Fatores dietéticos na prevenção e tratamento de comorbidades associadas à síndrome metabólica
Palavras-chave:
diabetes mellitus, dieta, doenças cardiovasculares, nutrição, síndrome metabólicaResumo
A síndrome metabólica constitui um fator de risco cardiovascular, sendo caracterizada pela associação de hipertensão arterial sistêmica, obesidade abdominal, tolerância à glicose prejudicada, hipertrigliceridemia e baixas concentrações sangüíneas de HDL-colesterol, além dos estados pró-trombótico e pró-inflamatório observados. No entanto, a alimentação adequada, associada a outras modificações no estilo de vida, tais como prática regular de atividade física e abandono do tabagismo, contribui para um melhor controle da doença, prevenindo suas complicações e aumentando a qualidade de vida. Desse modo, o objetivo deste estudo foi revisar, na literatura científica, o papel da dieta na prevenção e tratamento da síndrome metabólica. Os trabalhos sobre o assunto informam que a terapia nutricional visa a limitar o consumo de gorduras saturadas e ácidos graxos trans isômeros, os principais envolvidos no aumento da colesterolemia. O aporte protéico deve ser semelhante às recomendações da população geral, com ênfase no consumo de proteínas de origem vegetal e de peixe. Outro fator importante refere-se ao índice glicêmico dos alimentos: dietas de alto índice glicêmico estão relacionadas à promoção da resistência insulínica, obesidade e diabetes mellitus tipo 2. Quanto às fibras alimentares, muitos estudos comprovam que a dieta rica em fibras diminui o risco de doenças coronarianas e diabetes mellitus tipo 2, além de contribuir para melhor controle glicêmico. Portanto, a alimentação adequada constitui um fator indispensável não somente no tratamento, como também na prevenção da síndrome metabólica.
Referências
Pereira MA, Jacobs DRJ, van Horn L, Slattery ML, Kartashov AI, Ludwig DS. Dairy consumption, obesity, and the insulin resistance syndrome in young adults: the CARDIA Study. JAMA. 2002; 287(16):2081-9.
Isomaa B, Almgren P, Tuomi T, Forsén B, Lahti K, Nissén M, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care. 2001; 24(4):683-8.
Grundy SM. Metabolic Syndrome: what is it and how should I treat it? ACC Curr J Rev. 2003; 12(3):37-40.
World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications. Geneva; 1999. 59p.
Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP). JAMA. 2001; 285(19):2486–97.
Lorenzo C, Okoloise M, Williams K, Stern MP, Haffner SM. The metabolic syndrome as predictor of type 2 diabetes: the San Antonio heart study. Diabetes Care. 2003; 26(11):3153-9.
Ford ES, Giles WH. A comparison of the prevalence of the metabolic syndrome using two proposed definitions. Diabetes Care. 2003; 26(3):575-81.
Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults – findings from the Third National Health and Nutrition Examination Survey. JAMA. 2002; 287(3):356-9.
Pitsavos C, Panagiotakos D, Chrysohoou C, Papaioannou I, Papadimitriou L, Tousoulis D, et al. The Adoption of Mediterranean diet attenuates the development of acute coronary syndromes in people with the metabolic syndrome. Nutr J. 2003; 2(1):1-7.
Santos CR, Portella ES, Avila SS, Soares EA. Identificação da síndrome metabólica em diabéticos tipo dois atendidos em Hospital Universitário do Rio de Janeiro. Rev Soc Cardiol Estado de São Paulo. 2003; 13(2 Edição Especial):98.
Wallace TM, Matthews DR. The assessment of insulin resistance in man. Diabetic Med. 2002; 19(7):527-34.
Granberry MC, Fonseca VA. Insulin resistance syndrome: options for treatment. South Med J. 1999; 92(1):2-15.
American Diabetes Association. Clinical practice recommendations. Diabetes Care. 2004; 27(1):S1-S143.
Desouza C, Gilling L, Fonseca V. Management of the insulin resistance syndrome. Curr Diab Rep. 2001; 1(2):140-7.
Reaven G. Metabolic syndrome: pathophysiology and implications for management of cardiovascular disease. Circulation. 2002; 106(3):286-8.
