Metabolic syndrome dietary therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, M.B.B.S. [2]


Dietary modifications are the first step in the management of metabolic syndrome. It can be initiated either in isolation or along with other medications. It helps by assisting in weight loss, thus increasing insulin sensitivity. Studies support that diet, exercise, and drug therapy may inhibit the progression of metabolic syndrome to diabetes mellitus.[1]

Dietary Therapy

Findings from various studies suggest that:[2]

  • Westernized and high fructose diets have increased risk for developing metabolic syndrome.
  • Mediterranean diet rich in fresh fruits, vegetables, whole grains, nuts, seeds, legumes, seafood, yogurt and olive oil lowers the risks for metabolic syndrome.[3][4][5]
  • The DASH (Dietary Approaches to Stop Hypertension) diet focuses on decreasing sodium intake to 2400 mg/daily. When compared to a weight reducing diet, the DASH diet resulted in greater improvements in triglycerides, blood pressure, and fasting blood glucose.[6]
  • A low carbohydrate diet has favorable effects on atherogenic dyslipidemia and glycemic control compared to a conventional diet at 6 months, but there does not appear to be a significant benefit at 1 year.[7][8][9] However, the supporting studies are small randomized trials (less than 150 patients). Thus, larger studies are required to determine the long-term safety and efficacy of low-carbohydrate, high-protein, high-fat diets.
  • Some studies suggest that moderate red wine intake may protect against the development of metabolic syndrome.[10] However, further supportive evidence is required.
  • In a meta-analysis chocolate was found to reduce the risks of coronary artery disease, cardiac deaths, diabetes, and stroke by approximately 30%. The possible explanation for this is the presence of polyphenols in chocolates that increases the concentration of nitric oxide (antioxidants).[11]
  • Food with a low glycemic index may be helpful in preventing metabolic syndrome and its complications. However, further supportive trials are required to prove this.

Supportive Trial Data

Meta-analysis on effect of Mediterranean diet on metabolic syndrome

  • SOURCE and YEAR: J Am Coll Cardiol, 2011[4]
  • STUDY POPULATION: 50 original research studies (35 clinical trials, 2 prospective and 13 cross-sectional), with 534,906 participants
    • Mediterranean diet was associated with reduced risk of metabolic syndrome (log hazard ratio: -0.69, 95% confidence interval [CI]: -1.24 to -1.16)
    • Also, statistically significant reduction in waist circumference, triglycerides, systolic and diastolic blood pressure and glucose was found. Additionally, an elevation of HDL cholesterol level was demonstrated.

PREDIMED: Randomized controlled trial on effect of Mediterranean diet on metabolic syndrome

  • SOURCE and YEAR: Arch Intern Med. 2008[5]
  • STUDY NAME: PREDIMED (Prevención con Dieta Mediterránea)
  • OBJECTIVE: Determine the efficacy of the Mediterranean diet (Med-Diet) on the primary prevention of cardiovascular disease
  • METHOD: Multicenter, 3-arm randomized controlled trial.
  • STUDY POPULATION: 1224 participants
  • STUDY PERIOD: 1 year
  • INTERVENTIONS: Quarterly education about the MedDiet + provision of either 1 L/wk of virgin olive oil or 30 g/d of mixed nuts, and advice on a low-fat diet (control diet).
    • 61.4% of participants met criteria for the metabolic syndrome
    • 1 yr prevalence was reduced by 6.7%, 13.7%, and 2.0% in the MedDiet + virgin olive oil, MedDiet + nuts, and control diet groups, respectively
    • After adjustment for sex, age, baseline obesity status, and weight changes odds ratios for reversion of metabolic syndrome were:
      • 1.3 (95% confidence interval, 0.8-2.1) for the MedDiet + virgin olive oil compared with control group.
      • 1.7 (1.1-2.6) for the MedDiet + nuts group compared with control group.
  • CONCLUSION: A Mediterranean diet can be helpful in the management of metabolic syndrome.


  1. Levesque J, Lamarche B (2008). "The metabolic syndrome: definitions, prevalence and management". Journal of Nutrigenetics and Nutrigenomics. 1 (3): 100–8. doi:10.1159/000112457. PMID 19776619.
  2. Cornier MA, Dabelea D, Hernandez TL; et al. (2008). "The metabolic syndrome". Endocrine Reviews. 29 (7): 777–822. doi:10.1210/er.2008-0024. PMID 18971485. Unknown parameter |month= ignored (help)
  3. Barnes DE (2011). "The mediterranean diet: good for the heart = good for the brain?". Ann Neurol. 69 (2): 226–8. doi:10.1002/ana.22376. PMID 21387364.
  4. 4.0 4.1 Kastorini CM, Milionis HJ, Esposito K, Giugliano D, Goudevenos JA, Panagiotakos DB (2011). "The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals". J Am Coll Cardiol. 57 (11): 1299–313. doi:10.1016/j.jacc.2010.09.073. PMID 21392646.
  5. 5.0 5.1 Salas-Salvadó J, Fernández-Ballart J, Ros E, Martínez-González MA, Fitó M, Estruch R; et al. (2008). "Effect of a Mediterranean diet supplemented with nuts on metabolic syndrome status: one-year results of the PREDIMED randomized trial". Arch Intern Med. 168 (22): 2449–58. doi:10.1001/archinte.168.22.2449. PMID 19064829.
  6. Azadbakht L, Mirmiran P, Esmaillzadeh A, Azizi T, Azizi F (2005). "Beneficial effects of a Dietary Approaches to Stop Hypertension eating plan on features of the metabolic syndrome". Diabetes Care. 28 (12): 2823–31. PMID 16306540.
  7. Foster GD, Wyatt HR, Hill JO, McGuckin BG, Brill C, Mohammed BS; et al. (2003). "A randomized trial of a low-carbohydrate diet for obesity". N Engl J Med. 348 (21): 2082–90. doi:10.1056/NEJMoa022207. PMID 12761365.
  8. Stern L, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J; et al. (2004). "The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial". Ann Intern Med. 140 (10): 778–85. PMID 15148064.
  9. Meckling KA, Sherfey R (2007). "A randomized trial of a hypocaloric high-protein diet, with and without exercise, on weight loss, fitness, and markers of the Metabolic Syndrome in overweight and obese women". Appl Physiol Nutr Metab. 32 (4): 743–52. doi:10.1139/H07-059. PMID 17622289.
  10. Liu L, Wang Y, Lam KS, Xu A (2008). "Moderate wine consumption in the prevention of metabolic syndrome and its related medical complications". Endocr Metab Immune Disord Drug Targets. 8 (2): 89–98. PMID 18537695.
  11. Buitrago-Lopez A, Sanderson J, Johnson L, Warnakula S, Wood A, Di Angelantonio E; et al. (2011). "Chocolate consumption and cardiometabolic disorders: systematic review and meta-analysis". BMJ. 343: d4488. doi:10.1136/bmj.d4488. PMC 3163382. PMID 21875885.

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