AJM online Clinical research study| Volume 127, ISSUE 12, P1242.e1-1242.e10, December 2014

Lifestyle Modification for Metabolic Syndrome: A Systematic Review



      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.


      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.


      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.


      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.


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        • Grundy S.M.
        • Brewer Jr., H.B.
        • Cleeman J.I.
        • Smith Jr., S.C.
        • Lenfant C.
        • American Heart Association
        • National Heart, Lung, and Blood Institute
        Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition.
        Circulation. 2004; 109: 433-438
        • Ford E.S.
        Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the Metabolic Syndrome: a summary of the evidence.
        Diabetes Care. 2005; 28: 1769-1778
        • Hamaguchi M.
        • Kojima T.
        • Takeda N.
        • et al.
        The metabolic syndrome as a predictor of nonalcoholic fatty liver disease.
        Ann Intern Med. 2005; 143: 722-728
        • Mozumdar A.
        • Liguori G.
        Persistent increase of prevalence of metabolic syndrome among U.S. adults: NHANES III to NHANES 1999-2006.
        Diabetes Care. 2011; 34: 216-219
        • Grundy S.
        Point: the metabolic syndrome still lives.
        Clin Chem. 2005; 51: 1352-1354
        • Grundy S.M.
        • Cleeman J.I.
        • Daniels S.R.
        • et al.
        Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement.
        Circulation. 2005; 112: 2735-2752
        • Ridker P.M.
        • Pradhan A.
        • MacFadyen J.G.
        • et al.
        Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial.
        Lancet. 2012; 380: 565-571
        • Dunn A.L.
        • Marcus B.H.
        • Kampert J.B.
        • et al.
        Comparison of lifestyle and structured interventions to increase physical activity and cardiorespiratory fitness: a randomized trial.
        JAMA. 1999; 281: 327-334
        • Stunkard A.J.
        • McLaren-Hume M.
        The results of treatment for obesity.
        Arch Intern Med. 1959; 103: 79-85
        • Kassirer J.
        • Angell M.
        Losing weight—an ill-fated New Year's resolution.
        N Engl J Med. 1998; 338: 52-54
        • Obermayer J.
        • Riley W.
        • Asif O.
        • et al.
        College smoking-cessation using cell phone text messaging.
        J Am Coll Health. 2004; 53: 71-78
        • Franklin V.L.
        • Waller A.
        • Pagliari C.
        • et al.
        A randomized controlled trial of Sweet Talk, a text messaging system to support young people with diabetes.
        Diabet Med. 2006 12; 23: 1332-1338
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        PLoS Med. 2009; 6: e1000097
        • Higgins J.P.
        • Altman D.G.
        • Gøtzsche P.C.
        • et al.
        The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.
        BMJ. 2011; 343: d5928
        • Bo S.
        • Ciccone G.
        • Baldi C.
        • Benini L.
        • et al.
        Effectiveness of a lifestyle intervention on Metabolic Syndrome A randomized controlled trial.
        J Gen Intern Med. 2007; 22: 1695-1703
        • Busnello F.M.
        • Bodanese L.C.
        • Pellanda L.C.
        • et al.
        Nutritional intervention and the impact on adherence to treatment in patients with Metabolic Syndrome.
        Arq Bras Cardiol. 2011; 97: 217-224
        • Nishijima H.
        • Satake K.
        • Igarashi K.
        • et al.
        Effects of exercise in overweight Japanese with multiple cardiovascular risk factors.
        Med Sci Sports Exerc. 2007; 39: 926-933
        • den Boer A.T.
        • Herraets I.J.
        • Stegen J.
        • et al.
        Prevention of the metabolic syndrome in IGT subjects in a lifestyle intervention: results from the SLIM study.
        Nutr Metab Cardiovasc Dis. 2013; 23: 1147-1153
        • Pettman T.L.
        • Misan G.M.
        • Owen K.
        • et al.
        Self-management for obesity and cardio-metabolic fitness: description and evaluation of the lifestyle modification program of a randomised controlled trial.
        Int J Behav Nutr Phys Act. 2008; 5: 53
        • Yamashiro T.
        • Nishikawa T.
        • Isami S.
        • 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.
        Diabetes Obes Metab. 2010; 12: 790-797
        • Kemmler W.
        • Von Stengel S.
        • Engelke K.
        • et al.
        Exercise decreases the risk of Metabolic Syndrome in elderly females.
        Med Sci Sports Exerc. 2009; 41: 297-305
        • Thomas T.R.
        • Warner S.O.
        • Dellsperger K.C.
        • et al.
        Exercise and the metabolic syndrome with weight regain.
        J Appl Physiol. 2010; 109: 3-10
        • Ma J.
        • Yank V.
        • Xiao L.
        • et al.
