Metabolic syndrome refers to a group of disorders related to the process of metabolizingsubstances including lipid metabolism disorder, abdominal fat, high blood pressure and blood gluco
Trang 1Metabolic syndrome refers to a group of disorders related to the process of metabolizingsubstances including lipid metabolism disorder, abdominal fat, high blood pressure and blood glucose(blood sugar) disorder In patients with diabetes, blood glucose levels tend to be not properlyregulated; this would allow long-term carbohydrate disorders to result in lipid metabolism disorders,high blood pressure, body fat accumulation and finally, metabolic syndrome The appearance ofmetabolic syndrome among type 2 diabetes patients worsens the severity of the disease and furthercauses dangerous complications, especially to blood vessels and nerves
In Vietnam, white rice the chief source of energy in people’s meals Carbohydrate (a part ofCarbohydrate) constitutes quite a large percentage of the total energy (70%) in the meals However,after rice grain is milled, it loses 85% of its fat content, 15% of its protein content, 75% of itsphosphorus content, 90% of its calcium content, 75% of its vitamin Bs, iron, magnesium andespecially the fiber content that exist chiefly in its bran and germ layers Germinated Brown Rice(GBR) is made from rice grain that has only the husk milled away, thus keeping the bran and germlayers intact After removing the husk, the rice is then soaked in warm water until the sprouts growslightly Subsequently, the rice is dried The germination process of brown rice increases the amount
of biological chemicals located in rice bran that could help control blood glucose and blood lipidlevels
In order to collect more scientific data on the current state of & risk factors contributing to theprevalence of metabolic syndrome among type 2 diabetes, along with the effects of using GerminatedBrown Rice (GBR) in helping control the components of metabolic syndrome, we have conducted theresearch with the two following objectives:
1 Determine the current state of & risk factors contributing to the prevalence of metabolic syndrome among type 2 diabetes outpatients at Vu Thu General Hospital, Thai Binh Province were facing in 2016.
2 Evaluate the effects of Germinated Brown Rice (GBR) in helping control the components
of metabolic syndrome among type 2 diabetic outpatients that have metabolic syndrome.
New contributions of the research
This research has provided additional important scientific data on the current state of & riskfactors contributing to the prevalence of metabolic syndrome among type 2 diabetes patients This isthe first time ever the data on the current situation of metabolic syndrome along with its associatedrisk factors in type 2 diabetes patients are publicized and, domestically, at the present, there are onlyvery few studies on these problems
GBR - Germinated Brown Rice is the result of a scientific application in which husked brownrice is germinated, thus increasing the amount of beneficial nutrients that could help control thecomponents of metabolic syndrome in type 2 diabetes patients located in its bran and germ layers.This is the product that can completely replace white rice in daily consumption
Structure of the thesis
The thesis consists of 134 pages, 36 tables, 10 pictures and 135 references includingdocuments from foreign sources The introduction is 03 pages, overview 32 pages, subjects and
Trang 2methods of research 21 pages, research results 31 pages, discussion 44 pages, conclusion 02 pagesand recommendation 01 page.
