Adherence to the Mediterranean diet and risk of metabolic syndrome and its components

Background and aimsThe role of diet in the aetiology of metabolic syndrome (MetS) is not well understood. The aim of the present study was to evaluate the relationship between adherence to the Mediterranean diet (MedDiet) and MetS.Methods and resultsA cross-sectional study was conducted with 808 high cardiovascular risk participants of the Reus PREDIMED Centre. MetS was defined by the updated National Cholesterol and Education Program Adult Treatment Panel III criteria.An inverse association between quartiles of adherence to the MedDiet (14-point score) and the prevalence of MetS (P for trend < 0.001) was observed. After adjusting for age, sex, total energy intake, smoking status and physical activity, participants with the highest score of adherence to the MedDiet (≥9 points) had the lowest odds ratio of having MetS (OR [95% CI] of 0.44 [0.27–0.70]) compared to those in the lowest quartile.Participants with the highest MedDiet adherence had 47 and 54% lower odds of having low HDL-c and hypertriglyceridemia MetS criteria, respectively, than those in the lowest quartile. Some components of the MedDiet, such as olive oil, legumes and red wine were associated with lower prevalence of MetS.ConclusionHigher adherence to a Mediterranean diet is associated with a significantly lower odds ratio of having MetS in a population with a high risk of cardiovascular disease.     

Effect of the Mediterranean diet with and without weight loss on cardiovascular risk factors in men with the metabolic syndrome

Background and aims

No study has yet examined how weight loss modifies the impact of the Mediterranean diet (MedDiet) on cardiovascular risk factors in men with the metabolic syndrome (MetS). The objective of the study was to assess the efficacy of MedDiet, with and without weight loss, to modify the cardiometabolic risk profile of male patients with MetS.

Methods and results

Twenty-six men aged between 24 and 62 years with the MetS consumed a North American control diet for 5 weeks followed by a 5-week MedDiet, both under weight-maintaining conditions. Participants then underwent a 20-week weight loss period, after which they consumed the MedDiet for five weeks under weight stable conditions. Body weight was reduced by 10.2% ± 2.9% after the weight loss period (p < 0.001). All foods were provided to participants during the weight stable phases of the study. The MedDiet in the absence of weight loss decreased total plasma cholesterol (C) (−7.1%), LDL-C (−9.3%) and the total/HDL-C ratio (−6.5%) compared to the control diet (all p < 0.04). The MedDiet combined with weight loss led to reductions in systolic blood pressure (−4.7%), diastolic blood pressure (−7.7%), triglycerides (−18.2%), ApoB (−10.7%), fasting glucose (−4.2%) and insulin (−29.9%) compared to the control diet (all p < 0.001). Conclusion: The MedDiet in the absence of weight loss leads to significant changes in plasma cholesterol concentrations but has little effects on other cardiometabolic risk factors associated with the MetS in men.     

Metabolic syndrome in adolescents in the Balearic Islands, a Mediterranean region

Background and aims

To determine the prevalence of metabolic syndrome (MetS) and its components in adolescents in the Balearic Islands, in the western Mediterranean Sea.

Methods and results

A cross-sectional nutritional survey was carried out in the Balearic Islands (2007-2008). A random sample (n = 362, 143 boys and 219 girls) of the adolescent population (12-17 years) was interviewed, anthropometrically measured, and provided a fasting blood sample. The MetS prevalence was determined by the ATP III criteria adapted for youths. Adherence to the Mediterranean diet (MD) was defined according to a score constructed considering the consumption of MD components: high monounsaturated fatty acids (MUFA)/saturated fatty acids (SFA) ratio, moderate ethanol consumption, high legume, cereals and roots, fruit, vegetables, and fish consumption, and low meat and milk consumption.The overall MetS prevalence was 5.8% (boys 10.5%, girls 2.7%). MetS criteria were met by 10.0% of overweight, 45.5% of obese and in 1.8% of normal weight adolescents. Half of the adolescents (49.7%) had at least one MetS component. None of the adolescents had all five risk factors. High triglyceride level (90.5%), hypertension (85.7%), low HDL cholesterol level (78.9%) and central obesity (71.4%) were common among adolescents with MetS whereas hyperglycaemia (0.6%) was infrequent. Higher adherence to MD was associated with significantly lower odds ratio of having MetS, but half of the adolescents showed high adherence to MD.

