Which dietary modifications are used in the treatment of metabolic syndrome?

Updated: Mar 30, 2020
  • Author: Stanley S Wang, JD, MD, MPH; Chief Editor: Yasmine S Ali, MD, MSCI, FACC, FACP  more...
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Lifestyle change and weight loss are considered the most important initial steps in treating metabolic syndrome. Studies comparing ethnically similar populations exposed to different dietary environments suggested that Westernized diets are strongly associated with a higher risk of developing metabolic syndrome. [5]

On the other hand, diets rich in dairy, fish, and cereal grains may be associated with a lower risk of developing metabolic syndrome. [112, 113] Not surprisingly, Mediterranean-style diets appear to be associated with a much lower risk and possibly with resolution of metabolic syndrome in patients who have met diagnostic criteria, especially when coupled with adequate exercise regimens. [114]

A meta-analysis of multiple population studies associated chocolate consumption with a substantial risk reduction (approximately 30%) for cardiometabolic disorders, including coronary disease, cardiac deaths, diabetes, and stroke. [115] The apparent benefits of chocolate may accrue from a beneficial impact of polyphenols present in cocoa products that increase the bioavailability of nitric oxide.

Epidemiologic studies, particularly in males, suggest that moderate wine intake may protect against the development and complications of metabolic syndrome, an effect that is at least partially attributable to polyphenols, such as resveratrol, found in red wines. [116, 117]

The impact of sugar consumption on the risk of developing metabolic syndrome is controversial. Evidence suggests that absolute fructose intake may relate to incident metabolic syndrome. [118] Higher fructose diets have been blamed for elevated rates of metabolic syndrome in African American populations. [119]

However, glycemic load or intake does not appear to predispose persons to the development of metabolic syndrome, though avoidance of high-glycemic-index foods in patients with metabolic syndrome may improve characteristic parameters such as atherogenic dyslipidemia. [120]

In a single-blind, parallel, controlled, dietary intervention study, subjects with metabolic syndrome (n=472) from 8 European countries classified by different insulin resistance (IR) levels according to a homeostasis model assessment of insulin resistance (HOMA-IR) were randomly assigned to 4 diets: a high-saturated fatty acid (HSFA) diet; a high-monounsaturated fatty acid (HMUFA) diet; a low-fat, high-complex carbohydrate (LFHCC) diet supplemented with long-chain n-3 polyunsaturated fatty acids (1.2 g/d); or an LFHCC diet supplemented with placebo for 12 weeks (control). The results provided evidence that subjects’ degree of insulin resistance determines response to the quantity and quality of dietary fat on metabolic syndrome risk factors. [121]

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