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Original Communication

Effect of the Mediterranean diet in combination with exercise on metabolic syndrome parameters: 1-year randomized controlled trial

Published Online:https://doi.org/10.1024/0300-9831/a000462

Abstract. This work aimed to evaluate and compare the benefits of the energy restricted Mediterranean diet (MD) and Standard hypolipemic diet (SHD) accompanied by exercise on metabolic syndrome parameters. A 12-month, randomized, single-blinded, diet-controlled study was conducted on 124 obese participants in the University Hospital Dubrava. Participants were assigned to the MD (n = 63) or the SHD (n = 61) and received the same amount of nutritional education and guidance on physical activity. The completion rate was 67.7 %. Both diets produced significant beneficial changes in body weight and waist circumference (P < 0.001 for MD and SHD). Compared with the SHD, HDL cholesterol increased (P = 0.031) and systolic blood pressure (SBP) decreased (P = 0.020) in the MD group. Fasting plasma glucose decreased significantly in both diet groups (P < 0.001 for MD; P = 0.026 for SHD). Although both diets accompanied by physical activity yielded similar weight reduction results, adherence to the MD was associated with more prominent reduction of the MetS components, namely HDL level elevation and SBP reduction.

References

  • 1 International Diabetes Federation. (2006) The IDF consensus worldwide definition of the metabolic syndrome. Brussels, Belgium: Available from: https://www.idf.org/e-library/consensus-statements/60-idfconsensus-worldwide-definitionof-the-metabolic-syndrome First citation in articleGoogle Scholar

  • 2 International Diabetes Federation. (2013) IDF Diabetes Atlas. Brussels, Belgium Available from: https://www.idf.org/e-library/epidemiology-research/diabetes-atlas/19-atlas-6th-edition.html First citation in articleGoogle Scholar

  • 3 Athyros, V.G., Bouloukos, V.I., Pehlivanidis, A.N., Papageorgiou, A.A., Dionysopoulou, S.G., Symeonidis, A.N., et al. (2005) The prevalence of the metabolic syndrome in Greece: the MetS-Greece Multicentre Study Diabetes Obes. Metab. 7, 397–405. First citation in articleCrossref MedlineGoogle Scholar

  • 4 Hu, G., Qiao, Q., Tuomilehto, J., Balkau, B., Borch-Johnsen, K., & Pyorala, K. (2004) Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women Arch. Intern. Med. 164, 1066–1076. First citation in articleCrossref MedlineGoogle Scholar

  • 5 Maggi, S., Noale, M., Gallina, P., Bianchi, D., Marzari, C., Limongi, F., et al. (2006) Metabolic syndrome, diabetes, and cardiovascular disease in an elderly Caucasian cohort: the Italian Longitudinal Study on Aging J. Gerontol. A Biol. Sci. Med. Sci. 61, 505–510. First citation in articleCrossref MedlineGoogle Scholar

  • 6 Deka, R., Narancic, N.S., Xip, H., Turek, S., Cubrilo-Turek, M., Vrhovski-Hebrang, D., et al. (2008) Metabolic syndrome in an island population of the eastern Adriatic coast of Croatia Coll. Antropol. 32, 85–91. First citation in articleMedlineGoogle Scholar

  • 7 Tucak-Zoric, S., Curcic, I.B., Mihalj, H., Dumancic, I., Zelic, Z., Cetina, N.M., et al. (2008) Prevalence of metabolic syndrome in the interior of Croatia: the Baranja region Coll. Antropol. 32, 659–665. First citation in articleMedlineGoogle Scholar

  • 8 Gallus, S., Lugo, A., Murisic, B., Bosetti, C., Boffetta, P., & La, V.C. (2014) Overweight and obesity in 16 European countries Eur. J. Nutr. 54, 679–89. First citation in articleCrossref MedlineGoogle Scholar

  • 9 Keys, A., Menotti, A., Karvonen, M.J., Aravanis, C., Blackburn, H., Buzina, R., et al. (1986) The diet and 15-year death rate in the seven countries study Am. J. Epidemiol. 124, 903–915. First citation in articleCrossref MedlineGoogle Scholar

  • 10 Heidemann, C., Hoffmann, K., Spranger, J., Klipstein-Grobusch, K., Mohlig, M., Pfeiffer, A.F., & Boeing, H. (2005) A dietary pattern protective against type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study cohort Diabetologia 48, 1126–1134. First citation in articleCrossref MedlineGoogle Scholar