Conclusion

MetS prevalence was significant among adolescents in the Balearic Islands, especially among obese boys. A high adherence to MD in adolescents was associated with a low prevalence of the MetS criteria.     

The role of HDL cholesterol in metabolic syndrome predicting cardiovascular events. The Gubbio population study

Background and aims

Metabolic syndrome (MS) has recently been claimed to be an important new risk factor for the occurrence of coronary heart disease (CHD) and cardiovascular disease (CVD) events, although it is simply a combination of known risk factors used in a dichotomized fashion. The aims of this analysis were to explore the predictive role of MS for CHD and CVD events in a population study, in comparison with using the same factors in a continuous fashion, with special emphasis on HDL cholesterol.

Methods and results

In the second examination of the Gubbio population study from central Italy, 2650 cardiovascular disease-free men and women, aged 35-74 years around 1990, were examined and followed-up for 12 years. The classic risk factors (sex, age, systolic blood pressure, serum cholesterol and smoking habits) were studied as predictors of CHD and CVD events, alone and with the contribution of other factors (HDL cholesterol, blood glucose, serum triglycerides and waist circumference) included in the so-called MS, based on several multivariate models. MS was also tested after adjustment for other risk factors.MS produced a predictive significant relative risk of 1.67 for CHD events and 1.82 for CVD events, but considering its single risk factors, the only ones contributing to prediction were HDL cholesterol and systolic blood pressure. Dedicated analyses showed that MS does not add anything to the power of prediction beyond the role of the single risk factors treated in a continuous fashion, while the best predictive power is obtained using classic risk factors (sex, age, smoking habits, total cholesterol, systolic blood pressure) with the addition of HDL cholesterol.

Conclusions

The predictive power of MS is bound only to the presence of HDL cholesterol and blood pressure and does not add anything to using the same risk factor treated in a continuous fashion.     

代谢综合征与血脂异常及超敏C反应蛋白水平的关系

在江苏省多代谢异常和代谢综合征(MS)综合防治研究中的2330名研究对象就各脂因子水平分布等分成5组后,经多因素调整,发现脂因子与MS的OR中除低密度脂蛋白胆固醇以外均有统计学意义,尤其是发现一些非MS组分的脂指标,而超敏C反应蛋白(hsCRP)并未达到统计学意义。提示除了MS组分的血脂因子外,非MS组分的脂指标对MS的发生、发展可能有重要影响,而hsCRP与MS的联系较脂因子弱。     

Circulating IGFBP-2 levels are incrementally linked to correlates of the metabolic syndrome and independently associated with VLDL triglycerides

Objective: To assess whether plasma IGFBP-2 is independently associated with components of the lipoprotein-lipid profile and to suggest a cutoff value that could identify subjects with the features of the metabolic syndrome. Methods: In this cross-sectional study, 379 Caucasian men from the general population and covering a wide range of BMI were recruited through the media. Subjects with type 2 diabetes, BMI values > 40 kg/m², or taking medication targeting glucose or lipid metabolism or blood pressure were excluded. Anthropometric data were collected and plasma IGFBP-2 concentrations, glucose tolerance and an extensive plasma lipid profile were determined after an overnight fast. Results: Subjects with low IGFBP-2 levels were characterized by increased fat mass (p < 0.0001), impaired insulin sensitivity (p < 0.0001) and higher plasma triglyceride (TG) levels (p < 0.0001). When divided into 6 quantiles, only subjects with the highest IGFBP-2 levels (>221.5 ng/mL) did not meet the NCEP ATP III criteria for the clinical diagnosis of the metabolic syndrome. In addition, circulating IGFBP-2 levels were significantly associated with VLDL-TG (r = −0.51, p < 0.0001) and HDL-C (r = −0.27, p < 0.0001) levels. After adjustments, plasma IGFBP-2 was found to be independently associated with VLDL-TG levels but not with HDL-C concentrations. Conclusions: In our cohort, IGFBP-2 levels <221.5 ng/mL are incrementally associated with a detrimental plasma lipoprotein-lipid profile. After adjustment for covariates, IGFBP-2 remained independently associated with VLDL-TG but not HDL-C levels. This study supports further investigations in other populations and validation of IGFBP-2 as a biomarker of early dyslipidemia.     

功能性食品与代谢综合征

由于代谢综合征在世界范围内日益增多,饮食干预越发受到人们重视.近年来研究发现一些食物或成分(即功能性食品或成分)有希望改善代谢综合征,尤其是肥胖、糖尿病、血脂异常.此文主要从这三方面举例并评估了一些潜在功能性食品或成分.     

