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Dietary treatment of the metabolic syndrome — the optimal diet

Published online by Cambridge University Press:  09 March 2007

Gabriele Riccardi  and
A. A. Rivellese
Gabriele Riccardi*
Affiliation:
Department of Clinical and Experimental Medicine, Federico II University Medical School, Naples, Italy
A. A. Rivellese
Affiliation:
Department of Clinical and Experimental Medicine, Federico II University Medical School, Naples, Italy
*
*Corresponding author: G. Riccardi, fax +39 08174 62117, email [email protected]
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Abstract

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The treatment of the metabolic syndrome aims to improve insulin sensitivity and correct/prevent the associated metabolic and cardiovascular abnormalities. Since many individuals with the metabolic syndrome are overweight, dietary treatment should be primarily focused on weight reduction. This approach can improve insulin sensitivity and exert beneficial effects on all the other abnormalities clustering in the syndrome. Insulin sensitivity can also be influenced by diet composition. In this respect, the specific effects of the quality of dietary fat are of great interest, given the considerable evidence in experimental animals that saturated fat in the diet may lead to insulin resistance. In man, there is indirect evidence that a higher saturated fat intake is associated with impaired insulin action. Human studies have also attempted to evaluate the relationship between total fat intake and insulin sensitivity. They are consistent in showing that fat intake is correlated with both plasma insulin values (positively) and insulin sensitivity (negatively). However, these correlations are largely mediated by body weight. Conversely, intervention studies are consistent in showing that when total fat intake is moderately increased (from 20 to 40 %), no major effect is observed on insulin sensitivity. We have recently undertaken a large, multicentre intervention study in 162 healthy individuals given either a high-saturated-fat or a high-monounsaturated-fat diet for 3 months. It shows that a high-monounsaturated-fat diet significantly improves insulin sensitivity compared to a high-saturated-fat diet. However, this beneficial effect of monounsaturated fat disappears when total fat intake exceeds 38 % of total energy. Independently of its effects on insulin sensitivity, diet composition can influence the factors clustering in the metabolic syndrome. Dietary carbohydrate increases blood glucose levels, particularly in the postprandial period, and consequently also insulin levels and plasma triglycerides. The detrimental effects of a high-carbohydrate diet on plasma glucose/insulin, triglyceride/HDL or fibrinolysis occur only when carbohydrate foods with a high glycaemic index are consumed, while they are abolished if the diet is based largely on fibre-rich, low-glycaemic-index foods. In conclusion, weight reduction is a powerful measure for the treatment of metabolic syndrome. Moreover, the diet for the treatment of the metabolic syndrome should be limited in the intake of saturated fat, while high fibre/low-glycaemic-index foods should be used without specific limitations. Moderate amounts of monounsaturated fat could be permitted as they do not induce detrimental metabolic effects.

Keywords

Metabolic symdromeInsulin sensitivityMonounsaturated fatDiet
Type
Research Article
Information
British Journal of Nutrition , Volume 83 , Issue S1 , June 2000 , pp. S143 - S148
Copyright
Copyright © The Nutrition Society 2000

