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Mediterranean-style dietary pattern, reduced risk of metabolic syndrome traits, and incidence in the Framingham Offspring Cohort^1,2,3

¹ From the Nutritional Epidemiology Program, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA (MER, JTD, NMM, and PFJ); Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA (MER, JTD, NMM, and PFJ); Tufts Medical Center Hospital, Boston, MA (JTD); School of Medicine, Tufts University, Boston, MA (JTD); and the General Medicine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (JBM).

² Supported by the USDA (agreement 58-1950-7-707) and the Framingham Heart Study of the National Heart Lung and Blood Institute of the NIH (contract NO1-HC-25195). MER was a recipient of the Helen Smith Brownstein Memorial Scholarship. JBM was supported in part by the American Diabetes Association’s Career Development Award and the National Institute of Diabetes and Digestive and Kidney Diseases grant K24 DK080140. NMM was supported in part by the General Mills Bell Institute of Health.

³ Address correspondence to PF Jacques, Nutritional Epidemiology, JM USDA HNRCA at Tufts University, 711 Washington Street, Boston, MA 02111-1524. E-mail: paul.jacques{at}tufts.edu.

Background: The benefit of the Mediterranean-style dietary pattern in mitigating metabolic risk factors for type 2 diabetes and cardiovascular disease has not been well investigated among nondiabetic Americans.

Objective: The aim of this study was to examine the prospective association between the Mediterranean-style dietary pattern and metabolic syndrome.

Design: The Mediterranean-style dietary pattern score (MSDPS) was used to characterize a Mediterranean-style dietary pattern in the Framingham Heart Study Offspring Cohort. We examined the longitudinal association between MSDPS and metabolic syndrome traits (including homeostasis model assessment–insulin resistance, fasting glucose, waist circumference, triglyceride, HDL cholesterol, and systolic and diastolic blood pressure) among 2730 participants of the Framingham Heart Study Offspring Cohort without type 2 diabetes (baseline median age: 54 y; 55% women), who were followed from the fifth (baseline) to the seventh study examinations (mean follow-up time: 7 y), and metabolic syndrome incidence (according to the National Cholesterol Education Program Adult Treatment Panel III definition) in 1918 participants free of the condition at baseline.

Results: A higher MSDPS was associated with lower homeostasis model assessment–insulin resistance (P = 0.02), waist circumference (P < 0.001), fasting plasma glucose (P = 0.03), and triglycerides (P < 0.001) and higher HDL cholesterol (P = 0.02) after adjustment for the corresponding baseline values and for several confounding factors associated with type 2 diabetes risk. Participants in the highest quintile category of the MSDPS had a lower incidence of metabolic syndrome than those in the lowest quintile category (38.5% compared with 30.1%; P = 0.01).

Conclusion: Our study suggests that the consumption of a diet consistent with the principles of the Mediterranean-style diet may protect against metabolic syndrome in Americans.