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Volume 73 - 2010 - Fasc.2 - Symposium

Management of metabolic syndrome and associated cardiovascular risk factors

Patients with metabolic syndrome have a 1.5- to 3-fold increase in the risk of coronary heart disease and stroke. The association between metabolic syndrome and cardiovascular diseases raises important questions about the underlying pathological processes, especially for designing targeted therapeutic interventions. Cardiovascular risk reduction in individuals with metabolic syndrome should include at least three levels of interventions : 1) control of obesity, unhealthy diet and lack of physical activity ; 2) control of the individual components of metabolic syndrome, especially atherogenic dyslipidaemia, hypertension, dysglycaemia and prothrombotic state ; and 3) control of insulin resistance, a defect closely linked to metabolic syndrome. Metabolic syndrome generally precedes and is often associated with type 2 diabetes. Because of this intimate relationship, appropriate management of metabolic syndrome should be able to prevent the progression from impaired glucose tolerance to frank diabetes and thus to prevent type 2 diabetes, another important cardiovascular risk factor. The importance of prevention of diabetes in high-risk individuals (such as people with metabolic syndrome are) is highlighted by the substantial and worldwide increase in the prevalence of type 2 diabetes in recent years. Owing to the complex pathophysiology and phenotypic expres- sion of metabolic syndrome, lifestyle changes are crucial as they are able to positively and simultaneously influence almost all com- ponents of the syndrome. If such measures are not sufficient or not adequately followed, a pharmacological intervention may be con- sidered. However, no official guidelines are available yet concern- ing the pharmacological management of individuals with metabol- ic syndrome. (Acta gastroenterol. belg., 2010, 73, 261-267).


Involvement of the gut microbiota in the development of low grade inflammation associated with obesity : focus on this neglected partner

Nowadays, the literature provides evidence that obesity, type 2 diabetes and insulin resistance are characterized by a low grade inflammation. Among the environmental factors involved in such diseases, the gut microbiota has been proposed as a key player. This neglected “organ” has been found to be different between healthy and or obese and type 2 diabetic patients. For example, recent data have proposed that dysbiosis of gut microbiota (at phyla, genus, or species level) affects host metabolism and energy storage. Among the mechanisms, metabolic endotoxemia (higher plasma LPS levels), gut permeability and the modulation of gut peptides (GLP-1 and GLP-2) have been proposed as putative targets. Here we discuss 1° the specific modulation of the gut microbiota composition by using prebiotics and 2° the novel findings that may explain how gut microbiota can be involved in the development or in the control of obesity and associated low-grade inflammation. (Acta gastroenterol. belg., 2010, 73, 267-269).