiposity. J Am Geriatr Soc 46:875–9PubMedGoogle Scholar
  97. 97.
    Irwin M, Mayer-Davis E, Addy C et al (2000) Moderate intensity physical activity and fasting insulin levels in women: The Cross Cultural Activity Participation Study. Diabetes Care 23:449–454PubMedGoogle Scholar
  98. 98.
    Mayer-Davis E, D’Agostino R, Karter A et al (1998) Intensity and amount of physical activity in relation to insulin sensitivity. The Insulin Resistance Atherosclerosis Study. JAMA 279:669–674PubMedGoogle Scholar
  99. 99.
    Hu FB, Manson JE, Stampfer MJ et al (2001) Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med 345:790–797PubMedGoogle Scholar
  100. 100.
    Hu FB, Leitzmann MF, Stampfer MJ et al (2001) Physical activity and television watching in relation to risk for type 2 diabetes mellitus in men. Arch Intern Med 161:1542–1548PubMedGoogle Scholar
  101. 101.
    Katzmarzyk PT, Leon AS, Wilmore JH, Skinner JS, Rao DC, Rankinen T, Bouchard C (2003) Targeting the metabolic syndrome with exercise: evidence from the HERITAGE Family Study. Med Sci Sports Exerc 35:1703–1709PubMedGoogle Scholar
  102. 102.
    Pan XR, Li GW, Hu YH et al (1997) Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance: the Da Qing IGT and Diabetes Study. Diabetes Care 20:537–544PubMedGoogle Scholar
  103. 103.
    Orchard TJ, Temprosa M, Goldberg R et al (2005) Diabetes Prevention Program Research Group. The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial. Ann Intern Med 142:611–619PubMedGoogle Scholar
  104. 104.
    Anderssen SA, Hjermann I, Urdal P, Torjesen PA, Holme I (1996) Improved carbohydrate metabolism after physical training and dietary intervention in individuals with the “atherothrombogenic syndrome’. Oslo Diet and Exercise Study (ODES). A randomized trial. J Intern Med 240:203–209PubMedGoogle Scholar
  105. 105.
    Anderssen SA, Carroll S, Urdal P, Holme I (2007) Combined diet and exercise intervention reverses the metabolic syndrome in middle-aged males: results from the Oslo Diet and Exercise Study. Scand J Med Sci Sports 2007 (Epub ahead of print)Google Scholar
  106. 106.
    Lofgren IE, Herron KL, West KL, Zern TL, Brownbill RA, Ilich JZ, Koo SI, Fernandez ML (2005) Weight loss favorably modifies anthropometrics and reverses the metabolic syndrome in premenopausal women. J Am Coll Nutr 24:486–493PubMedGoogle Scholar
  107. 107.
    Panagiotakos DB, Pitsavos C, Chrysohoou C, Skoumas J, Tousoulis D, Toutouza M, Toutouzas P, Stefanadis C (2004) Impact of lifestyle habits on the prevalence of the metabolic syndrome among Greek adults from the ATTICA study. Am Heart J 147:106–112PubMedGoogle Scholar
  108. 108.
    Liese AD, Schulz M, Moore CG, Mayer-Davis EJ (2004) Dietary patterns, insulin sensitivity and adiposity in the multi-ethnic Insulin Resistance Atherosclerosis Study population. Br J Nutr 92:973–984PubMedGoogle Scholar
  109. 109.
    Halkjaer J, Sorensen TI, Tjonneland A, Togo P, Holst C, Heitmann BL (2004) Food and drinking patterns as predictors of 6-year BMI-adjusted changes in waist circumference. Br J Nutr 92:735–748PubMedGoogle Scholar
  110. 110.
    Koh-Banerjee P, Chu NF, Spiegelman D, Rosner B, Colditz G, Willett W, Rimm E (2003) Prospective study of the association of changes in dietary intake, physical activity, alcohol consumption, and smoking with 9-y gain in waist circumference among 16 587 US men. Am J Clin Nutr 78:719–727PubMedGoogle Scholar
  111. 111.
    Lopes HF, Martin KL, Nashar K, Morrow JD, Goodfriend TL, Egan BM (2003) DASH diet lowers blood pressure and lipid-induced oxidative stress in obesity. Hypertension 41:422–430PubMedGoogle Scholar
  112. 112.
    He FJ, Markandu ND, MacGregor GA (2005) Modest salt reduction lowers blood pressure in isolated systolic hypertension and combined hypertension. Hypertension 46:66–70PubMedGoogle Scholar
  113. 113.
    Hajjar IM, Grim CE, George V, Kotchen TA (2001) Impact of diet on blood pressure and age-related changes in blood pressure in the US population: analysis of NHANES III. Arch Intern Med 161:589–593PubMedGoogle Scholar
