Strategies to prevent the metabolic syndrome at the population level: role of authorities and non-governmental bodies

The remarkable increase over the past 40 years in some chronic diseases, including the metabolic syndrome, has increased the demand for government and international policies to encourage various approaches to decrease the risk of these diseases. There are some prerequisites for working out successful national food and nutrition policies. Firstly, it is necessary to have a clear picture of the dietary pattern in a country and its associated public health problems. Based on these data, nutrient recommendations and goals are formulated by international or national scientific committees. Governments should translate these nutrient goals into food goals and eventually into national dietary guidelines. The means by which the national authorities can implement a nutrition policy include fortification and supplementation. Equally important are educational and informative tools, such as labelling on the packed food products including information about ingredients and nutrient content. With respect to the metabolic syndrome, this implies nutrient recommendations regarding the intake of fat and carbohydrates (energy per cent) and dietary fibre; dietary guidelines regarding balance between energy intake and expenditure; decreased consumption of products rich in fat and increased consumption of cereals and other products rich in dietary fibre, etc.; recommendations from the authorities regarding nutrient labelling (content of fat and dietary fibre) on relevant products; and nutrient and health claims and other aids (symbols) as tools to make it easier for consumers to select the appropriate food products.

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Comparison of two exploratory dietary patterns in association with the metabolic syndrome in a Northern German population

British Journal Of Nutrition ◽

10.1017/s0007114514002098 ◽

2014 ◽

Vol 112 (8) ◽

pp. 1364-1372 ◽

Cited By ~ 33

Author(s):

Janett Barbaresko ◽

Sabine Siegert ◽

Manja Koch ◽

Imke Aits ◽

Wolfgang Lieb ◽

...

Keyword(s):

Metabolic Syndrome ◽

Dietary Patterns ◽

Dietary Pattern ◽

Dietary Guidelines ◽

Processed Meat ◽

German Population ◽

Food Groups ◽

Reduced Rank Regression ◽

Cross Sectional ◽

The Metabolic Syndrome

Diet is related to many chronic disease conditions such as the metabolic syndrome (MetS). We set out to compare behaviour-related with disease-related patterns and their association with the MetS in a German cross-sectional study. A total of 905 participants of a Northern German cohort (aged 25–82 years) completed a FFQ, underwent anthropometric assessments and provided a blood sample. Dietary patterns were derived by principal component analysis (PCA) and reduced-rank regression (RRR) from forty-two food groups. Components of the MetS were used as response variables for the RRR analysis. Simplified patterns comprising ten food groups were generated. Logistic regression analysis was performed to evaluate the likelihood of having the MetS across the quartiles of simplified pattern scores. We identified two similar dietary patterns derived by PCA and RRR characterised by high intakes of potatoes, various vegetables, red and processed meat, fats, sauce and bouillon. Comparing simplified patterns, an increased RRR pattern score was associated with a higher OR (2·18, 95 % CI 1·25, 3·81) of having the MetS than an increased PCA pattern score (OR 1·92, 95 % CI 1·21, 3·03). Comparing concordant food groups by both dietary pattern methods, a diet high in legumes, beef, processed meat and bouillon was also positively associated with the prevalence of the MetS after adjustment for potential confounders (OR 1·71, 95 % CI 1·04, 2·79). We identified a behaviour-related pattern that was positively associated with the MetS. The application of both dietary pattern methods may be advantageous to obtain information for designing and realising dietary guidelines. Prospective studies are needed to confirm the results.

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A Western dietary pattern is prospectively associated with cardio-metabolic traits and incidence of the metabolic syndrome

British Journal Of Nutrition ◽

10.1017/s000711451800079x ◽

2018 ◽

Vol 119 (10) ◽

pp. 1168-1176 ◽

Cited By ~ 19

Author(s):

Isabel Drake ◽

Emily Sonestedt ◽

Ulrika Ericson ◽

Peter Wallström ◽

Marju Orho-Melander

Keyword(s):

