According to the PASSI Surveillance System of the Ministry of Health , over 40% of the Italian population suffers from excess weight , which includes overweight and obesity . However, only 50% of overweight subjects recognize their health status as problematic. This underestimation, together with the reduced attention by health professionals, is a cause for concern, since obesity has become a chronic disease that requires specific treatment. Timely intervention is crucial to prevent long-term complications, such as cardiovascular diseases and metabolic disorders.
Excess weight , particularly abdominal obesity , is often associated with problems such as high blood pressure , alterations in the glucose profile and lipid alterations . These factors can evolve into a pathological condition known as metabolic syndrome , which requires an accurate diagnosis. The diagnostic criteria for metabolic syndrome have been updated over time and vary according to the guidelines of different scientific societies . ( F ig. 1). Early intervention is essential to prevent the onset of diabetes and cardiovascular problems .
| Organization | Insulin resistance | Arterial hypertension (max/min) | Triglycerides | HDL Cholesterol (♂︎/♀︎) | Obesity (♂︎/♀︎) |
|---|---|---|---|---|---|
| WHO | T2DM, IGT, HOMA-IR | ≥140/90 mmHg | ≥150 mg/dL | <35-39 mg/dL | BMI >30, WHR >0.9-0.85 |
| ATP III-NCEP | Fasting blood glucose ≥110 mg/dL | ≥130/85 mmHg | ≥150 mg/dL | ≤40-50 mg/dL | Abdominal circumference >102-88 cm |
| IDF | Fasting blood glucose ≥110 mg/dL | ≥130/85 mmHg | ≥150 mg/dL | ≤40-50 mg/dL | Abdominal circumference >102-88 cm |
| AHA/NHLBI | Fasting blood glucose ≥100 mg/dL | ≥130/85 mmHg | ≥150 mg/dL | ≤40-50 mg/dL | Abdominal circumference >102-88 cm |
Fig. 1: Diagnostic criteria for Metabolic Syndrome, according to various scientific societies.
Abbreviations: WHO: World Health Organization ; ATP III-NCEP: Adult Treatment Panel - National Cholesterol Education Program; IDF: International Diabetes Federation; AHA/NHLBI: American Heart Association/National Heart, Lung , and Blood Institute
Metabolic Syndrome: Prevalence and Diagnosis
According to data from the World Health Organization (WHO) , metabolic syndrome could have a global prevalence of 25%, that is, one in four people could be diagnosed with this condition. A central aspect of metabolic syndrome is dysfunction of carbohydrate metabolism , which represents a major risk factor for the development of diabetes and cardiovascular disease.
Diabetes andPre -diabetes: Diagnosis and References
Diabetes is diagnosed when plasma glucose values are equal to or greater than 126 mg/ dL , detected on two separate measurements. If values are between 100 and 125 mg/ dL , this is called pre -diabetes or impaired fasting glucose . Other parameters to consider include:
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Glycated hemoglobin (HbA1c) : diagnosis of diabetes if greater than 48 mmol , pre -diabetes if between 40 and 47 mmol .
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Insulin : hyperinsulinemia with values greater than 25 μU / mL .
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HOMA ( Homeostasis Model Assessment ) index: value higher than 2.5 indicates insulin resistance .
What is InsulinResistance ?
Insulin resistance is a condition in which the body's cells become less sensitive to insulin, leading to increased levels of insulin in the blood ( hyperinsulinemia ). This resistance is mainly caused by obesity (especially visceral fat), genetic factors , and chronic inflammation .
Metainflammation : The Influence of Visceral Fat
Visceral fat is the main culprit of the so-called metainflammation , a chronic low-grade inflammation that does not respond easily to anti-inflammatory therapies. This type of inflammation is associated with the secretion of pro-inflammatory cytokines (e.g., IL-6, TNF-α), which further worsen insulin resistance.
Nutraceuticals for Glycemic Control
In recent years, various nutraceutical extracts have been studied that can support glycemic control and counteract metabolic syndrome. The Mediterranean diet is particularly rich in polyphenols , which have shown benefits in reducing blood sugar and improving insulin sensitivity. In particular, citrus extracts , such as lemon and orange , have been the focus of numerous studies.
Citrus Polyphenols: Benefits for Blood Sugar
Flavonoids extracted from lemon (Citrus Limon) and orange (Citrus Sinensis ), including eriocitrin , hesperidin , and naringin , have been shown to:
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Improve plasma glucose control .
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Increase insulin sensitivity .
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Reduce LDL cholesterol and increase HDL.
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Promote the reduction of body mass index and oxidative stress .
These flavonoids may act by increasing the expression of insulin receptors and improving glucose uptake by muscles.
The Role of Chromium in Glycemic Metabolism
Chromium is an essential trace element that plays a crucial role in carbohydrate metabolism, improving insulin action and the ability of cells to absorb glucose. Chromium picolinate supplements ( 50 μg daily ) have been shown to reduce fasting blood glucose and insulin resistance . However, the best results are obtained when chromium is combined with other nutraceutical extracts .
Clinical Study on Glycemic Control with Nutraceuticals
A 2022 clinical study (Di Folco U.) demonstrated that the association of chromium picolinate And citrus extracts have produced positive results in the treatment of pre -diabetes . After 12 weeks, participants saw a reduction in fasting blood glucose by 7.7%, fasting insulin by 31%, and HOMA Index by 36%. The combination with flavonoids also reduced glycated hemoglobin by 5%.
The Role of Fiber and MicrobiotaEubiosis
Fiber plays a key role in improving the glycemic profile. Resistant dextrins from wheat starch, for example , are not digested and arrive intact in the colon, where they promote the eubiosis of the intestinal microbiota, thus improving glycemia and reducing systemic inflammation.
Conclusion: The Role of the Nutritionist
The nutritionist has a crucial role in recognizing patients at risk for pre -diabetes and diabetes , and in working with the treating physician for a complete evaluation of the glucose profile. The goals for the patient include:
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Reduction of body weight and waist circumference .
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Improved glycemic control.
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Reduction of insulin resistance.
The association of a balanced diet, particularly the Mediterranean diet, and the use of selected nutraceuticals can reduce the need for pharmacological therapies and improve the quality of life of patients with metabolic syndrome.
Bibliography:
Di Folco U, et al. Nutraceutical Effects of Mediterranean Citrus Extracts in Dysglycemia : A Pilot Study. Ann Med Health Sci Res. 2022;12: 298-303.
