Healthy lifestyle for metabolic health: no more excuse!

Abstract

Metabolic syndrome (MS) constitutes a growing problem worldwide. Whether or not one accepts this condition as a by-product of our modern lifestyle, the concept of MS continues to gain acceptance. There is a quite general agreement that its rising prevalence is largely due to the increasing incidence of obesity and associated lifestyle factors. The increased risk of type 2 diabetes and cardiovascular events in people with MS is well known [1]; recent epidemiological evidence also suggests a positive association between MS and the risk of some common cancer [2–4]. Studies of the beneficial health effects of physical activity (PA) date back to the 1950s [5] and have been replicated in large cohorts. Overall, PA is associated with many health-related benefits, including a reduced risk of developing several chronic diseases such as obesity, cardiovascular disease, type 2 diabetes, and cancer. Recommendations for PA and health have included 30 min/day (or more) of at least moderate-intensity PA on most days of the week with respect to cardiovascular benefits [6]. Data from the U.S. National Health and Nutrition Examination Survey (NHANES) indicate that the vast majority of daily non-sleeping time is spent in either sedentary behavior (58 %) or light-intensity activity (39 %), and only 3 % in exercise time [7]. Cross-sectional studies found an inverse gradient between amount of PA and MS. Guidelines support that at least 150 min of moderate-intensity PA per week is associated with a lower prevalence of MS and diabetes [8]. The EPIC Norfolk prospective population study investigated the association among PA, MS, and the risk of future coronary heart disease (CHD) and mortality due to CHD in 10,134 middle-aged men and women [9]. The prevalence of MS was 37.6 % in men and 30.2 % in women. There was no longer a significant difference in CHD event rate between men with MS who were active and men without MS who were inactive, indicating that PA lowers the CHD risk associated with MS. He and coworkers [10] did the first meta-analysis of prospective studies, including 64,353 participants and 11,271 incident cases reporting the association between leisure-time physical activity (LTPA) and risk of future MS. Compared to inactive people, a high level of LTPA was associated with a 20 % reduced risk of incident MS independent of sex, definition of MS, and duration of follow-up; on the other hand, the association between moderate level of LTPA and incident MS was modest (5 % reduced risk), except in men (12 % reduced risk) and in studies with a long follow-up ([10 years). The aim to focus upon LTPA was not by chance: PA at work, walking, and bicycling have declined dramatically in industrial and urban societies. This is an important reason why more recent epidemiologic studies in high-income countries have focused on leisure-time activity, with less emphasis on K. Esposito (&) Department of Clinical and Experimental Medicine, and Diabetes Canter, Second University of Naples, Piazza L. Miraglia 2, 80138 Naples, Italy e-mail: katherine.esposito@unina2.it