Cardio-metabolic risk: what is the role of nutrition?
Cardio-metabolic risk (CMR) describes the collection of risk factors that account for much of the early, subclinical expression of cardiovascular disease (CVD) risk in populations. Globally, CVD remains the most common cause of death, with the 2016 Global Health Estimates study estimating that CVD accounted for 31.4 % of all deaths and 15% of global Disability-Adjusted Life Years (DALYs).
Sometimes clinically referred to as metabolic syndrome (when several CMR risk factors co-exist in individuals), it’s estimated that more than 30% of people in Europe are affected, a figure only projected to increase in light of demographic transition and increasing global obesity prevalence. CVD mortality and morbidity rates remain high highlighting a need for interventions that focus on tackling the modifiable determinants of CMR. Exploring the potential for diet and lifestyle changes to manage and reduce CMR, and subsequent CVD risk, is therefore relevant for both clinical practice and public health.
Defining cardio-metabolic risk
Comprising a group of risk factors that tend to cluster together, there is no accepted diagnostic criteria or set of accepted cut-offs for CMR, although experts agree that the main risk factors include:
- Central obesity, or increased waist circumference
- Raised triglycerides
- Reduced HDL-cholesterol
- Raised blood pressure, or hypertension
- Raised fasting plasma glucose
According to the International Diabetes Federation and American Heart Association, any three or more factors are sufficient to increase risk of developing vascular problems leading to chronic illnesses. There is also uncertainty as to whether all patients with increased CMR are insulin-resistant, and the definition and aetiology have broadened to include adipose tissue disorders in more recent years.
What is clear however, is that while some determinants of CMR cannot be avoided (for example advancing age and genetic predisposition), many can be prevented or modified. While treatment tends to focus on the management of either cardiovascular disease risk or type II diabetes mellitus, depending on the specific risk factors present, all CMR risk factors share similar diet and lifestyle traits.
Diet and lifestyle changes
As such, diet and lifestyle interventions offer an opportunity to modify CMR and subsequently reduce the incidence of CVD events. A holistic approach to tackling the dietary contributors to CMR may even prove effective in prevention and treatment strategies for other related non-communicable diseases, with further research required.
With research suggesting that adherence to a Mediterranean diet can reduce the progression and prevalence of cardio-metabolic risk, and evidence that a Western dietary pattern is prospectively associated with increased CMR, there is a growing role for diet and lifestyle strategies in the management of cardio-metabolic risk.
The Winter Conference
Recognising the challenges to patients, practitioners, and researchers, Professor Bruce Griffin, University of Surrey and Council Member for Academia, has created a programme for the 2018 Winter Conference which focuses on optimal diet and lifestyle strategies for the management of cardio-metabolic risk. The conference, in partnership with the Royal Society of Medicine, will begin with a plenary lecture by Professor Jean-Pierre Després, Laval University, Canada examiningthe evolving understanding of CMR and its pathogenesis (‘from syndrome X to cardio-metabolic risk’),before a series of symposium investigating the role played by dietary fatty acids in metabolic tissue health. The Keynote Lecture from Professor Eric Rimm, Harvard Medical School, USA, will conclude day one with what is sure to be an engaging lecture; ‘The Optimal Diet – So Many Pieces to that Pie!’. Day two will examine the role played by carbohydrates, before the conference finishes with a broader look at dietary patterns, meal timing, and drug therapy on CMR. Dr. Alison Tedstone, Chief nutritionist at Public Health England, will conclude the conference with a summary and discussion of the implications for UK dietary policy.