Basic evidence and best practices to

enhance the quality of care,

as well as patient and
program safety in preventive and
promotion medicine

BJ. Istiti Kandarina

BEPH – 2022
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Nutrition is thought to play a fundamental role
in the prevention, treatment, and prognosis of
both acute and chronic diseases

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 Evidence-based Nutrition
• The practice of evidence-based nutrition involves
using the best available nutrition evidence, together
with clinical experience, to conscientiously work with
patients’ values and preferences to help them
prevent (sometimes), resolve (sometimes), or cope
with (often) problems related to their physical,
mental, and social health.

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The 3 Fundamental
Principles Of Evidence Based Nutrition

1. optimal clinical decision-making requires awareness of the best

available evidence that will ideally come from systematic
summaries of the available evidence.

2. EBN provides guidance to decide whether evidence is more or less

trustworthy - that is, how certain can we be of our patients’
prognosis, of our therapeutic options,or of the properties of
diagnostic tests?

3. evidence alone is never sufficient to make a clinical decision.

Decision makers must always trade off the benefits with the risks, burden, and
costs associated with alternative managementstrategies, as well as individuals’
dietary habits and preferences,
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Levels of evidence GRADES
(Grading of Recommendation Assessment, Development, and
Evaluation) are used to summarize the available scientific
evidenceand guide recommendations for the prevention and
treatment of Metabolic Syndrome:

A: evidence from meta-analyses that incorporated quality

B: evidence from prospective cohort studies or case–control
studies; and
C: expert consensus/opinion or clinical experience.

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introduction
The metabolic syndrome (MetS) is a constellation of associated
factors that may be influenced by overnutrition and sedentary
lifestyle.

MetS represents a common clinical condition in countries where

obesity and so-called Western (unhealthy) dietary patterns
prevail. In close association with the rising obesity epidemic, the
prevalence of MetS is also increasing to epidemic
proportions,which entails substantial healthcare costs.

The importance of MetS lays in its associated risk of

cardiovascular (CV) disease (CVD) and type 2 diabetes (T2DM), as
well as other harmful conditions such as nonalcoholic fatty liver
disease.

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Definition of metabolic syndrome

The International Diabetes Federation defined

MetS as central obesity in addition
to any 2 of the following:
 raised triglyceride (TG) levels,
 low high-density lipoprotein cholesterol (HDL-C)
levels,
 hypertension, and
 elevated fasting plasma glucose.

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Grading of the evidence and recommendations
regarding alcohol consumption and metabolic
syndrome

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Grading of the evidence and recommendations
regarding smoking and metabolic syndrome

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 Grading of the evidence and recommendations
regarding physical activity and metabolic syndrome

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Summary of available evidence on physical
activity

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Grading of the evidence and recommendations
regarding weight control and metabolic
syndrome

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Grading of the evidence and recommendations
regarding the Mediterranean diet and metabolic
syndrome

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Grading of the evidence and recommendations
regarding olive oil and metabolic syndrome

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 Grading of the evidence and recommendations
regarding particular diets and metabolic syndrome

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Grading of the evidence and recommendations
regarding legumes and metabolic syndrome

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Grading of the evidence and recommendations
regarding cereals and metabolic syndrome

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Grading of the evidence and recommendations
regarding fruit/vegetable intake and metabolic
syndrome

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 Grading of the evidence and recommendations
regarding intake of fish and n-3 fish oils and metabolic
syndrome

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Grading of the evidence and recommendations
regarding nut intake and metabolic syndrome

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 Grading of the evidence and recommendations
regarding dairy product and egg intake and metabolic
syndrome

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 Grading of the evidence and recommendations
regarding sweets, sugar-sweetened beverages, and artificial
sweetener intake and metabolic syndrome

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 Grading of the evidence and recommendations
regarding chronobiology and metabolic syndrome

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Lifestyle recommendations for management of
metabolic syndrome

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Foods, nutrients, and dietary patterns in the
prevention of metabolic syndrome

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 Conclusion
A healthy lifestyle is critical to prevent or delay
the onset of MetS in susceptible individuals and
to prevent CVD and T2DM in those with MetS.

The recommendations presented here should

help patients and clinicians understand and
implement the most effective approaches for
lifestyle change to prevent MetS and improve
cardio-metabolic health.
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THANK YOU
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