Prevalence of metabolic syndrome in women with polycystic ovary syndrome and the factors associated: A cross sectional study at a tertiary care center in Hyderabad,south-eastern India

Background and aimsMetabolic syndrome (MetS) and polycystic ovary syndrome (PCOS) are two interrelated but distinct endocrine problems with several health consequences secondary to insulin resistance. This study aimed to determine the prevalence of MetS in women with PCOS.MethodsThis was a cross sectional study carried out from May 2017 to October 2017 at the gynecology outpatient clinic of a tertiary care private hospital in Hyderabad, India. Eligible women diagnosed with PCOS according to Rotterdam criteria were enrolled. The primary outcome was the prevalence of MetS diagnosed by the modified NCEP ATP III criteria.ResultsThe study comprised 382 patients with a mean age of 26.8 ± 5.3 years. MetS was present in 147 (38.5%) women with PCOS. The most frequently observed individual components of MetS were increased waist circumference and decreased HDL cholesterol. When predictors for MetS were analyzed by multivariate regression, BMI (aOR 1.14; 1.06–1.23; p ≪0.001) and age (aOR 1.12; 1.06–1.17; p ≪0.001) were significantly associated with MetS; however, the effect size was modest.ConclusionA high prevalence of MetS was observed in women with PCOS at this tertiary center in Hyderabad, with abdominal obesity and low HDL cholesterol as predominant components. We believe that universal screening of all PCOS women is a reasonable option.     

The implication of hepatokines in metabolic syndrome

Hepatokines are liver–derived proteins with equivocal roles in metabolic syndrome (MetS). These proteins have prominent role in pathogenesis of MetS component such as obesity, insulin resistance, dyslipidemia and hypertension. The identification and functional characterization of hepatokines may provide significant insights that could help in better understanding of MetS pathogenesis. Fetuin-A, Hepatocyte-derived fibrinogen-related protein 1, Fibroblast growth factor 21, Angiopoietin–related growth factor, Selenoprotein-P, Angiopoietin like proteins, Leukocyte cell-derived chemotaxin 2 are regarded as the most significant hepatokines. We describe recent data on these new hormones in progression of MetS. Understanding of the accurate role of these proteins in pathophysiology of MetS can help improving prevention and treatment of this syndrome.     

Effectiveness of the Mediterranean diet in the elderly

The Mediterranean diet is known to be one of the healthiest dietary patterns in the world due to its relation with a low morbidity and mortality for some chronic diseases. The purpose of this study was to review literature regarding the relationship between Mediterranean diet and healthy aging. A MEDLINE search was conducted looking for literature regarding the relationship between Mediterranean diet and cardiovascular disease (or risk factors for cardiovascular disease), cancer, mental health and longevity and quality of life in the elderly population (65 years or older). A selection of 36 articles met the criteria of selection. Twenty of the studies were about Mediterranean diets and cardiovascular disease, 2 about Mediterranean diets and cancer, 3 about Mediterranean diets and mental health and 11 about longevity (overall survival) or mental health. The results showed that Mediterranean diets had benefits on risks factors for cardiovascular disease such as lipoprotein levels, endothelium vasodilatation, insulin resistance, the prevalence of the metabolic syndrome, antioxidant capacity, the incidence of acute myocardial infarction, and cardiovascular mortality. Some positive associations with quality of life and inverse associations with the risk of certain cancers and with overall mortality were also reported.     

Low serum high density lipoprotein is associated with the greatest risk of metabolic syndrome among U.S. adults

Aims

Better understanding risk factors for metabolic syndrome (MetS) will allow early targeted intervention to mitigate long term risk. We aim to determine the disparate impact of each individual MetS component on overall risk of developing MetS, stratified by sex, race/ethnicity, and age.

