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Dietary Interventions to Reduce Metabolic Syndrome in an Uninsured Population: an Evidence-Based Approach Michele Smith Bednarzyk University of North Florida

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Dietary Interventions to Reduce Metabolic Syndrome in an Uninsured Population: an Evidence-Based Approach Michele Smith Bednarzyk University of North Florida UNF Digital Commons UNF Graduate Theses and Dissertations Student Scholarship 2009 Dietary Interventions to Reduce Metabolic Syndrome in an Uninsured Population: An Evidence-Based Approach Michele Smith Bednarzyk University of North Florida Suggested Citation Bednarzyk, Michele Smith, "Dietary Interventions to Reduce Metabolic Syndrome in an Uninsured Population: An Evidence-Based Approach" (2009). UNF Graduate Theses and Dissertations. 207. https://digitalcommons.unf.edu/etd/207 This Doctoral Project is brought to you for free and open access by the Student Scholarship at UNF Digital Commons. It has been accepted for inclusion in UNF Graduate Theses and Dissertations by an authorized administrator of UNF Digital Commons. For more information, please contact Digital Projects. © 2009 All Rights Reserved DIETARY INTERVENTIONS TO REDUCE METABOLIC SYNDROME IN AN UNINSURED POPULATION: AN EVIDENCED-BASED APPROACH by Michele Smith Bednarzyk A project submitted to the School of Nursing in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice UNIVERSITY OF NORTH FLORIDA BROOKS COLLEGE OF HEALTH December, 2009 Certificate of Approval DATE Signature Removed <floC:' /1/~. i Y Signature Removed / / I i JQ41t~(:), Rodriguez Signature Removed Kathaleen C. Bloom, Committee Chair Signature Removed Lillia M. Loriz, Director, School ofNurs' Acc pt d for the Colle e: Signature Removed Pamela S. Chally, Dean, Brooks Col cc pted for the University: Signature Removed Mark . Workman, Provost and Vice President for Academic Affairs iii Acknowledgements Obviously a doctoral project is not possible without the support of numerous people. None of this would have been possible without the love and patience of my immediate family who has been a constant source of love, concern, support and strength all these years. I would like to thank my husband Paul for his emotional support and encouragement. Without his help, I would not be able to complete this project. I would like to express my heart-felt gratitude to my sister and family for their faith in me. My mother and father, along with my grandparents, showed me how to appreciate the need for education. My extended family has also aided and encouraged me throughout this endeavor. I have to give a special mention for the support given by Judy Rewis and Debi Wagner. I warmly appreciate their generosity and understanding. My deepest gratitude is to my advisor, Dr. Kathaleen Bloom. I have been fortunate to have an advisor and friend who gave me the freedom to explore my own ideas and at the same time provided me the advice and support to continue with this endeavor. Kathy taught me how to express ideas and learn to enjoy research. I am also thankful to her for encouraging the use of evidence based research and for carefully reading and commenting on countless revisions of this manuscript. My advisor and friend, Dr. Lillia Loriz, has been always there to listen and give advice. I am deeply grateful to her for the long discussions that helped me sort out the iv details of my work. Her patience and support helped me overcome many crisis situations and finish this project. Dr. Judy Rodriguez helped me focus my thoughts and the direction of this project. Her experience has been invaluable to me as a novice in dietary interventions. I am grateful for her encouragement and practical advice. I am also thankful to her for reading my chapters; commenting on my views and thus helping me reach my goals. Many people on the faculty and staff of the School of Nursing assisted and encouraged me in various ways during my course of studies. I am also grateful to the following former or current doctoral students at University of North Florida for their various forms of support during my graduate study, especially the original “first class”. I am especially thankful to Dr. Pam Chally and Dr. Lucy Trice who gave me the opportunity to fulfill my degree at UNF. I can say I received my degree from one of the best DNP programs in the county!! v Table of Contents Acknowledgements .......................................................................................................... iii List of Tables .................................................................................................................... vii List of Figures ................................................................................................................. viii Abstract ............................................................................................................................ ix Chapter One: ...................................................................................................................... 1 Problem .........................................................................................................................3 Treatment ......................................................................................................................6 Purpose ..........................................................................................................................6 Definition of Terms........................................................................................................7 Chapter Two: Literature Review .........................................................................................9 Search Strategies ...........................................................................................................9 Metabolic Syndrome and Cardiovascular Disease .....................................................10 General Treatment Strategies for Metabolic Syndrome .............................................16 Pharmacologic Measures for Treatment of Metabolic Syndrome ..............................18 Nonpharmacologic Measures for Treatment of Metabolic Syndrome .......................19 Chapter Three: Methodology .............................................................................................29 Study Design ...............................................................................................................29 Sample .........................................................................................................................30 Methods .......................................................................................................................30 Evaluation Plan ...........................................................................................................31 Protection of Human Subjects ....................................................................................33 Chapter Four: Results ........................................................................................................34 Demographic Data .......................................................................................................34 Comparison of Study Groups.......................................................................................36 Chapter Five: Conclusions .................................................................................................38 vi Discussion ...................................................................................................................38 Limitations ..................................................................................................................39 Conclusion ..................................................................................................................42 Appendices ........................................................................................................................45 Appendix A Critical Analysis Table: Review of the Evidence ................................45 Appendix B Data Collection Sheet ...........................................................................51 Appendix C Dietary Counseling Sessions ................................................................53 References .........................................................................................................................63 Curriculum Vitae ..............................................................................................................68 vii List of Tables Table 1.1 Criteria Proposed for Clinical Diagnosis of Metabolic Syndrome .....................4 Table 1.2 NHANES III Prevalence of Individual Metabolic Syndrome Abnormalities Among U.S. Adults by Disease Category ..........................................................5 Table 1.3 ATP III Clinical Identification of the Metabolic Syndrome ...............................7 Table 1.4 Nutrient Composition of the TLC Diet ................................................................8 Table 2.1 Characteristics of Cohort Studies of Metabolic Syndrome and Incidents of Cardiovascular Disease and Death ...................................................................11 Table 2.2 Risk factors for Chronic Heart Disease and their Association with Framingham Risk Scoring System and Metabolic Syndrome Diagnostic Criteria ...............15 Table 2.3 Therapeutic Lifestyle Diet in ATP III ...............................................................21 Table 2.4 Meta-Analysis Evaluation .................................................................................27 Table 4.1 Baseline Measures of Sample ...........................................................................35 Table 4.2 24-Hour Diet Recall ..........................................................................................35 Table 4.3 Study Group Mean Metabolic Syndrome
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