References

ADA (1996) Nutrition Recommendations and principles for people with diabetes mellitus. Position Statement. Diabetes Care 19(Suppl. 1), S16-S19.CrossRefGoogle Scholar
Asp, NG, Bjork, I & Nyman, M (1993) Physiological effects of cereal dietary fibre. Carbohydrate Polymers 21, 183–187.CrossRefGoogle Scholar
Borkman, M, Campbell, LV, Chisholm, DJ & Storlien, LH (1991) Comparison of the effects on insulin sensitivity of high carbohydrate and high fat diets in normal subjects. Journal of Clinical Endocrinology and Metabolism 72, 432–437.CrossRefGoogle ScholarPubMed
Campbell, LV, Marmot, PE, Dyer, JA, Borkman, M & Storlien, LH (1994) The high-monounsaturated fat diet as a practical alternative for NIDDM. Diabetes Care 17, 177–188.CrossRefGoogle ScholarPubMed
Chen, M, Bergman, R & Porte, D (1988) Insulin resistance and beta-cell dysfunction in aging: the importance of dietary carbohydrate. Journal of Clinical Endocrinology and Metabolism 67, 951–957.CrossRefGoogle ScholarPubMed
DNSG–EASD (1995), –. Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes. Recommendations for the nutritional management of patients with diabetes mellitus. Diabetes, Nutrition and Metabolism 8, 1–4.Google Scholar
Donovan, DS, Soloman, CG & Seely, EW (1993) Effect of sodium intake on insulin sensitivity. American Journal of Physiology 264, E730-E734.Google ScholarPubMed
Facchini, F, Chen, Y-DI & Reaven, GM (1994) Light-to-moderate alcohol intake is associated with enhanced insulin sensitivity. Diabetes Care 17, 115–119.CrossRefGoogle ScholarPubMed
Frost, G, Keogh, B, Smith, D, Akinsanya, K & Leeds, A (1996) The effect of low glycemic carbohydrate on insulin and glucose response in vivo and in vitro in patients with coronary heart disease. Metabolism 45, 669–672.CrossRefGoogle ScholarPubMed
Frost, G, Leeds, AA, Dore, CJ, Madeiros, S, Brading, S & Dornhorst, A (1999) Glycemic index as a determinant of serum HDL-cholesterol concentration. Lancet 353, 1045–1048.CrossRefGoogle ScholarPubMed
Garg, A (1998) High-monounsaturated fat diets for patients with diabetes mellitus: a meta-analysis. American Journal of Clinical Nutrition 67, 577S-582S.CrossRefGoogle ScholarPubMed
Garg, A, Bonanome, A, Grundy, SM, Zheng, ZJ & Unger, RH (1988) Comparison of a high-carbohydrate diet with a high-monounsaturated-fat diet in patients with non-insulin-dependent diabetes mellitus. New England Journal of Medicine 319, 829–834.CrossRefGoogle ScholarPubMed
Garg, A, Grundy, SM & Unger, RH (1992) Comparison of effects of high and low carbohydrate diets on plasma lipoproteins and insulin sensitivity in patients with mild NIDDM. Diabetes 41, 1278–1285.CrossRefGoogle ScholarPubMed
Garg, A, Bantle, JP & Henry, RR (1994) Effects of varying carbohydrate content of diet in patients with non-insulin dependent diabetes mellitus. Journal of the American Medical Association 271, 1421–1428.CrossRefGoogle ScholarPubMed
Heini, AF & Weinsier, RL (1997) Divergent trends in obesity and fat intake patterns: the American paradox. American Journal of Medicine 102, 259–264.CrossRefGoogle ScholarPubMed
Hepp, KD (1995) Food consumption habits in Germany — the clinician's point of view. Metabolism 44(Suppl. 2), 14–17.CrossRefGoogle ScholarPubMed
Hornstra, G, Barth, CA, Galli, C, Mensink, RP, Mutanen, M, Riemersma, RA, Roberfroid, M, Salminen, K, Vansant, G & Vershuren, PM (1998) Functional food science and the cardiovascular system. British Journal of Nutrition 80, S113-S146.CrossRefGoogle ScholarPubMed
Hughes, VA, Fiatarone, MA, Fielding, RA, Ferrara, CM, Elahi, D & Evans, WJ (1995) Long-term effects of a high-carbohydrate diet and exercise on insulin action in older subjects with impaired glucose tolerance. American Journal of Clinical Nutrition 62, 426–433.CrossRefGoogle ScholarPubMed
Jenkins, DJA & Jenkins, AL (1995) Nutrition principles and diabetes. A role for ‘lente carbohydrate’?. Diabetes Care 18, 1491–1498.CrossRefGoogle ScholarPubMed