Metabolic Syndrome ◽

Dietary Patterns ◽

Dietary Pattern ◽

Dietary Guidelines ◽

Reduced Rank Regression ◽

Metabolic Traits ◽

The Metabolic Syndrome ◽

Western Dietary Pattern ◽

Response Variables

AbstractThe aim of this study was to derive dietary patterns associated with cardio-metabolic traits and to examine whether these predict prospective changes in these traits and incidence of the metabolic syndrome (iMetS). Subjects from the Malmö Diet and Cancer Study cardiovascular cohort without cardio-metabolic disease and related drug treatments at baseline (n 4071; aged 45–67 years, 40 % men) were included. We applied reduced rank regression on thirty-eight foods to derive patterns that explain variation in response variables measured at baseline (waist circumference, TAG, HDL- and LDL-cholesterol, systolic and diastolic blood pressure, fasting glucose and insulin). Patterns were examined in relation to change in cardio-metabolic traits and iMetS in subjects who were re-examined after 16·7 years (n 2704). Two dietary patterns (‘Western’ and ‘Drinker’) were retained and explained 3·2 % of the variation in response variables. The ‘Western’ dietary pattern was inversely associated with HDL-cholesterol and positively with all other response variables (both at baseline and follow-up), but there was no association with LDL at follow-up. After adjustment for potential confounders, the ‘Western’ dietary pattern was associated with higher risk of iMetS (hazard ratio Q4 v. Q1: 1·47; 95 % CI 1·23, 1·77; Ptrend=1·5×10−5). The ‘Drinker’ dietary pattern primarily explained variation in HDL and was not associated with iMetS. In conclusion, this study supports current food-based dietary guidelines suggesting that a ‘Western’ dietary pattern with high intakes of sugar-sweetened beverages and red and processed meats and low intakes of wine, cheese, vegetables and high-fibre foods is associated with detrimental effects on cardio-metabolic health.

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Menu Descriptions and Nutrient Content of Food Items in U.S. Restaurants (FS02-01-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz051.fs02-01-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Danielle Krobath ◽

William Masters ◽

Megan Mueller

Keyword(s):

Saturated Fat ◽

Nutrient Content ◽

The United States ◽

Dietary Guidelines ◽

Health Claims ◽

Trans Fat ◽

Dietary Recommendations ◽

Food Items ◽

Significant Difference ◽

Nutrient Data

Abstract Objectives This study concerns how the description of foods on restaurant menus relates to their nutrient content as disclosed on company websites. We aimed to test halo effects, regarding how claims about some desirable features might be associated with the presence of other attributes. Methods We used item descriptions and nutrient data for food items (n = 92,949) at the top-selling restaurant chains (n = 92) from 2012 through 2017 in the United States, compiled by the MenuStat project. We classified items into 4 types (mains, appetizers, desserts, sides) and claims into 3 groups using 29 search terms based on consumer interests in health (e.g., “nutritious”), product sourcing (e.g., “local” or “organic”), and vegetal items (vegetarian or vegan). Nutrient data focus on 4 dietary recommendations to limit sodium (mg), trans-fat (g) and saturated fats (% of energy), and to increase fiber (g). We also report calories per item (kcal) and its share from carbohydrates, protein and total fat (%). We used multiple regression to test whether nutrient content was associated with menu claims, controlling for year and restaurant brand, the item being marked as “shareable”, on a kid's menu, or regional and limited-time offerings. Methods and hypotheses were preregistered on As-Predicted.com. Results Contrary to our prediction, nutrient content was more often aligned with U.S. dietary guidelines when their description did include claims. With 3 claim types, 4 food types and 4 recommendations we test 48 possible cases. In 25 (52%) we found alignment between claims and nutrient recommendations, e.g., main dishes with health-related claims had 2% less calories from saturated fat (P < 0.01) and 142 mg less sodium (P < 0.01). In 3 of 48 cases (7%), claims were contrary to recommendations, all of which were desserts with sourcing claims which had more sodium, more trans-fat and more saturated fat than other desserts (all P < 0.01). In 20 of 48 cases (42%) there was no significant difference between items with and without claims. Conclusions Items described as vegetarian/vegan or with sourcing and health claims had nutrient contents that were more often aligned with dietary guidelines than other items. Menu labeling that communicates meal content more directly, such as nutrient fact panels, could inform choice and build trust in restaurant meals. Funding Sources None.

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Serum Hepcidin Levels Correlate with Phenotypes of the Metabolic Syndrome At Population Level

Blood ◽

10.1182/blood.v118.21.348.348 ◽

2011 ◽

Vol 118 (21) ◽

pp. 348-348

Author(s):

Nicola Martinelli ◽

Michela Traglia ◽

Natascia Campostrini ◽

Ginevra Biino ◽

Sara Previtali ◽

...

