NUTRITION THERAPY FOR

DYSLIPIDEMIA & METABOLIC

SYNDROME
Dr. ETISA ADI MURBAWANI, M.Si, SpGK
METABOLIC SYNDROME
Clustering of Components:
Hypertension : BP. > 140/90
Dyslipidemia : TG > 150 mg/ dL ( 1.7 mmol/L )
HDL- C < 35 mg/ dL (0.9 mmol/L)
Obesity (central): BMI > 30 kg/M2
Waist girth > 94 cm (37 inch)
Waist/Hip ratio > 0.9
Impaired Glucose Handling: IR , IGT or DM
FPG > 110 mg/dL (6.1mmol/L)
2hr.PG >200 mg/dL(11.1mmol/L)
Microalbuninuria (WHO)
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DYSLIPIDEMIA

(A consequence of abnormal lipoprotein
metabolism)
Elevated Total Cholesterol (TC)
Elevated Low-density lipoproteins (LDL)
Elevated triglycerides (TG)
Decreased High-density lipoproteins (HDL)
Secondary Causes of Lipoprotein
Abnormalities
Hypothyroidism; Obstructive liver disease;
Nephrotic syndrome; Drugs:
progestogens, cyclosporine, thiazides
Hypercholesterolemia
Obesity, DM, Pregnancy, CRF, Alcohol,
Stress, Sepsis, Acute hepatitis, SLE, Drugs:
estrogen, -blockers, steroids, acid resins,
thiazides
Hypertriglyceridemia
Type-2 DM, Rheumatoid arthritis,
Malnutrition, Obesity, Cigarette smoking,
Beta blockers
Low HDL
Epidemiological Studies
For every 1% increase in cholesterol level
there is 1-2% increase in the incidence of CHD
There is a gender difference in relation to
age: male at higher risk in 50-60s while
female in 60s-70s
CHD cause death in female more than all
cancer combined
Rationale for Treating Dyslipidemia
Treatment Modalities
Therapeutic
Life Style
Changes
(TLC)
Drug Therapy
Lipid Management Recommendations

Start dietary therapy (<7% of total calories as saturated
fat and <200 mg/d cholesterol)

Adding plant stanol/sterols (2 gm/day) and viscous fiber
(>10 mg/day) will further lower LDL

Promote daily physical activity and weight management.

Encourage increased consumption of omega-3 fatty
acids in fish or 1 g/day omega-3 fatty acids in capsule
form for risk reduction.
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For all patients
Therapeutic Lifestyle Changes
Nutrient Composition of TLC Diet
Nutrient Recommended Intake
Saturated fat Less than 7% of total calories
Polyunsaturated fat Up to 10% of total calories
Monounsaturated fat Up to 20% of total calories
Total fat 2535% of total calories
Carbohydrate 5060% of total calories
Fiber 2030 grams per day
Protein Approximately 15% of total calories
Cholesterol Less than 200 mg/day
Total calories (energy) Balance energy intake and expenditure
to maintain desirable body weight
Therapeutic Life Style Changes
When restricting saturated fat by < 10% of
calories blood cholesterol reduces by 3-14%
Response to diet is variable
Patients who adhere to a low fat diet also
response to a lower doses of lipid-lowering
drugs
Moderate physical activity at least 30-60 minutes 5 days
a week or longer will help to raise HDL-C, lower total and
LDL-C, lower TG, lower glucose, insulin, and blood
pressure levels.
Therapeutic Life Style
Changes
Other life style changes include:
Weight reduction specially in overweight
patients (reduce 10% in the first 6 months)
Increase physical activity
Smoking cessation
Possible Benefits From Other Therapies
Therapy Result
Soluble fiber in diet (28 g/d) (oat
bran, fruit, and vegetables)

Soy protein (2030 g/d)

Stanol esters (1.54 g/d) (inhibit
cholesterol absorption)

Fish oils (39 g/d)
(n-3 fatty acids)
LDL-C 1% to 10%


LDL-C 5% to 7%

LDL-C 10% to 15%


Triglycerides 25% to 35%

Jones PJ. Curr Atheroscler Rep. 1999;1:230-235.
Lichtenstein AH. Curr Atheroscler Rep. 1999;1:210-214.
Rambjor GS et al. Lipids. 1996;31:S45-S49.
Ripsin CM et al. JAMA. 1992;267:3317-3325.