  114. 114.
    Zilkens RR, Burke V, Hodgson JM, Barden A, Beilin LJ, Puddey IB (2005) Red wine and beer elevate blood pressure in normotensive men. Hypertension 45:874–879PubMedGoogle Scholar
  115. 115.
    McKeown NM, Meigs JB, Liu S, Saltzman E, Wilson PW, Jacques PF (2004) Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care 27:538–546PubMedGoogle Scholar
  116. 116.
    Liese AD, Schulz M, Fang F, Wolever TM, D’Agostino RB Jr, Sparks KC, Mayer-Davis EJ (2005) Dietary glycemic index and glycemic load, carbohydrate and fiber intake, and measures of insulin sensitivity, secretion, and adiposity in the Insulin Resistance Atherosclerosis Study. Diabetes Care 28:2832–2838PubMedGoogle Scholar
  117. 117.
    Choi HK, Willett WC, Stampfer MJ, Rimm E, Hu FB (2005) Dairy consumption and risk of type 2 diabetes mellitus in men: a prospective study. Arch Intern Med 165:997–1003PubMedGoogle Scholar
  118. 118.
    Stern L, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, Williams M, Gracely EJ, Samaha FF (2004) The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med 140:778–785PubMedGoogle Scholar
  119. 119.
    Azadbakht L, Mirmiran P, Esmaillzadeh A, Azizi T, Azizi F (2005) Beneficial effects of a Dietary Approaches to Stop Hypertension eating plan on features of the metabolic syndrome. Diabetes Care 28:2823–2831PubMedGoogle Scholar
  120. 120.
    Liu S, Manson JE, Stampfer MJ, Holmes MD, Hu FB, Hankinson SE, Willett WC (2001) Dietary glycemic load assessed by food-frequency questionnaire in relation to plasma high-density-lipoprotein cholesterol and fasting plasma triacylglycerols in postmenopausal women. Am J Clin Nutr 73:560–566PubMedGoogle Scholar
  121. 121.
    Finnegan YE, Minihane AM, Leigh-Firbank EC, Kew S, Meijer GW, Muggli R, Calder PC, Williams CM (2003) Plant- and marine-derived n-3 polyunsaturated fatty acids have differential effects on fasting and postprandial blood lipid concentrations and on the susceptibility of LDL to oxidative modification in moderately hyperlipidemic subjects. Am J Clin Nutr 77:783–795PubMedGoogle Scholar
  122. 122.
    Katzmarzyk PT, Leon AS, Wilmore JH, Skinner JS, Rao DC, Rankinen T, Bouchard C (2003) Targeting the metabolic syndrome with exercise: evidence from the HERITAGE Family Study. Med Sci Sports Exerc 35:1703–1709PubMedGoogle Scholar
  123. 123.
    Barengo NC, Hu G, Lakka TA, Pekkarinen H, Nissinen A, Tuomilehto J (2004) Low physical activity as a predictor for total and cardiovascular disease mortality in middle-aged men and women in Finland. Eur Heart J 25:2204–2211PubMedGoogle Scholar
  124. 124.
    Laaksonen DE, Lakka HM, Salonen JT, Niskanen LK, Rauramaa R, Lakka TA (2002) Low levels of leisure-time physical activity and cardiorespiratory fitness predict development of the metabolic syndrome. Diabetes Care 25:1612–1618PubMedGoogle Scholar
  125. 125.
    Mann JI (2006) Nutrition recommendations for the treatment and prevention of type 2 diabetes and the metabolic syndrome: an evidenced-based review. Nutr Rev 64:422–427PubMedGoogle Scholar
  126. 126.
    Szapary PO, Hark LA, Burke FM (2002) The metabolic syndrome:a new focus for lifestyle modification. Patient Care 36:75–88Google Scholar
  127. 127.
    Bravata DM, Sanders L, Huang J et al (2003) Eficacy and safety of low carbohydrate diets: a systemic review. JAMA 289:1837–1850PubMedGoogle Scholar
  128. 128.
    Samaha FF, Iqbal N, Seshadri P et al (2003) A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med 348:2074–81PubMedGoogle Scholar
  129. 129.
    Brehm BJ, Seeley RJ, Daniels SR et al (2003) A randomized trial comparing a very low carbohydrate diet and a calorie restricted low-fat diet on body weight and cardiovascular risk factors in healthy women. J Clin Endocrinol Metab 88:1617–1623PubMedGoogle Scholar
  130. 130.
    Foster GD, Wyatt HR, Hill JO et al (2003) A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 348:2082–2090PubMedGoogle Scholar