Keyword(s):

Metabolic Syndrome ◽

Serum Ferritin ◽

Multivariate Analyses ◽

Conflicts Of Interest ◽

Fasting Blood Glucose ◽

Population Level ◽

Subclinical Inflammation ◽

Iron Stores ◽

The Metabolic Syndrome ◽

Serum Hepcidin

Abstract Abstract 348 Background and Aims: Hepcidin is a 25 amino acid hormone mainly produced by the liver in response to increased plasma or tissue iron to homeostatically down-regulate absorption and recycling of the metal from duodenum and macrophages, respectively. Hepcidin expression is also upregulated by inflammation. Dysmetabolic hyperferritinemia is among the commonest causes of increased serum ferritin levels encountered in clinical practice, but its pathophysiology remains unclear. Indeed, the Metabolic Syndrome (MS) that affects near 20–25% of western adults, is characterized by subclinical inflammation, which hampers the interpretation of serum ferritin as a marker of body iron stores. We recently measured serum hepcidin levels in the large Val Borbera (VB) population to evaluate their genetic determinants (Traglia et al. J Med Genet 2011). Taking advantage of this survey, we investigated for the first time the relationships between hepcidin, ferritin, C-Reactive Protein (CRP) and MS phenotypes at population level. Subjects and Methods: Serum hepcidin-25 levels measured by Mass Spectrometry were analyzed in 941 subjects for whom complete data allowing classification of MS according to NLHBI criteria (fasting glucose ≥100 mg/dl or antidiabetes medication; blood pressure ≥135/85 mmHg or antihypertensive medication; triglycerides ≥150 mg/dl; HDL cholesterol <40 mg/dl in men and < 50 mg/dl in women; and obesity) and CRP levels were available. MS was defined by having ≥3 of the above criteria. Due to the known important gender differences in hepcidin levels (Traglia M et al. J Med Genet 2011), multivariate analyses were done separately in males (n=400, 21.8% with MS) and females (n=541, 18.5% with MS). Main Results: Serum hepcidin-25 levels increased linearly with the increasing number of MS traits in males (ANOVA: F=6.8, P=0.009) and, even more strongly, in females (ANOVA: F=35.2, P<0.001). This trends paralleled those of serum ferritin levels in both genders. In multivariate analyses adjusted for age and SNP rs1800562 (C282Y mutation in the HFE gene), the inclusion of ferritin in males abolished but in females only reduced the association of hepcidin with MS. On the contrary, CRP did not influence the same association in both genders. Regarding the single MS criteria, the strongest association of hepcidin were observed with body mass index, triglycerides, and fasting blood glucose (P<0.001 for all three) in females. Conclusions: Hepcidin levels are strongly associated with MS features at population level, independently of subclinical inflammation. This association appears to reflect a response to increasing iron stores in males, while in females some MS traits may directly influence hepcidin levels. Disclosures: No relevant conflicts of interest to declare.

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Metabolic syndrome in youth: current issues and challenges

Applied Physiology Nutrition and Metabolism ◽

10.1139/h06-094 ◽

2007 ◽

Vol 32 (1) ◽

pp. 13-22 ◽

Cited By ~ 42

Author(s):

Terry T.-K. Huang ◽

Geoff D.C. Ball ◽

Paul W. Franks

Keyword(s):

Physical Activity ◽

Metabolic Syndrome ◽

Children And Adolescents ◽

Lifestyle Modification ◽

Pediatric Population ◽

Population Level ◽

Individual Risk ◽

Adult Health ◽

The Metabolic Syndrome ◽

Definition Of

The current paper reviews the important issues and challenges facing children and adolescents with the metabolic syndrome (MetS). Studies suggest that the MetS and its risk components may be on the rise in children along with rising rates of obesity; however, further study remains warranted. The topics reviewed encompass the definition of the syndrome, its prevalence, clustering and tracking of metabolic risk factors, the role of physical activity and diet in the development of the MetS, criticisms and utility of the MetS definition, and special considerations needed in the pediatric population. Physical activity and diet may play important roles in the MetS; however, research with precise measurements of activity, diet, and metabolic outcomes is needed. The paper concludes by emphasizing that regardless of one’s position in the ongoing debate about the MetS, the long-term risks attributable to each individual risk component are real. The abnormality of one component should automatically prompt the screening of other components. Among children and adolescents, lifestyle modification should always serve as the frontline strategy. Prevention during childhood is key to the largest possible impact on adult health at the population level.