Trang 3Chapter 1: OVERVIEW OF THE THESIS
1.1 Diagnostic criteria for metabolic syndrome
At the present, there are many criteria used to diagnose metabolic syndrome Depending on theopinion on pathogenesis and prevention mechanism, each organization provides different diagnosticcriteria Firstly, the experts of WHO, based on Reaven’s concept, produced a new definition onmetabolic syndrome with specific diagnostic criteria Afterwards, European Group for the Research ofInsulin Resistance (EGIR), National Cholesterol Education Program - Adult Treatment Panel-III(NCEP-ATPIII) provided a definition for metabolic syndrome in 2001 and updated it in 2005,International Diabetes Federation (IDF) also produced a definition for themselves These sets ofcriteria all agree that the main components of metabolic syndrome are glucose malabsorption, obesity,high blood pressure and lipid metabolism disorders; however, each criteria set is different from theother regarding the dominant risk factors and the threshold used to determine the components Thecriteria of WHO and EGIR both state that glucose malabsorption and insulin resistance as the majorrisk factors Conversely, the criteria set of NCEP does not include insulin resistance as a component
in their diagnosis
In 2009, the common criteria formed from the criteria sets of all the aforementionedorganizations for diagnosing metabolic syndrome contained 03 among 05 components aboveincluding: wider waist circumference, high triglycerides, low HDL-C, high blood pressure and highblood glucose Abdominal fat was not an essential criterion in diagnosing metabolic syndrome but itwas one among the five main criteria and was effective in initial screening
1.2 The current state of metabolic syndrome among type 2 diabetes patients
Overall, the studies on metabolic syndrome among type 2 diabetes patients all over the Worldand Vietnam are still quite limited and they all show that the prevalence of metabolic syndrome intype 2 diabetes patients is high
The research of S H Song shows that the prevalence of metabolic syndrome in type 2 diabetespatients undergoing treatment at the hospital at the time, for both male and female, measuredaccording to the IDF criteria, was 91.7% and 94.8%, and according to the criteria of NCEP-ATPIIIwas 87.6 and 94.2%, respectively A research in Pakistan in 2012 shows that the prevalence ofmetabolic syndrome in type 2 diabetes patients according to WHO criteria was 81.4%
The research conducted by Le Thanh Duc at Vinh Long General Hospital illustrates that theprevalence of metabolic syndrome in accordance with IDF criteria was 59% Another researchconducted at Ho Chi Minh city in 2004 states that the prevalence of metabolic syndrome according toNCEP-ATPIII’s criteria was 77.6%, according to NCEP-ATPIII’s criteria for Asian people was86.0%, according to WHO 1999’s criteria was 91.4% and according to WHO 1999’s criteria for Asianpeople was 92.4%
1.3 The risk factors contributing to the prevalence of metabolic syndrome
Physical activities: Physical activities are a very important factor in the process of energyexpenditure; physical activities enable the body to balance between then energy intake and the energy
Trang 4consumed On the other hand, physical activities also promote for beneficial energy conversion in thebody, thus reducing fat, promoting insulin sensitivity and reducing blood insulin.
Sex: Many researches have shown that the prevalence of metabolic syndrome among femaletype 2 diabetes patients is higher than that of the male counterpart This may be because it is morelikely for women to have abdominal fat and female hormones increase the likelihood of having thecomponents of metabolic syndrome
Smoking and drinking: Many studies have shown that smoking and drinking alcohol or beercould lead to high blood pressure, wider waist circumference and high triglycerides, as well as lowHDL-C and lowered insulin sensitivity or insulin resistance
Frequency of consumption of a few types of food: Diet is one of the essential factors thatdirectly affects obesity, diabetes and metabolic syndrome A surplus supply of energy from meals thatcontain a large quantity of fat, sugar, of unreasonable portions, an imbalance between nutrients such
as lipid, carbohydrate, protein, amino acids… shall result in carbohydrate and lipid disorder
1.4 The nutrition content in Germinated Brown Rice (GBR)
GBR is produced by soaking husked brown rice in water and let germinate The germinationprocess would soften the rice when cooked as well as render it tastier than husked brown rice; inaddition, this also enriches the amount of active substances found in husked brown rice such asGamma-aminobutyric acid, acylated steryl glucosides, inositol hexaphosphate, ferulic acid, inositol, γ-oryzanol, tocopherols, tocotrienols, vitamins and minerals