  131. 131.
    Riccardi G, Giacco R, Rivellese AA (2004) Dietary fat, insulin sensitivity and the metabolic syndrome. Clin Nutr 23:447–456PubMedGoogle Scholar
  132. 132.
    Howard BV (2002) Dietary fat as a risk factor for type 2 diabetes. Ann N Y Acad Sci 967:324–328PubMedCrossRefGoogle Scholar
  133. 133.
    Ylonen K, Saloranta C, Kronberg-Kippila C, Groop L, Aro A, Virtanen SM, Botnia Dietary Study (2003) Associations of dietary fiber with glucose metabolism in nondiabetic relatives of subjects with type 2 diabetes: the Botnia Dietary Study. Diabetes Care 26:1979–1985PubMedGoogle Scholar
  134. 134.
    Schulze MB, Liu S, Rimm EB, Manson JE, Willett WC, Hu FB (2004) Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women. Am J Clin Nutr 80:348–356PubMedGoogle Scholar
  135. 135.
    Appel LJ, Moore TJ, Obarzanek E et al (1997) A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med 336:1117–1124PubMedGoogle Scholar
  136. 136.
    Sacks FM, Svetkey LP, Vollmer WM et al (2001) Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet. N Engl J Med 344:3–10PubMedGoogle Scholar
  137. 137.
    Appel LJ, Champagne CM, Harsha DW et al (2003) Writing Group of the PREMIER Collaborative Research Group. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA 289:2083–2093PubMedGoogle Scholar
  138. 138.
    Freiberg MS, Cabral HJ, Heeren TC, Vasan RS, Curtis Ellison R (2004) Third national health and nutrition examination survey. Alcohol consumption and the prevalence of the metabolic syndrome in the US.: a cross-sectional analysis of data from the Third National Health and Nutrition Examination Survey. Diabetes Care 27:2954–2959PubMedGoogle Scholar
  139. 139.
    Arif AA, Rohrer JE (2005) Patterns of alcohol drinking and its association with obesity: data from the Third National Health and Nutrition Examination Survey, 1988–1994. BMC Public Health 5:126PubMedGoogle Scholar
  140. 140.
    Trichopoulou A, Costacou T, Bamia C, Trichopoulos D (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348:2599–2608PubMedGoogle Scholar
  141. 141.
    Panagiotakos DB, Polychronopoulos E (2005) The role of Mediterranean diet in the epidemiology of metabolic syndrome; converting epidemiology to clinical practice. Lipids Health Dis 4:7PubMedGoogle Scholar
  142. 142.
    Keller C, Trevino RP (2001) Effects of two frequencies of walking on cardiovascular risk factor reduction in Mexican American women. Res Nurs Health 24:390–401PubMedGoogle Scholar
  143. 143.
    Thompson PD, Buchner D, Pina IL et al (2003) Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the American Heart Association council on clinical cardiology (subcommittee on exercise, rehabilitation, and prevention) and the council on nutrition, physical activity, and metabolism (subcommittee on physical activity). Circulation 107:3109–3116PubMedGoogle Scholar
  144. 144.
    Ross R, Dagnone D, Jones PJ et al (2000) Reduction in obesity and related co-morbid conditions after diet-induced weight loss or exercise-induced weight loss in men. Ann Intern Med 133:92–103PubMedGoogle Scholar
  145. 145.
    Hu G, Tuomilehto J, Borodulin K, Jousilahti P (2007) The joint associations of occupational, commuting, and leisure-time physical activity, and the Framingham risk score on the 10-year risk of coronary heart disease. Eur Heart J 28:492–498PubMedGoogle Scholar
  146. 146.
    Nilsson P, Lundgren H, Soderstrom M, Fagerstrom KO, Nilsson-Ehle P (1996) Effects of smoking cessation on insulin and cardiovascular risk factors–a controlled study of 4 months’ duration. J Intern Med 240:189–194PubMedGoogle Scholar

Copyright information

© SIMI 2008

Authors and Affiliations

  • Cristina Bianchi
    • 1
  • Giuseppe Penno
    • 1
  • Giuseppe Daniele
    • 1
  • Luca Benzi
    • 1
  • Stefano Del Prato
    • 1
  • Roberto Miccoli
    • 1
    Email author
  1. 1.Department of Endocrinology and Metabolism, Section of Diabetes and MetabolismUniversity of PisaPisaItaly

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