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Development of the Choices 5-Level Criteria to Support Multiple Food System Actions

Nutrients ◽

10.3390/nu13124509 ◽

2021 ◽

Vol 13 (12) ◽

pp. 4509

Author(s):

Gianluca Tognon ◽

Belen Beltramo ◽

Rutger Schilpzand ◽

Lauren Lissner ◽

Annet J. C. Roodenburg ◽

...

Keyword(s):

Food System ◽

Food Products ◽

Food Group ◽

Dietary Guidelines ◽

Health Policies ◽

Flexible Tool ◽

Nutrient Profiling ◽

Nutrition Policies ◽

Marketing To Children ◽

Threshold Criteria

In 2008, the Choices International Foundation developed its logo criteria, identifying best-in-class food products. More advanced, global and graded nutrient profiling systems (NPSs) are needed to substantiate different national nutrition policies. The objective of this work was to extend Choices NPS to identify five levels of the healthiness of food products, so that the Choices NPS can also be used to support other nutrition policies, next to front-of-pack labelling. Based on the same principles as the previous logo criteria, four sets of threshold criteria were determined using a combination of compliance levels, calculated from a large international food group-specific database, the Choices logo criteria, and WHO-NPSs developed to restrict marketing to children. Validation consisted of a comparison with indicator foods from food-based dietary guidelines from various countries. Some thresholds were adjusted after the validation, e.g., because intermediate thresholds were too lenient. This resulted in a new international NPS that can be applied to different contexts and to support a variety of health policies, to prevent both undernutrition and obesity. It can efficiently evaluate mixed food products and represents a flexible tool, applicable in various settings and populations.

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A place for dietary fibre in the management of the metabolic syndrome

Current Opinion in Clinical Nutrition & Metabolic Care ◽

10.1097/01.mco.0000171124.06408.71 ◽

2005 ◽

Vol 8 (6) ◽

pp. 636-640 ◽

Cited By ~ 101

Author(s):

Nathalie M Delzenne ◽

Patrice D Cani

Keyword(s):

Metabolic Syndrome ◽

Dietary Fibre ◽

The Metabolic Syndrome

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Destigmatizing Carbohydrate with Food Labeling: The Use of Non-Mandatory Labelling to Highlight Quality Carbohydrate Foods

Nutrients ◽

10.3390/nu12061725 ◽

2020 ◽

Vol 12 (6) ◽

pp. 1725 ◽

Cited By ~ 1

Author(s):

Christopher P.F. Marinangeli ◽

Scott V. Harding ◽

Andrea J. Glenn ◽

Laura Chiavaroli ◽

Andreea Zurbau ◽

...

Keyword(s):

Dietary Fibre ◽

Nutrient Content ◽

The United States ◽

Health Claims ◽

Food Labelling ◽

Healthy Foods ◽

Regulatory Frameworks ◽

Related Risk ◽

Carbohydrate Quality ◽

Low Glycemic Index

Dietary carbohydrates are components of healthy foods, but many carbohydrate foods have recently been stigmatized as primary causes of diet-related risk factors for chronic disease. There is an opportunity to enhance efforts within the food landscape to encourage the consumption of higher quality carbohydrate foods. The use of labelling is one strategy that permits consumers to identify healthy carbohydrate foods at the point-of-purchase. This review discusses the regulatory frameworks and examples of associated non-mandatory food labelling claims that are currently employed to highlight healthy carbohydrate foods to consumers. The existing labelling frameworks discussed here align with established measures of carbohydrate quality, such as 1. dietary fibre nutrient content claims and associated dietary fibre-based health claims; 2. the presence of whole carbohydrate foods and ingredients that are intact or reconstituted, such as whole grains; and 3. low glycemic index and glycemic response claims. Standards from Codex Alimentarius, and regulations from Australia and New Zealand, Canada, Europe, and the United States will be used to illustrate the means by which food labelling can be used by consumers to identify quality carbohydrate foods.

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