الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Metabolic syndrome is defined by a constellation of interconnected physiological, biochemical, clinical and metabolic factors that directly increases the risk of cardiovascular diseases, type 2 diabetes mellitus and cancers. Insulin resistance, visceral adiposity, atherogenic dyslipidemia, endothelial dysfunction, genetic susceptibility, elevated blood pressure, hypercoagulable state and chronic stress are several factors which constitute the syndrome.
The metabolic syndrome is a major escalating public-health problem and clinical challenge worldwide has increased due to the wake of urbanization, increasing obesity and sedentary life habits. Metabolic syndrome confers a 5-fold increase in the risk of type 2 diabetes mellitus and 2-fold the risk of developing cardiovascular diseases over the next 5 to 10 years. Furthermore, patients with metabolic syndrome are at 2- to 4-fold increase risk of stroke, 3- to 4-fold increase risk of myocardial infarction and 2-fold increase the risk of sudden death from such an event compared with those without the syndrome.
Metabolic syndrome causes major adverse health outcomes such as type 2 diabetes, cardiovascular diseases, dyslipidemia, chronic kidney diseases and cancers, which are serious problems worldwide. These pathological states are strongly associated with insulin resistance or hyperinsulinemia. Low-grade chronic inflammation in metabolic syndrome is one of the most innovative and newly identified concepts.
The aim of the present study was to investigate the role of nutrition in the reduction of health risks in individuals with metabolic syndrome. Moreover, to assess the prevalence of metabolic syndrome among the studied sample, to investigate dietary habits and lifestyle practices among individuals with metabolic syndrome, to plan and implement a nutritional program to reduce the risk factors associated with metabolic syndrome and to evaluate the impact of the nutrition intervention program.
In order to accomplish the aim, this study was conducted in two phases .The study was conducted at the High Institute of Public Health and Medical Research Institute. This study included employees and workers at High Institute of Public Health and Medical Research Institute. Both sexes were involved in the study with the age interval 20-60 years old.
The first stage was the cross sectional approach to study the prevalence of metabolic syndrome among the studied sample .The total sample size was 400 individuals. For execution of this phase, a predesigned interviewing questionnaire was used to collect the following information: personal and socioeconomic characteristics, medical history, personal and family history .Health information related to criteria for diagnosis of metabolic syndrome, lifestyle practices included daily physical activities, smoking and identification of health risk factors. Anthropometric measurements in the form of weight, height, waist circumference, body mass index and body fat composition were taken.
Dietary intake assessment including food habits, frequency of food consumption, daily dietary intake by using 24 hour recall method .This was followed by laboratory investigations that included fasting blood glucose, fasting blood insulin level, lipid profile including total cholesterol, high density lipoproteins, low density lipoproteins, triglycerides and C-reactive protein. Blood pressure measurement was taken.
Metabolic syndrome was diagnosed when the subject had at least three of the following criteria: waist circumference ≥ 102cm for men, ≥88cm for women, high blood pressure ≥130mmHg systolic or ≥85 mmHg diastolic, plasma triglycerides ≥ 150 mg/dl, HDL cholesterol ˂40mg/dl for men or ˂50mg/dl for women and fasting blood glucose ≥110 mg/dl.
The second phase was the intervention phase .The nutrition intervention program was based on nutrition guidance and counseling. The duration of the program was six months. This was achieved by adopting Mediterranean diet low in fat especially saturated fat, increased intake of variety of fruits, vegetables, grains and seafood with modification of sedentary lifestyle. Evaluation of the effectiveness of the program was done after six months by reassessment of laboratory parameters and blood pressure measurements. A comparison was done. After completion of the phases, data was fed into computer for tabulation and analysis.
The study revealed the following findings
First phase:
• Prevalence of metabolic syndrome was 54% among MetS group, nearly 84% of them were females and also nearly 36% of them were among the age group 51-60 years.
• 59 % of MetS group didn’t perform any physical activity; on the other hand, 24% watched TV or computer 3 hours per day.
• Regarding the dietary habits, 58.5% of MetS group took the dinner daily, 96.8% of the group took snacks between meals and desserts represented the highest category (23%).
• Nearly 37% among MetS group had 4-6 pieces of desserts per day.
• 38.2% of the MetS group sometimes had fast food while 55.3% watched television while taking their meals.
• As for obesity 88.9% among MetS group were obese compared to nearly 25% among non-MetS group. 99.5% of the MetS group had dyslipidemia compared to 82.5% of non-MetS group.
• While 96.3% among MetS group suffer from hypertension compared to 44.3% among non-MetS group.
• Liver disease was predominant among MetS group.
• Total energy intake as well as total fat intake was higher among MetS group compared to non-MetS group.
Second phase:
• Marked decline in the anthropometric measurements, where decrease in weight by 6.14%, waist circumference decreased by 3.69%, fat percent declined by 3.84%, whereas BMI decreased by 3% at the end of the intervention program.
• Blood pressure showed marked improvement where the systolic blood pressure decreased by 3.7%, while diastolic blood pressure decreased by 10% at the end of follow up period.
• The laboratory parameters also showed marked improvement where fasting blood glucose decreased by 23.29%, fasting blood insulin improved by 14.63%, whereas total cholesterol decreased by 5.78%, low density lipoproteins by 4.11%, triglycerides by 11.9% and finally C-reactive protein improved by 16.67%.
In the view of the previous conclusions the following recommendations were suggested:
Ministerial Approach:
• Intensifying the nutrition education program as a part of curriculum teaching students how to eat properly and to avoid unhealthy practice.
• Mass media as televisions, magazines and computers should be used to disseminate information about well balanced diet and healthy food choices that should be adopted on wide scale.
• Strict supervision on medical information disseminated through media as it is very influencing to the whole community.
• Regulate food advertising especially those aiming children.
• Strict supervision on the advertisement and the selling of medications concerned with weight loss.
• Acknowledging metabolic syndrome as a serious problem with high social and economic cost and training health care workers in the field of its prevention and management .Services should be offered to the community on regular basis through incentives that can be an effective strategy to encourage production and consumption of nutritionally beneficial foods.
• The design and implementation of food pricing policies, such as agricultural subsidies with reduction of added taxes in order to increase accessibility and affordability of fruits, vegetables, legumes, nuts and whole grains.
• Menu labeling in fast-food outlets and restaurants is another strategy being considered with caloric labeling on chain restaurant menus to have beneficial effects on food choices and caloric intake.
• Governments should perform zoning laws that limit the number of fast-food restaurants in and around schools and universities.
Clinical Approach:
• Incorporation of the prevention and management of metabolic syndrome as a part of primary health care system.
• Adopting a family oriented approach with promoting altered behavioral pattern and food habits for healthier life style.
• Increasing the activity level through organized sports and the female should be particularly a target group.
• Increase the awareness among young aged groups about the hazards and the future consequences of metabolic syndrome such as diabetes mellitus and heart problem.
• Identifying individuals at risk of metabolic syndrome as a part of routine medical checkup, those must be a target with more attention, education and taught to identify their unhealthy habits.