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Context: The metabolic syndrome has been identified as a target for dietary th erapies to reduce risk of cardiovascular disease; however, the role of diet in t he etiology of the metabolic syndrome is poorly understood. Objective: To assess the effect of a Mediterranean style diet on endothelial function and vascular inflammatory markers in patients with the metabolic syndrome. Design, Setting, a nd Patients: Randomized, single blind trial conducted from June 2001 to January 2004 at a university hospital in Italy among 180 patients (99 men and 81 women) with the metabolic syndrome, as defined by the Adult Treatment Panel III. Inter ventions: Patients in the intervention group (n=90) were instructed to follow a Mediterranean style diet and received detailed advice about how to increase dai ly consumption of whole grains, fruits, vegetables, nuts, and olive oil; patient s in the control group (n=90) followed a prudent diet (carbohydrates, 50%-60% ; proteins, 15%-20%; total fat,< 30%). Main Outcome Measures: Nutrient intak e; endothelial function score as a measure of blood pressure and platelet aggreg ation response to L arginine; lipid and glucose parameters; insulin sensitivity ; and circulating levels of high sensitivity C reactive protein (hs CRP) and interleukins 6 (IL-6), 7 (IL-7), and 18 (IL-18). Results: After 2 years, pati ents following the Mediterranean style diet consumed more foods rich in monouns aturated fat, polyunsaturated fat, and fiber and had a lower ratio of omega-6 t o omega-3 fatty acids. Total fruit, vegetable, and nuts intake (274 g/d), whole grain intake (103 g/d), and olive oil consumption (8 g/d) -were also significantly higher in the intervention group (P< .001). The leve l of physical activity increased in both groups by approximately 60%, without d ifference between groups (P=.22). Mean (SD) body weight decreased more in patien ts in the intervention group (-4.0 [1.1] kg) than in those in the control gro up (-1.2 [0.6] kg) (P< .001). Compared with patients consuming the control diet , patients consuming the intervention diet had significantly reduced serum concent rations of hs CRP (P=.01), IL-6 (P=.04), IL-7 (P=0.4), and IL-18 (P=0.3), as well as decreased insulin resistance (P< .001). Endothelial function score impr oved in the intervention group (mean [SD] change, +1.9 [0.6];P< .001) but r emai ned stable in the control group (+0.2 [0.2]; P=.33). At 2 years of follow up , 40 patients in the intervention group still had features of the metabolic syndro me, compared with 78 patients in the control group (P< .001). Conclusion: A Medi terranean style diet might be effective in reducing the prevalence of the metab olic syndrome and its associated cardiovascular risk.
Context: The metabolic syndrome has been identified as a target for dietary th erapies to reduce risk of cardiovascular disease; however, the role of diet in t he etiology of the metabolic syndrome is poorly understood. Objective: To assess the effect of a Mediterranean style diet on endothelial function and vascular inflammatory markers in patients with the metabolic syndrome. Design, Setting, a nd Patients: Randomized, single blind trial conducted from June 2001 to January 2004 at a university hospital in Italy among 180 patients (99 men and 81 women ) with the metabolic syndrome, as defined by the Adult Treatment Panel III. Interventions: Patients in the intervention group (n = 90) were instructed to follow a Mediterranean style diet and received detailed advice about how to increase dai ly consumption of whole grains , fruits, vegetables, nuts, and olive oil; patient s in the control group (n = 90) followed a prudent diet (carbohydrates, 50% -60%; proteins, 15% -20%; total fat, <30% Ma in Outcome Measures: Nutrient intak e; endothelial function score as a measure of blood pressure and platelet aggregation response to L arginine; lipid and glucose parameters; insulin sensitivity; and circulating levels of high sensitivity C reactive protein (hs CRP) and interleukins 6 Results: After 2 years, pati ents following the Mediterranean style diet eating more foods rich in monouns aturated fat, polyunsaturated fat, and fiber and had Total fruit, vegetable, and nuts intake (274 g / d), whole grain intake (103 g / d), and olive oil consumption (8 g / d) The leve l of physical activity increased in both groups by approximately 60%, without d ifference between groups (P = .22). Mean (SD) body weight decreased more in patien ts in the intervention group (-4.0 [1.1] kg) than in those in the control gro up (-1.2 [0.6] kg) (P <.001). Compared with patients consuming the control diet, patients consuming the intervention diet significantly reduced serum concentration of hs CRP (P = .01), IL-6 (P = .04), IL-7 -18 (P = 0.3), as well as decreased insulin resistance (P <.001). Endothelial function score impr oved in the intervention group (mean [SD] change, +1.9 [ At 2 years of follow up, 40 patients in the intervention group still had features of the metabolic syndro me, compared with 78 patients in the control group (+0.2 [0.2]; P = .33) (P <.001). Conclusion: A Medi terranean style diet might be effective in reducing the prevalence of the metab olic syndrome and its associated cardiovascular risk.