Barroso SG, Abreu VG, Francischetti EA. A participação do tecido adiposo visceral na gênese da hipertensão e doença cardiovascular aterogênica: um conceito emergente. Arq Bras Cardiol. 2002; 78(6):618-30.
Grundy SM, Brewer Jr HB, Cleeman JI, Smith SC Jr, Lenfant C. 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(3):433-8.
Grundy SM. Hypertriglyceridemia, insulin resistance and the metabolic syndrome. Am J Cardiol. 1999; 83(9B):25F-9F.
Souza LJ, Chalita F, Reis A, Teixeira C, Neto C, Bastos D, et al. Prevalência de diabetes mellitus e fatores de risco em Campos dos Goytacazes, RJ. Arq Bras Endocrinol Metab. 2003; 47(1):69-74.
Lerário DDG, Gimeno SG, Franco LJ, Iunes M, Ferreira SRG. Excesso de peso e gordura abdominal para a síndrome metabólica em nipo-brasileiros. Rev Saúde Pública. 2002; 36(1):4-11.
Reseland J, Anderssen S, Solvoll K, Hjermann I, Urdal P, Holme I, et al. Effect of long-term changes in diet and exercise on plasma leptin concentrations. Am J Clin Nutr. 2001; 73(2): 240-5.
Fernández-Real JM, Broch M, Vendrell J, Ricart W. Insulin resistance, inflammation, and serum fatty acid composition. Diabetes Care. 2003; 26(5):1362-8.
Han TS, Sattar N, Williams K, Gonzalez-Villalpando C, Lean MEJ, Haffner SM. Prospective study of C-reactive protein in relation to the development of diabetes and metabolic syndrome in the Mexico City Diabetes Study. Diabetes Care. 2002; 25(11):2016-21.
Liu S, Manson J, Buring J, Stampfer M, Willett W, Ridker P. Relation between a diet with a high glycemic load and plasma concentrations of highsensitivity C-reactive protein in middle-aged women. Am J Clin Nutr. 2002; 75(3):492-8.
Mozaffarian D, Pischon T, Hankinson S, Rifai N, Joshipura K, Willett W, et al. Dietary intake of trans fatty acids and systemic inflammation in women. Am J Clin Nutr. 2004; 79(4):606-12.
Meigs J, Jacques P, Selhub J, Singer D, Nathan D, Rifai N, et al. Fasting plasma homocysteine levels in the insulin resistance syndrome: the framingham offspring study. Diabetes Care. 2001; 24(8): 1403-10
Godsland IF, Rosankiewicz JR, Proudler AJ, Johnston DG. Plasma total homocysteine concentrations are unrelated to insulin sensitivity and components of the metabolic syndrome in healthy men. J Clin Endocrinol Metab. 2001; 86(2):719-23.
Hamdy O, Ledbury S, Mullooly C, Jarema C, Porter S, Ovalle K, et al. Lifestyle modification improves endothelial function in obese subjects with the insulin resistance syndrome. Diabetes Care. 2003; 26(7):2119-25.
Marckmann P. Dietary treatment of thrombogenic disorders related to the metabolic syndrome. Br J Nutr 2000; 83(Suppl 1):S121-S6.
Riccardi G, Rivellese AA. Dietary treatment of the metabolic syndrome: the optimal diet. Br J Nutr. 2000; 83(Suppl 1):S143-S8.
Nestel P. Nutritional aspects in the causation and management of the metabolic syndrome. Endocrinol Metab Clin North Am. 2004; 33(3):483-92.
Haber EP, Curi R, Carvalho CRO, Carpinelli AR. Secreção da insulina: efeito autócrino da insulina e modulação por ácidos graxos. Arq Bras Endocrinol Metab. 2001; 45(3):219-27.
El-Assaad W, Buteau J, Peyot M, Nolan C, Roduit R, Harby S, et al. Saturated fatty acids synergize with elevated glucose to cause pancreatic beta-cell death. Endocrinology. 2003; 144(9):4154-63.
Rique ABR, Soares EA, Meirelles CM. Nutrição e exercício na prevenção e controle das doenças cardiovasculares. Rev Bras Med Esp. 2002; 8(6):1-11.
World Health Organization. Diet, nutrition and the prevention of chronic diseases. Geneva; 2003. 149p.