量化运动及饮食对代谢综合征干预疗效观察

目的观察生活方式对代谢综合征（MS）发病率的影响,探讨量化运动及饮食干预对代谢综合征的疗效。方法以2008年1月至2009年12月进入深圳市慢性病防治中心健康体检的人群作为观察对象,选取有效观察对象256例,根据生活方式、工作劳动强度、身体活动问卷调查将观察对象分成积极运动生活方式组及静坐生活方式组,分析不同运动、生活方式对MS患病率的影响。选取新发现MS患者58例,随机分为运动饮食干预组（A组）29例,采取运动、饮食干预联合基础药物治疗;基础药物干预组（B组）29例,仅采取基础药物治疗。两组病例分别于干预前、干预后3个月和6个月检测体重指数、血压、血糖、血脂,观察两组干预疗效。结果积极运动生活方式组MS发病率为12．3％,明显低于静坐生活方式组的31．0％。量化饮食运动干预组患者体重指数下降明显,其3个月、6个月MS控制达标率分别为86．2％和93．1％,明显高于基础药物干预组的69．0％和82．8％（P〈0．05）。结论积极运动是MS的保护因素。多食少动的生活方式是MS发生的不良因素,加强健康教育,改变不健康生活方式,可有效预防MS的发生。运动饮食干预治疗能有效改善胰岛素敏感性,增强MS疗效。     

老年人代谢综合征与饮食习惯的相关性分析

目的 探讨老年人群代谢综合征(MS)和饮食习惯的相关性.方法 连续抽取老年人781例,通过问卷调查和体检采集相关资料;采用Logistic回归分析方法分析饮食习惯与MS相关性.结果 老年人MS总患病率为40.7%,其中男性36.7%,女性55.4%,女性高于男性(P=0.000).低脂饮食组腰围(86.0±9.3)cm,与适中饮食组(88.8±8.5)cm及高脂饮食组(90.0±7.9)cm比较,差异有统计学意义(P＜0.05).低脂饮食组空腹血糖(5.78±0.98)mmol/L,与高脂饮食组(6.27±1.80)mmol/L比较,差异有统计学意义(P＜0.05).多元回归分析显示,以低脂饮食组为基准,适中饮食组OR值[1.541(1.092～2.174),P＜0.05];高脂饮食OR值[2.293(1.317～3.994),P＜0.01];适中饮食和高脂饮食是老年人群MS的独立危险因素.结论 适中饮食和高脂饮食是老年人群发生MS的危险因素,提倡在食物多样化的前提下,养成清淡低脂的饮食习惯,从而降低MS的患病率.

Abstract：

Objective To investigate the relationship between metabolic syndrome (MS) and diet style in the elderly. Methods The 781 old people were consecutively selected. Related data were collected by means of questionnaires and physical examinations. And logistic regression was performed to analyze if moderate and high fat diet were risk factors of MS. Results The total prevalence rate of MS in old people was 40. 7%, with 36.7% in old males and 55.4% in old females,and the prevalence rate of MS was higher in old women than in old men (P=0. 000). The significant differences in waist circumferences among three groups of low, moderate and high-fat diet [(86.0±9.3) cm vs. (88.8±8.5) cm vs. (90. 0±7.9) cm, respectively (all P＜0.05)]were found. Fasting blood glucose showed a significant difference between two groups of low and high-fat diet, with the results of (5.78 ± 0.98) mmol/L and (6.27 ± 1.80) mmol/L, respectively ( P＜0. 05 ). The logistic regression analysis showed that odds ratio for people with moderate and high-fat diets were 1. 541 ( 1. 092-2. 174) and 2. 293 ( 1. 317-3. 994), respectively (P＜0.05), which indicated that moderate and high-fat diet was independent risk factors for MS in old people. Conclusions Both moderate and high-fat diets are risk factors of MS in old population, low fat diet with food balance is recommended to old population in order to decrease the prevalence of MS.     

Adherence to Mediterranean diet and anthropometric and metabolic parameters in an observational study in the 'Alto Molise' region: the MOLI-SAL project

Background and aimsThe Mediterranean diet is reportedly a healthy eating pattern with protective effects on chronic diseases. The aim of this study was to assess the relationship between adherence to the Mediterranean diet and anthropometric and metabolic variables in a rural setting in southern Italy, in the context of a health screening initiative.Methods and resultsFive hundred and twenty-two healthy participants from the “Alto Molise” region in southern Italy were studied. Blood pressure, glucose, and total cholesterol were measured using automatic devices. Food intake was evaluated with a semi-quantitative food-frequency questionnaire, and the Mediterranean adequacy index (MAI) was calculated. The median value of MAI in the population studied was 3.0 (1.5–5.4) in men and 2.4 (1.2–5.1) in women.In women, the stronger contributors to MAI were dairy products (42.5%), sweets (29.3%) and meat (19.4%), while in men they were cereals (39.1%), meat (18.6%), dairy products (16.9%) and sweets (16.1%). In multiple linear regression analysis MAI was positively associated with age in both sexes (P = 0.0044 in men and P = 0.0054 in women) and with systolic blood pressure in women (P = 0.012). After stratification of women by age, systolic blood pressure was significantly associated with MAI only in older persons (P = 0.040) but not at younger ages (interaction effect P < 0.0001).ConclusionsAdherence to the Mediterranean diet depends on age, possibly because in younger people the traditional Mediterranean style diet is decreasing, even in rural areas of southern Italy. Age also influences the association between MAI and metabolic variables such as systolic blood pressure in women.     

