Abstract
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.
Keywords
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Article info
Publication history
Published online: July 05, 2014
Footnotes
Funding: None.
Conflicts of Interest: None of the authors have any disclosures except for our nurse, EM who gets paid by Becton Dickinson for teaching injection techniques for insulin. NJS consulted with the American Academy of Nutrition and Dietetics (a non-profit, formerly the American Dietetic Association) last year on diets for heart failure.
Authorship: All authors were involved in the design, data collection, analysis, and composition of this manuscript, and gave their consent for its publication.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
