Wirth A
Teutoburger-Wald-Klinik, Bad Rothenfelde.
Herz. 1995 Feb;20(1):56-69.
The metabolic syndrome usually goes along with abdominal obesity: diabetes type II, hypertension, dyslipidemia, and gout are often associated. The common characteristic is the resistance to insulin action. Reasons for the metabolic syndrome are--besides a genetic determination--overnutrition, physical inactivity, and alcohol consumption. Therefore, a causal therapy aims at the elimination of these factors. Consequently, the non-pharmacological therapy of the metabolic syndrome should be emphasized. The most important treatment is the reduction of body weight in the presence of obesity which is relevant for almost 90% of the patients. Body weight can rapidly be diminished by hypocaloric diets. Both, conventional reducing diets or formula diets may be used for weight reduction. Total fasting should not be performed for several reasons. For minor weight reduction or weight maintenance following a period of rapid weight loss with a hypocaloric diet, increased physical activity also lowers weight or prevents relapsing. Aims of therapeutical procedures are the elimination or amelioration of insulin resistance and subsequently the diseases of the metabolic syndrome. Both methods, reducing diet and physical training, act on various factors related to insulin resistance. For example, hypocaloric diets activate thyroxine kinase of the insulin receptor and reduce glucose and insulin in plasma. Physical training reduces not only insulin and glucose in plasma but also free fatty acids in addition and increases capillary density in skeletal muscle. Using the glucose clamp technique, diets and training are equally effective in improving glucose metabolism. Compared to these non-pharmacological methods drugs are less convincing. Since the non-pharmacological treatment implies behavioral changes with regard to nutrition, physical activity and alcohol consumption, simple instructions are not sufficient. Usually long-lasting changes in life style are necessary in order to achieve health improvement. Therefore, health care programs on individual or social basis are required in order to improve nutrition and increase physical activity. However, long-acting effects are difficult to achieve in adults; more promising is the prevention of insulin resistance.
常常伴有2型糖尿病、高血压、血脂异常和痛风。其共同特征是胰岛素作用抵抗。除了基因决定因素外，代谢综合征的病因还包括营养过剩、缺乏体育活动和饮酒。因此，因果治疗旨在消除这些因素。因此，应强调代谢综合征的非药物治疗。最重要的治疗方法是在存在肥胖的情况下减轻体重，这对几乎90%的患者都很重要。低热量饮食可使体重迅速减轻。传统的减肥饮食或配方饮食均可用于减轻体重。由于多种原因，不应进行完全禁食。对于在采用低热量饮食快速减重一段时间后的轻度体重减轻或体重维持，增加体育活动也可减轻体重或防止体重反弹。治疗程序的目标是消除或改善胰岛素抵抗，进而消除代谢综合征相关疾病。节食和体育锻炼这两种方法都作用于与胰岛素抵抗相关的各种因素。例如，低热量饮食可激活胰岛素受体的甲状腺素激酶，降低血浆中的葡萄糖和胰岛素水平。体育锻炼不仅可降低血浆中的胰岛素和葡萄糖水平，还可降低游离脂肪酸水平，并增加骨骼肌中的毛细血管密度。使用葡萄糖钳夹技术，节食和锻炼在改善葡萄糖代谢方面同样有效。与这些非药物方法相比，药物的效果不太令人信服。由于非药物治疗意味着在营养、体育活动和饮酒方面的行为改变，简单的指导是不够的。通常需要持久的生活方式改变才能改善健康状况。因此，需要基于个人或社会层面的医疗保健计划来改善营养状况并增加体育活动。然而，在成年人中很难实现长效效果；预防胰岛素抵抗更有前景。
