title: Lifestyle modification for metabolic syndrome: a systematic review.
abstract: BACKGROUND
  All 5 components of metabolic syndrome have been shown to improve with lifestyle and diet modification. New strategies for achieving adherence to meaningful lifestyle change are needed to optimize atherosclerotic cardiovascular risk reduction. We performed a systematic literature review, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework (PRISMA), investigating optimal methods for achieving lifestyle change in metabolic syndrome.
  
  
  METHODS
  We submitted standardized search terms to the PubMed Central, CINAHL, Web of Science, and Ovid databases. Within those results, we selected randomized controlled trials (RCTs) presenting unique methods of achieving lifestyle change in patients with one or more components of the metabolic syndrome. Data extraction using the population, intervention, comparator, outcome, and risk of bias framework (PICO) was used to compare the following endpoints: prevalence of metabolic syndrome, prevalence of individual metabolic syndrome components, mean number of metabolic syndrome components, and amount of weight loss achieved.
  
  
  RESULTS
  Twenty-eight RCTs (6372 patients) were included. Eight RCTs demonstrated improvement in metabolic syndrome risk factors after 1 year. Team-based, interactive approaches with high-frequency contact with patients who are motivated made the largest and most lasting impact. Technology was found to be a useful tool in achieving lifestyle change, but ineffective when compared with personal contact.
  
  
  CONCLUSIONS
  Patient motivation leading to improved lifestyle adherence is a key factor in achieving reduction in metabolic syndrome components. These elements can be enhanced via frequent encounters with the health care system. Use of technologies such as mobile and Internet-based communication can increase the effectiveness of lifestyle change in metabolic syndrome, but should not replace personal contact as the cornerstone of therapy. Our ability to derive quantitative conclusions is limited by inconsistent outcome measures across studies, low power and homogeneity of individual studies, largely motivated study populations, short follow-up periods, loss to follow-up, and lack of or incomplete blinding.
authors.affiliation: Department of Cardiology, Feinberg School of Medicine, Chicago, Ill; Department of Medicine, Feinberg School of Medicine, Chicago, Ill.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Bassi
authors.affiliation: Department of Cardiology, Feinberg School of Medicine, Chicago, Ill; Department of Medicine, Feinberg School of Medicine, Chicago, Ill.
authors.forename: Ilya
authors.initials: I
authors.lastname: Karagodin
authors.affiliation: Department of Cardiology, Feinberg School of Medicine, Chicago, Ill; Department of Medicine, Feinberg School of Medicine, Chicago, Ill.
authors.forename: Serena
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Cardiology, Feinberg School of Medicine, Chicago, Ill; Department of Medicine, Feinberg School of Medicine, Chicago, Ill.
authors.forename: Patricia
authors.initials: P
authors.lastname: Vassallo
authors.affiliation: Department of Cardiology, Feinberg School of Medicine, Chicago, Ill; Department of Medicine, Feinberg School of Medicine, Chicago, Ill.
authors.forename: Aparna
authors.initials: A
authors.lastname: Priyanath
authors.affiliation: Department of Endocrinology, Feinberg School of Medicine, Chicago, Ill.
authors.forename: Elaine
authors.initials: E
authors.lastname: Massaro
authors.affiliation: Department of Cardiology, Feinberg School of Medicine, Chicago, Ill; Department of Medicine, Feinberg School of Medicine, Chicago, Ill. Electronic address: n-stone@northwestern.edu.
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Stone
mesh_terms: D005081:Exercise Therapy / Q000379:methods*; D005247:Feeding Behavior; D006801:Humans; D020407:Internet; D024821:Metabolic Syndrome / Q000628:therapy*; D063731:Mobile Applications; D009042:Motivation; D010349:Patient Compliance; D040242:Risk Reduction Behavior; D016896:Treatment Outcome; D061217:Weight Reduction Programs / Q000379:methods*
keywords: Adherence; Metabolic syndrome; Motivation; Technology