- The effects of GBR on controlling post-meal blood glucose and blood insulin levels inhealthy people were measured under two diets, one had the ratio of white rice/GBR being 2/1 and theother 1/2; the blood sugar levels after 120 mins of the GBR-heavy diet was 54.4±5.1, statisticallylower than that of the white rice-heavy diet, which was 74.6±6.2 mg/dl, the blood sugar levels is inreverse proportion with the ration of GBR/white rice
- The effects of GBR on controlling blood glucose and blood lipid levels for people with bloodsugar disorder when hungry or with diabetes: According to a research on subjects with blood sugardisorder when hungry or diagnosed with diabetes, after 6 weeks of intervention, the group that ateGBR had blood sugar levels lowered compared to before eating GBR (135±7mg/dl and 153±9mg/dl,respectively) The amount of total cholesterol and triglycerides of GBR eating subjects bothexperienced statistically significant reduction
- The effects of GBR on controlling blood glucose levels and weight for pre-diabetes women:Bui Thi Nhung carried out a research on pre-diabetes women aged 45-65 using GBR as thereplacement for white rice continuously for 04 months The results show that the post-interventionblood glucose levels, HbA1c, triglycerides, HDL-C, LDL-C all experienced statistically significantchanges compared to pre-intervention The figures related to biometry such as weight, BMI, body fat,waist size, hip size, waist/hip ratio all underwent statistically significant changes as well
- Tran Ngoc Minh conducted a research on the effects of GBR on controlling post-meal bloodglucose levels in type 2 diabetes patients The intervention research results also illustrate that, after 16weeks, GBR reduced blood glucose levels and helped regulate blood lipid levels compared to pre-intervention
Trang 5- Effects of GBR on patients with metabolic syndrome A research in which GBR was used asthe intervention on metabolic syndrome patients aged 55-70 years old for 03 months continuouslyshows that the blood glucose levels, insulin, HbA1c, cholesterol, triglycerides, LDL-C all wentthrough statistically significant reduction compared to pre-intervention The prevalence of metabolicsyndrome was lowered from 100% down to 70% post-intervention.
Trang 6Chapter 2: SUBJECTS AND METHODS OF RESEARCH
2.1 Subjects of the research
Pre-intervention phase: Outpatients diagnosed with type 2 diabetes being treated at Vu ThuGeneral Hospital at the time
Intervention phase: Pre-intervention patients with metabolic syndrome, aged 45-65 years old atthe research location
2.3 Research location: Vu Thu District, Thai Binh Province
2.4 Research time: Over 02 years, from 2016 to 2017.
2.5 Sample size and method of selecting sample
Sample size:
Sample size before intervention: All type 2 diabetes outpatients undergoing treatment at VuThu General Hospital, Thai Binh province in 2016 As the result, the research group managed toselect 846 subjects after screening all other unqualified patients
Intervention subject size:
(1 +2/) (Z1-/2 +Z1-)2
N1 =
(μ1- μ2)2The sample size was n = 43 The research group estimated that 15% of the subjects would quit
so the sample size needed to be 50 intervention subjects and 100 comparison subjects In reality, theresearch group managed to acquire 54 intervention subjects and 108 comparison subjects However,during the intervention process there were 02 subjects of the intervention group and 04 subjects of thecomparison group moved to another Province, therefore the data of 52 intervention subjects and 104comparison subjects was ultimately assessed
Subject selection for intervention phase:
- Step 1: Make a list of type 2 diabetes patients with metabolic syndrome
- Step 2: Select 54 patients, aged 45-65 that do not have any diabetes complication yet, and donot have their treatment plan changed 06 months prior to the time of intervention Remove patientswith acute disease, that are using insulin drugs and supplements that help control blood lipid disordersand blood glucose disorders and are using husked brown rice/germinated brown rice at the time.Select subjects for the comparison group: In order to ensure the similarity of the comparisongroup, for each intervention subject, choose 02 comparison subjects based on criteria: same sex (both
Trang 7are male or female), age gap does not exceed 05 years, HbA1c difference does not exceed 01% Sex,age, HbA1c are the most objective components that are not affected by other unwanted elementsduring the intervention process.
