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Lee, Choi, and Yang: Effects of Dietary and Physical Activity Interventions on Metabolic Syndrome: A Meta-analysis
Review Article

Journal of Korean Academy of Nursing 2015; 45(4): 483-494.

Published online: 31 August 2015

DOI: https://doi.org/10.4040/jkan.2015.45.4.483

Effects of Dietary and Physical Activity Interventions on Metabolic Syndrome: A Meta-analysis

Guna Lee1, Hye-Young Choi2, Sook-Ja Yang2

1Division of Nursing Science, Ewha Womans University, Seoul, Korea.

2Department of Nursing, Tongmyong University, Busan, Korea.

Address reprint requests to: Yang, Sook-Ja. Helen Hall 203-3, Division of Nursing Science, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea. Tel: +82-2-3277-4652, Fax: +82-2-3277-2850, yangsj@ewha.ac.kr

Received 15 January 2015       Revised 31 January 2015       Accepted 26 May 2015

© 2015 Korean Society of Nursing Science

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0/) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

This study identified effects of dietary and physical activity interventions including dietary interventions or physical activity interventions alone or combined dietary-physical activity interventions to improve symptoms in metabolic syndrome including abdominal obesity, high triglycerides, low high density lipoprotein cholesterol, elevated blood pressure, and elevated fasting glucose through meta-analysis.

Methods

Articles on metabolic syndrome X published from 1988 to 2013 were searched through electronic databases, Google Scholar, and reference reviews. Methodological quality was assessed by the checklist, SIGN (Scottish Intercollegiate Guidelines Network).

Results

In the meta-analysis, there were 9 articles reporting 13 interventions with 736 participants. Using random effect models, the dietary and/or physical activity interventions showed a lower mean difference in waist circumference ( - 1.30 cm, 95% CI: - 2.44~ - 0.15, p =.027). The combined dietary-physical activity interventions showed a lower mean difference in waist circumference ( - 2.77 cm, 95% CI: - 4.77~ - 0.76, p =.007) and systolic blood pressure ( - 5.44 mmHg, 95% CI: - 10.76~ - 0.12, p =.044). Additionally, interventions of over 24 weeks yielded a lower mean difference in waist circumference ( - 2.78 cm, 95% CI: - 4.69~ - 0.87, p =.004) and diastolic blood pressure ( - 1.93 mmHg, 95% CI: - 3.63~ - 0.22, p =.026).

Conclusion

The findings indicate that dietary and/or physical activity interventions for metabolic syndrome reduce central obesity with no adverse effects. This finding provides objective evidences for dietary and physical activity management on metabolic syndrome as an efficient intervention.

Keywords: Metabolic syndrome X, Meta-analysis, Physical activity, Diet therapy, Health behavior

Figures and Tables

Figure 1

The flow diagram of study selection for the meta-analysis.

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Figure 2

Forest plot of the effect of dietary and/or physical activity interventions and funnel plot of the effect sizes by standard error on metabolic syndrome criteria.

Pooled effect estimates are shown as diamonds, one each for trials conducted in waist circumference, triglycerides, high-density lipoprotein cholesterol, systolic blood pressure, diastolic blood pressure, and fasting glucose. Data are expressed as mean difference with 95% confidence interval, using fixed effects models(waist circumference, triglycerides, high-density lipoprotein cholesterol, diastolic blood pressure and fasting glucose) and random effects model(systolic blood pressure). Inter-study heterogeneity was tested by using the Q statistic(Chi2) at significance level of p<.10 and quantified by the Higgins' I2 statistic (I2>50%).
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Table 1

Characteristics of Studies Included in the Meta-analysis

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*The data was reported not considering the drop out of 3 participants from the study; †The number indicates participants' baseline mean of outcome items; Exp.=Experimental group; Cont.=Control group; Mets.=Metabolic syndrome; WC=Waist circumference; TG=Triglycerides; HDL=High-density lipoprotein cholesterol; SBP=Systolic blood pressure; DBP=Diastolic blood pressure; FG=Fasting glucose; NR=Not reported; NCEP=National cholesterol education program adult treatment panel III; IDF=International Diabetes Federation; D=Dietary intervention; P=Physical activity intervention; + =Statistically significant difference between experimental group and control group; - =No significant difference between experimental group and control group; NA=Not applicable.

Table 2

Quality Assessment of Studies Included in the Meta-analysis

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*Indicates that the factor was ignored or not mentioned in this study design; †Indicates that the factor was reported in this study but in insufficient detail to allow assessment; ‡Indicates that the factor was not applicable in this study design; + +All or most of the criteria have been fulfilled: USA.

Table 3

Subgroup Analysis of Studies Included in the Meta-analysis

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*Outcomes are presented as mean difference between intervention groups; †Number of dietary intervention studies; ‡Number of physical activity intervention studies; §Studies with a<24 week intervention period; ∥Studies with an=24 week intervention period; WC=Waist circumference; TG=Triglycerides; HDL=High-density lipoprotein cholesterol; SBP=Systolic blood pressure; DBP=Diastolic blood pressure; FG=Fasting glucose; CI=Confidence interval; D=Dietary intervention; P=Physical activity intervention.

Appendices

Appendix 1

9 Selected Studies in Meta-analysis

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Appendix 2

Search Strategy Utilized for PubMed

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