Sociedade Brasileira de Cardiologia. III Diretrizes Brasileiras sobre Dislipidemias e Diretriz de Prevenção da Aterosclerose do Departamento de Aterosclerose da Sociedade Brasileira de Cardiologia. Arq Bras Cardiol. 2001; 77(Suppl 3): 1-48.
Samaha F, Iqbal N, Seshadri P, Chicano K, Daily D, McGrory J, et al. A low carbohydrate as compared with a low fat diet in severe obesity. N Engl J Med. 2003; 348(21):2074-81.
Ryan M, McInerney D, Owens D, Collins P, Johnson A, Tomkin GH. Diabetes and the Mediterranean diet: a beneficial effect of oleic acid on insulin sensitivity, adipocyte glucose transport and endothelium-dependent vasoreactivity. QJM. 2000; 93(2): 85-91.
Vessby B, Unsitupa M, Hermansen K, Riccardi G, Rivellese A, Tapsell L, et al. Substituting dietary saturated for monounsaturated fat impairs insulin sensitivity in healthy men and women: the KANWU study. Diabetologia. 2001; 44(3):312-9.
Summers L, Fielding B, Bradshaw H, Ilic V, Beysen C, Clark M, et al. Substituting dietary saturated fat with polyunsaturated fat changes abdominal fat distribution and improves insulin sensitivity. Diabetologia. 2002; 45(3):369-77.
Foster-Powell K, Holt SH, Brand-Miller JC. International table of glycemic index and glycemic load values: 2002. Am J Clin Nutr. 2002; 76(1):5-56.
Frost G, Leeds A, Dore C, Madeiros S, Brading S, Dornhorst A. Glycaemic index as a determinant of serum HDL-cholesterol concentration. Lancet. 1999; 353(9158):1045-8.
Brand-Miller J, Hayne S, Petocz P, Colagiuri S. Lowglycemic index diets in the management of diabetes: a meta-analysis of randomized controlled trials. Diabetes Care. 2003; 26(8):2261-7.
Santos CRB, Portella ES, Avila SS, Soares EA. Avaliação do índice e CG de dietas ingeridas por diabéticos tipo 2. In: Libro de memorias del XIII Congreso Latinoamericano de Nutrición; 2003. Acapulco, México. México: Argiletum Editores; 2003. p.223-4.
Meyer K, Kushi L, Jacobs D Jr, Slavin J, Sellers T, Folsom A. Carbohydrates, dietary fiber, and incident type 2 diabetes in older women. Am J Clin Nutr. 2000; 71(4):921-30.
McKeown NM, Meigs JB, Liu S, Saltzman E, Wilson PWF, Jacques PF. Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care. 2004; 27(2):538-46.
Ludwig D, Pereira M, Kroenke C, Hilner J, van Horn L, Slattery M, et al. Dietary fiber, weight gain, and cardiovascular disease risk factors in young adults. JAMA. 1999; 282(16):1539-46.
McKeown NM, Meigs JB, Liu S, Wilson PW, Jacques PF. Whole-grain intake is favorably associated with metabolic risk factors for type 2 diabetes and cardiovascular disease in the Framingham Offspring Study. Am J Clin Nutr. 2002; 76(2): 390-8.
Pereira M, Jacobs D Jr, Pins J, Raatz S, Gross M, Slavin J, et al. Effect of whole grains on insulin sensitivity in overweight hyperinsulinemic adults. Am J Clin Nutr. 2002; 75(5):848-55.
Philippi ST. Tabela de composição de alimentos: suporte para decisão nutricional. São Paulo: Coronário; 2002. 107p.
Song Y, Manson JE, Buring JE, Liu S. Dietary magnesium intake in relation to plasma insulin levels and risk of type 2 diabetes in women. Diabetes Care. 2004; 27(1):59-65.
Ford ES, Mokdad AH, Giles WH, Brown DW. The metabolic syndrome and antioxidant concentrations: findings from the Third National Health and Nutrition Examination Survey. Diabetes. 2003; 52(9):2346-52.
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Copyright (c) 2023 Cláudia Roberta Bocca SANTOS, Emilson Souza PORTELLA, Sonia Silva AVILA, Eliane de Abreu SOARES
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