2.6 Contents of the research
- Objective no 01
To gather data on the current state of metabolic syndrome prevalence among type 2 diabetespatients: Take biometric measurements, blood pressure, waist measurement, perform blood test todetermine whether a subject has metabolic syndrome
To determine a number of related social elements: Interview the subjects on their economicand social background, their own characteristics, characteristics of their lifestyle and diets todetermine the connections to metabolic syndrome prevalence among type 2 diabetes patients
- Objective no 02
Intervene by having the selected subjects eating GBR instead of white rice completely andcontinuously for 16 weeks in a row Monitor their meals, perform tests and analyze their 24-hour dietsfor 03 days in a row and compare the results of pre and post intervention
2.7 Techniques used in the research
Interview to gather information of the subjects such as age, sex, education, occupation,lifestyle, physical activities, frequency of consuming certain types of food, take their biometricmeasurements, waist measurement, perform blood test to gather data on glucose, triglycerides, HDL-
C, total cholesterol, LDL-C, HbA1c and interview them on their 24-hour diets
Using Germinated Brown Rice (GBR): GBR used in the test was produced at Viet NamBiomedical Technology Joint Stock Company at no 117 Thai Binh street, Nam Dinh city, Nam Dinhprovince using Japanese technology Rice grain was husked and still had its bran and germ layerintact Then the husked rice was soaked in warm water until sprouts grew Subsequently, the rice wasdried and bagged Each bag contained 01 kg of rice and was tightly sealed The rice was tested for itsnutrition values, heavy metal content and underwent microbiological test at National Institute ofNutrition
The subjects were supplied with GBR each week and use it in every meal In the process ofcooking the rice was not washed to avoid losing nutrients The rice was cooked in a normal electriccooker, the water content put in depended on the preference of each subject (whether that personpreferred eating drier or wet rice) It was required that each subject must eat GBR for the two mainmeals of the day continuously for the duration of 16 weeks
2.8 Methods of managing, processing and analyzing data
The data was entered into EpiData 3.1 software and was analyze on SPSS 16.0 software Thestatistic tests were used as single variable, multivariate logistic regression; Chi-squared test was used
to compare and establish the differences between the groups; independent t test and paired t test wereused to compare and establish the differences regarding the average values between the groups Thedifferences were accepted when p<0.05 ARR (absolute risk reduction) and NNT (number needed to
Trang 8treat - the number of patients we need to treat to prevent one additional bad outcome) were used toassess the effectiveness of the intervention.
Trang 9Chapter 3: RESEARCH RESULTS 3.1 The current state of, and a number of risk factors contributing to the prevalence of metabolic syndrome among type 2 diabetes patients
Table 3.1 Common characteristics of the test subjects Characteristics
Number (%) Number
(%)
Number (%) Age group
Figure 3.1 Prevalence of metabolic syndrome and its components
According to the chart, the prevalence of metabolic syndrome is 67.6% High triglycerides isthe component that the subjects are most likely to have (62.3%), while wider waist circumference isthe least likely (36.3%)
Trang 10Figure 3.2 Prevalence of metabolic syndrome based on age group
We could see that the prevalence of metabolic syndrome has the tendency to increase with age
It is at its lowest in under 45 years old group (30.3%) and at its highest in 65-74 years old group(72.5%)
Table 3.2 Prevalence of metabolic syndrome and its components according to sex
Number (%)
Female Number (%)
Trang 11Figure 3.3 Rate of having metabolic syndrome’s components
The number of subjects that have 03 components is the highest (38.7%), while the number ofsubjects that possess all 05 components is the lowest (5.7%)
Figure 3.4 Percentage of combinations of the components among the subjects (HA = High blood pressure, TG = High triglycerides, VE = Wider waist circumference,
HDL = Low HDL-C, Glu = High blood glucose)
As can be seen from the chart, the most common combination is high blood glucose – highblood pressure – high triglycerides (17.8%) The least common combination is high blood glucose –wider waist circumference – low HDL-C and high blood glucose – wider waist circumference – lowHDL-C – high triglycerides (both at 4.4%) The combination of all 05 components: high bloodglucose – high blood pressure – high triglycerides – wider waist circumference – low HDL-Cconstitute 8.4%