        Translating the Diabetes Prevention Program lifestyle intervention for weight loss into primary care: a randomized trial.
        JAMA Intern Med. 2013; 173: 113-121
        • Spring B.
        • Schneider K.
        • McFadden H.G.
        • et al.
        Multiple behavior changes in diet and activity: a randomized controlled trial using mobile technology.
        Arch Intern Med. 2012; 172: 789-796
        • Dansinger M.L.
        • Gleason J.A.
        • Griffith J.L.
        • et al.
        Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial.
        JAMA. 2005; 293: 43-53
        • Sacks F.M.
        • Bray G.A.
        • Carey V.J.
        • et al.
        Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates.
        N Engl J Med. 2009; 360: 859-873
        • Jacobs Jr., D.R.
        • Sluik D.
        • Rokling-Andersen M.H.
        • 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.
        Am J Clin Nutr. 2009; 89: 509-517
        • Weinstock R.S.
        • Trief P.M.
        • Cibula D.
        • Morin P.C.
        • Delahanty L.M.
        Weight loss success in metabolic syndrome by telephone interventions: results from the SHINE study.
        J Gen Intern Med. 2013; 28: 1620-1628
        • Digenio A.G.
        • Mancuso J.P.
        • Gerber R.A.
        • et al.
        Comparison of methods for delivering a lifestyle modification program for obese patients: a randomized trial.
        Ann Intern Med. 2009; 150: 255-262
        • Kukkonen-Harjula K.T.
        • Borg P.T.
        • Nenonen A.M.
        • et al.
        Effects of a weight maintenance program with or without exercise on the metabolic syndrome: a randomized trial in obese men.
        Prev Med. 2005; 41: 784-790
        • Morey M.C.
        • Pieper C.F.
        • Edelman D.E.
        • 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.
        J Am Geriatr Soc. 2012; 60: 1655-1662
        • Maruyama C.
        • Kimura M.
        • Okumura H.
        • et al.
        Effect of a worksite-based intervention program on metabolic parameters in middle-aged male white- workers: a randomized controlled trial.
        Prev Med. 2010; 51: 11-17
        • Tate D.F.
        • Jackvony E.H.
        • Wing R.R.
        A randomized trial comparing human e-mail counseling, computer-automated tailored counseling, and no counseling in an Internet weight loss program.
        Arch Intern Med. 2006; 166: 1620-1625
        • Svetkey L.P.
        • Stevens V.J.
        • Brantley P.J.
        • et al.
        Weight Loss Maintenance Collaborative Research Group. Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial.
        JAMA. 2008; 299: 1139-1148
        • Patrick K.
        • Raab F.
        • Adams M.A.
        • et al.
        A text message-based intervention for weight loss: randomized controlled trial.
        J Med Internet Res. 2009; 11: e1
        • Oh E.G.
        • Bang S.Y.
        • Hyun S.S.
        • 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.
        Metabolism. 2010; 59: 1035-1043
        • Nanri A.
        • Tomita K.
        • Matsushita Y.
        • et al.
        Effect of six months lifestyle intervention in Japanese men with Metabolic Syndrome: randomized controlled trial.
        J Occup Health. 2012; 54: 215-222
        • Munakata M.
        • Honma H.
        • Akasi M.
        • et al.
        Repeated counseling improves the antidiabetic effects of limited individualized lifestyle guidance in Metabolic Syndrome: J-STOP-Metabolic Syndrome final results.
        Hypertens Res. 2011; 34: 612-616
        • Fappa E.
        • Yannakoulia M.
        • Ioannidou M.
        • et al.
        Telephone counseling intervention improves dietary habits and metabolic parameters of patients with the metabolic syndrome: a randomized controlled trial.
        Rev Diabet Stud. 2012; 9: 36-45
        • Melanson K.J.
        • Summers A.
        • Nguyen V.
        • 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.
        Nutr J. 2012; 11: 57
        • Chen Y.C.
        • Tsao L.I.
        • Huang C.H.
        • et al.
        An Internet-based health management platform may effectively reduce the risk factors of metabolic syndrome among career women.
        Taiwan J Obstet Gynecol. 2013; 52: 215-221
        • Wu Y.T.
        • Hwang C.L.
        • Chen C.N.
        • et al.
        Home-based exercise for middle-aged Chinese at diabetic risk: a randomized controlled trial.
        Prev Med. 2011; 52: 337-343
        • Venditti E.M.
        • Wylie-Rosett J.
        • Delahanty L.M.
        • Mele L.
        • Hoskin M.A.
        • Edelstein S.L.
        Diabetes Prevention Program Research Group. Short and long-term lifestyle coaching approaches used to address diverse participant barriers to weight loss and physical activity adherence.
        Int J Behav Nutr Phys Act. 2014; 11: 16


        • Knowler W.C.
        • Barrett-Connor E.
        • Fowler S.E.
        • et al.
        Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
        N Engl J Med. 2002; 346: 393-403