Effect of a mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial.

By K. Esposito, R. Marfella, M. Ciotola, C. Di Palo, F. Giugliano, G. Giugliano, M. D'armiento, F. D’Andrea, D. Giugliano. Journal of the American Medical Association (JAMA), 2004

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CONTEXT The metabolic syndrome has been identified as a target for dietary therapies to reduce risk of cardiovascular disease; however, the role of diet in the 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, AND 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 daily consumption of whole grains, fruits, vegetables, nuts, and olive oil; patients in the control group (n = 90) followed a prudent diet (carbohydrates, 50%-60%; proteins, 15%-20%; total fat, <30%). MAIN OUTCOME MEASURES Nutrient intake; 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 (IL-6), 7 (IL-7), and 18 (IL-18). RESULTS After 2 years, patients following the Mediterranean-style diet consumed more foods rich in monounsaturated fat, polyunsaturated fat, and fiber and had a lower ratio of omega-6 to 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 level of physical activity increased in both groups by approximately 60%, without difference between groups (P =.22). Mean (SD) body weight decreased more in patients in the intervention group (-4.0 [1.1] kg) than in those in the control group (-1.2 [0.6] kg) (P<.001). Compared with patients consuming the control diet, patients consuming the intervention diet had significantly reduced serum concentrations 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 improved in the intervention group (mean [SD] change, +1.9 [0.6]; P<.001) but remained 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 syndrome, compared with 78 patients in the control group (P<.001). CONCLUSION A Mediterranean-style diet might be effective in reducing the prevalence of the metabolic syndrome and its associated cardiovascular risk.

Subfields: Physiology, Public Health, Environmental and Occupational Health

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Citations in the corpus

Cytokine and cytokine-like inflammation markers, endothelial dysfunction, and imbalanced coagulation in development of diabetes and its complications. (2009, background): “A Mediterranean diet has been shown to improve markers of inflammation and endothelial dysfunction (75), whereas a eucaloric low-fat, high-carbohydrate diet has unfavorableeffectsoninflammatorymarkerswithreduction in adiponectin levels (76, 77), an effect that is prevented if weight loss is achieved”
Adverse Childhood Experiences and Adult Risk Factors for Age-Related Disease (2009, positive): “At age 32 years, the study members reported their daily intake of fruits and vegetables because of the evidence linking Mediterranean-style diet with reduced age-related-disease risks.(52) The samplewide distribution was divided into quartiles for analysis.”
Interleukin-6 in aging and chronic disease: a magnificent pathway. (2006, background): “Moreover, consuming a Mediterranean diet is associated with significantly lower IL-6 (61,62).”
Diet and inflammation. (2010, methodology): “After 2 years, patients ingesting the Mediterranean diet had significantly reduced serum concentrations of HS-CRP, IL-6, IL-7, and IL-18 than patients on the AHA diet.(47) A smaller study of Spanish men and women with high risk of cardiovascular disease found no association between adherence to a Sp”
Inflammation: depression fans the flames and feasts on the heat. (2015, background): “inflammation among individualswithhealthrisks (84)”
Dietary factors and low-grade inflammation in relation to overweight and obesity (2011, positive): “In a randomised controlled trial lasting 2 years, 180 subjects with the metabolic syndrome were assigned either to a Mediterranean-style diet (instructions were provided on increasing daily consumption of whole grains, fruit, vegetables, nuts and olive oil) or to a control group (prudent diet, with ”
Mediterranean Diet and Mild Cognitive Impairment (2009, background): “At the same time, according to the vast majority of the literature (but see the articles by Ambring et al(63) and Michalsen et al(64)), higher adherence to the MeDi seems to improve carbohydrate metabolism, and in interventional studies it has been associated with significant reductions in plasma gl”
Association of the Mediterranean dietary pattern with the incidence of depression: the Seguimiento Universidad de Navarra/University of Navarra follow-up (SUN) cohort. (2009, background): “The MDP has been shown to reduce the levels of these cytokines and inflammatory modulators.(39,40,42-44) Finally, it is well known that coronary heart disease (CHD) and some of its major risk factors, such as hypertension,(52) obesity,(53) diabetes mellitus,(54) metabolic syndrome,(55,56) or low hig”
Obesity and female infertility: potential mediators of obesity's impact. (2017, background): “These and similar observational studies of disease prevalence, including obesity and type II diabetes, across populations led to interest in the potential therapeutic benefit of the ‘‘Mediterranean’’ diet, characterized by higher intake of unsaturated fats, lower intake of animal fats, and lower rat”