代谢综合征其它组分与高血压的关系

2005年4月,国际糖尿病联盟统一使用"代谢综合征"概括相关临床表型,其主要成分包括中心性肥胖、血脂代谢异常、血糖升高和(或)胰岛素抵抗及高血压。其中,高血压的发生原因复杂,代谢综合征中的其它组分包括中心性肥胖、血脂代谢异常、胰岛素抵抗等最终都能引起高血压并影响其发展过程,其中,中心性肥胖的影响最为关键。代谢综合征是2型糖尿病和心血管疾病的高危因素,早期诊断和早期干预,有助于2型糖尿病和心血管疾病的防治。本文综述代谢综合征其它组分与高血压的关系。     

Back to the future: The Mediterranean diet paradigm

The Mediterranean diet was introduced to the scientific community by the classic Seven Countries study. Since then data on the association between this diet and cardiovascular disease, cancer and other chronic diseases have been accumulating. The Mediterranean diet is characterized by a high intake of olive oil, plant products, fish and seafood; a low intake of dairies, meat and meat products; and a moderate ethanol intake. The Mediterranean diet has been operationalized through various computational scores (e.g. the Mediterranean diet score for adults and the KIDMED index for children) which are all based on the dietary components that capture its essence. Next to evidence generated through both observational studies and intervention trials on the inverse association between Mediterranean diet and several risk factors, inflammatory markers and mortality or incidence of disease, there is increasing evidence that Mediterranean populations are abandoning their traditional eating habits. Publications presenting changes over time in the diet of populations participating in the Seven Countries Study point towards an increase in the intake of processed foods and saturated fat and a decrease in the intake of plant foods and monounsaturated fatty acids. Findings are alarming, particularly in relation to younger generations. Studies among children and adolescents in the Mediterranean region clearly indicate that the largest proportions of these populations poorly adhere to their traditional diet. Mediterraneans have clearly not been the major benefactors in the research on the effects of the Mediterranean lifestyle and younger populations in the regions are already following the wrong path.     

Low serum magnesium levels and metabolic syndrome

Low serum magnesium levels are related to diabetes mellitus (DM) and high blood pressure (HBP), but as far as we know, there are no previous reports that analyzed the serum magnesium concentration in individuals with metabolic syndrome (MS). We performed a cross-sectional population-based study to compare 192 individuals with MS and 384 disorder-free control subjects, matched by age and gender. Magnesium supplementation treatment and conditions likely to provoke hypomagnesemia, including previous diagnosis of diabetes mellitus (DM) and/or high blood pressure (HBP), were exclusion criteria. In this regard, only incident cases of DM and HBP were included. MS was defined by the presence at least of two of the following features: hyperglycemia (≥7.0 mmol/l); HBP (≥160/90 mmHg); dyslipidemia (fasting triglycerides ≥1.7 mmol/l and/or HDLcholesterol <1.0 mmol/l); and obesity (body mass index ≥30 kg/m² and/or waist-to-hip ratio ≥0.85 in women or ≥0.9 in men). Low serum magnesium levels were identified in 126 (65.6%) and 19 (4.9%) individuals with and without MS, p<0.00001. The mean serum magnesium level among subjects with MS was 1.8±0.3 mg/dl, and among control subjects 2.2±0.2 mg/dl, p<0.00001. There was a strong independent relationship between low serum magnesium levels and MS (odds ratio (OR)=6.8, CI_95% 4.2–10.9). Among the components of MS, dyslipidemia (OR 2.8, CI_95% 1.3–2.9) and HBP (OR 1.9, CI_95% 1.4–2.8) were strongly related to low serum magnesium levels. This study reveals a strong relationship between decreased serum magnesium and MS. Received: 19 July 2001 / Accepted in revised form: May 2002 Correspondence to F. Guerrero-Romero