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Effects of moderate variations in the macronutrient content of the diet on cardiovascular disease risk factors in obese patients with the metabolic syndrome^1,2,3

¹ From the Clinical Nutrition Unit (FM and LM) and the Department of Internal Medicine (DS), G Salvini Hospital, Garbagnate Milanese, Milan, Italy; the Nutrition and Metabolic Disease Research Institute, South Dakota Health Research Foundation, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD (WSH); and the Department of Internal Medicine, University of Milan, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico. Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy (AB)

Background: The metabolic syndrome is a cluster of abnormalities that is accompanied by a 2-fold increase in the risk of cardiovascular disease. Even if there is full agreement that lifestyle changes to induce weight loss are the first-line approach, the ideal diet for the treatment of the metabolic syndrome remains uncertain.

Objective: The objective was to compare the effects of 2 diets on cardiovascular disease risk factors in obese patients with the metabolic syndrome.

Design: The study was carried out in 100 patients randomly assigned to either a diet relatively rich in carbohydrate [65% of energy as carbohydrate, 13% as protein, and 22% as fat (17% as unsaturated fat)] or a diet that was low in carbohydrate and high in protein and in monounsaturated fat [48% of energy as carbohydrate, 19% as protein, and 33% as fat (24% as unsaturated fat)].

Results: All 100 patients completed the 5-mo study. At the end of the study, all the components of the metabolic syndrome (except HDL, which did not change) decreased significantly in both groups. With the high-carbohydrate diet, a significant decrease in LDL-cholesterol concentrations was also observed. Although the extent of the resolution of the metabolic syndrome was not different between groups, the low-carbohydrate diet was associated with a greater decrease in the prevalence of hypertension (P < 0.05) and of hypertriacylglycerolemia (P < 0.001).

Conclusion: Tailoring diet interventions to the specific presentation of the metabolic syndrome may be the best way of reducing the risk factors for cardiovascular disease.

Key Words: Metabolic syndrome • diet treatment • cardiovascular disease risk factors • high-protein diets • low-carbohydrate diets • high-lipid diets • insulin resistance • blood pressure

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