Kiechl, S, Willeit, J, Poewe, W, Egger, G, Oberhollenzer, F, Muggeo, M & Bonora, E (1996) Insulin sensitivity and regular alcohol consumption: large, prospective, cross sectional population study (Bruneck Study). British Medical Journal 313, 1040–1044.CrossRefGoogle ScholarPubMed
Lerman-Garber, I, Ichazo-Cerro, S, Zamora-Gonzales, J, Cardoso-Saldana, G, Posadas-Romero, C (1994) Effect of a high monounsaturated-fat diet enriched with avocado in NIDDM patients. Diabetes Care 17, 311–315.CrossRefGoogle ScholarPubMed
Linn, T, Geyer, R, Prassek, S & Lauke, H (1996) Effect of dietary protein intake on insulin secretion and glucose metabolism in insulin-dependent diabetes mellitus. Journal of Clinical Endocrinology and Metabolism 81, 3938–3943.Google ScholarPubMed
Lopez-Segura, F, Velasco, F, Lopez-Miranda, J, Castro, P, Lopez-Pedrera, R, Blanco, A, Jimenez-Pereperez, J, Torre, A, Trujillo, J, Ordovas, JM, Perez-Jimenez, F (1996) Monounsaturated fatty acid-enriched diet decreases plasma plasminogen activator inhibitor type 1. Arteriosclerosis, Thrombosis and Vascular Biology 16, 82–88.CrossRefGoogle ScholarPubMed
Macdiarmid, JI, Cade, JE & Blundell, JE (1996) High and low fat consumers, their macronutrient intake and body mass index: further analysis of the National Diet and Nutrition Survey of British Adults. European Journal of Clinical Nutrition 50, 505–512.Google ScholarPubMed
Parillo, M, Rivellese, A, Ciardullo, AV, Capaldo, B, Giacco, A, Genovese, S & Riccardi, G (1992) A high monounsaturated fat/low carbohydrate diet improves periferal insulin sensitivity in non insulin dependent diabetic patients. Metabolism 41, 1373–1378.CrossRefGoogle Scholar
Parillo, M, Giacco, R, Ciardullo, AV, Rivellese, AA & Riccardi, G (1996) Does a high-carbohydrate diet have different effects in NIDDM patients treated with diet alone on hypoglycemic drugs? Diabetes Care 19, 498–500.CrossRefGoogle ScholarPubMed
Rasmussen, OW, Thomsen, C, Hansen, KW, Vesterlund, M, Winther, E & Hermansen, K (1993) Effects of blood pressure, glucose, and lipid levels of a high-monounsaturated fat diet compared with a high-carbohydrate diet in NIDDM subjects. Diabetes Care 16, 1565–1571.CrossRefGoogle ScholarPubMed
Reaven, G (1997) Do high carbohydrate diets prevent the development or attenuate the manifestations (or both) of syndrome X? A viewpoint strongly against. Current Opinion in Lipidology 8, 23–27.CrossRefGoogle ScholarPubMed
Riccardi, G & Rivellese, AA (1991) Effects of dietary fiber and carbohydrate on glucose and lipoprotein metabolism in diabetic patients. Diabetes Care 14, 1115–1125.CrossRefGoogle ScholarPubMed
Rivellese, AA, Giacco, R & Genovese, S (1990) Effects of changing amount of carbohydrate in diet on plasma lipoproteins and apolipoproteins in type II diabetic patients. Diabetes Care 13, 446–448.CrossRefGoogle ScholarPubMed
Rivellese, AA, Auletta, P, Marotta, G, Saldalamacchia, G, Giacco, A, Mastrilli, V, Vaccaro, O & Riccardi, G (1994) Long term metabolic effects of two dietary methods of treating hyperlipidemia. British Medical Journal 308, 227–231.CrossRefGoogle Scholar
Salméron, J, Manson, JE, Stampfer, MJ, Colditz, GA, Wing, AL & Willett, WC (1997) Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. Journal of the American Medical Association 277, 472–477.CrossRefGoogle ScholarPubMed
Sanchez-Lugo, L, Mayer-Davis, EJ, Howard, G, Selby, JV, Ayad, MF, Rewers, M & Haffner, S (1997) Insulin sensitivity and intake of vitamins E and C in African American, Hispanic, and non-Hispanic white men and women: the Insulin Resistance and Atherosclerosis Study (IRAS). Americal Journal of Clinical Nutrition 66, 1224–1231.CrossRefGoogle Scholar
Storlien, LH, Baur, LA, Kriketas, AD, Pan, DA, Cosney, GJ, Jankins, AB, Calvert, GD & Campbell, LV (1996) Dietary fats and insulin action. Diabetologia 39, 621–631.CrossRefGoogle ScholarPubMed
Vessby, B (1999) Effect of dietary fat on insulin sensitivity and insulin secretion. The Kanwu Study. Diabetologia 42(Suppl. 1), A46.Google Scholar
Weinstock, RS, Dai, H & Wadden, T (1998) Diet and exercise in the treatment of obesity. Effects of three interventions on insulin resistance. Archives of Internal Medicine 158, 2477–2483.CrossRefGoogle Scholar