  • 11 Kant, A.K. (2010) Dietary patterns: biomarkers and chronic disease risk Appl. Physiol. Nutr. Metab. 35, 199–206. First citation in articleCrossref MedlineGoogle Scholar

  • 12 Ruel, M.T. (2003) Operationalizing dietary diversity: a review of measurement issues and research priorities J. Nutr. 133, 3911S–3926S. First citation in articleCrossref MedlineGoogle Scholar

  • 13 Babio, N., Bullo, M., & Salas-Salvado, J. (2009) Mediterranean diet and metabolic syndrome: the evidence Public Health Nutr. 12, 1607–1617. First citation in articleCrossref MedlineGoogle Scholar

  • 14 Esposito, K., Kastorini, C.M., Panagiotakos, D.B., & Giugliano, D. (2013) Mediterranean diet and metabolic syndrome: an updated systematic review Rev. Endocr. Metab. Disord. 14, 255–263. First citation in articleCrossref MedlineGoogle Scholar

  • 15 Grosso, G., Mistretta, A., Frigiola, A., Gruttadauria, S., Biondi, A., Basile, F., et al. (2014) Mediterranean diet and cardiovascular risk factors: a systematic review Crit. Rev. Food Sci. Nutr. 54, 593–610. First citation in articleCrossref MedlineGoogle Scholar

  • 16 Schwingshackl, L., & Hoffmann, G. (2014) Comparison of the long-term effects of high-fat v. low-fat diet consumption on cardiometabolic risk factors in subjects with abnormal glucose metabolism: a systematic review and meta-analysis Br. J. Nutr. 111, 2047–2058. First citation in articleCrossref MedlineGoogle Scholar

  • 17 Sofi, F., Cesari, F., Abbate, R., Gensini, G.F., & Casini, A. (2008) Adherence to Mediterranean diet and health status: meta-analysis BMJ 337, a1344. First citation in articleCrossref MedlineGoogle Scholar

  • 18 Estruch, R., Martinez-Gonzalez, M.A., Corella, D., Salas-Salvado, J., Ruiz-Gutierrez, V., Covas, M.I., et al. (2006) Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial Ann. Intern. Med. 145, 1–11. First citation in articleCrossref MedlineGoogle Scholar

  • 19 Vincent-Baudry, S., Defoort, C., Gerber, M., Bernard, M.C., Verger, P., et al. (2005) The Medi-RIVAGE study: reduction of cardiovascular disease risk factors after a 3-mo intervention with a Mediterranean-type diet or a low-fat diet Am J Clin Nutr. 82, 964–971. First citation in articleCrossref MedlineGoogle Scholar

  • 20 Yamaoka, K., & Tango, T. (2012) Effects of lifestyle modification on metabolic syndrome: a systematic review and meta-analysis BMC Med. 10, 138. First citation in articleCrossref MedlineGoogle Scholar

  • 21 Ortner Hadziabdic, M., Mucalo, I., Hrabac, P., Matic, T., Rahelic, D., & Bozikov, V. (2015) Factors predictive of drop-out and weight loss success in weight management of obese patients J. Hum. Nutr. Diet. 28, 24–32. First citation in articleCrossref MedlineGoogle Scholar

  • 22 Ortner Hadziabdic, M., Vitali Čepo, D., Rahelić, D., & Bozikov, V. (2015) The effect of the Mediterranean diet on serum total antioxidant capacity in obese patients: a randomized controlled trial J. Am. Coll. Nutr 19, 1–12. First citation in articleGoogle Scholar

  • 23 Craig, C.L., Marshall, A.L., Sjostrom, M., Bauman, A.E., Booth, M.L., Ainsworth, B.E., et al. (2003) International physical activity questionnaire: 12-country reliability and validity Med. Sci. Sports Exerc. 35, 1381–1395. First citation in articleCrossref MedlineGoogle Scholar

  • 24 Turcinov, D., Stanley, C., Canchola, J.A., Rutherford, G.W., Novotny, T.E., & Begovac, J. (2009) Dyslipidemia and adherence to the Mediterranean diet in Croatian HIV-infected patients during the first year of highly active antiretroviral therapy Coll. Antropol. 33, 423–430. First citation in articleMedlineGoogle Scholar

  • 25 Chobanian, A.V., Bakris, G.L., Black, H.R., Cushman, W.C., Green, L.A., Izzo, J.L., et al. (2003) The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report JAMA 289, 2560–2572. First citation in articleCrossref MedlineGoogle Scholar

  • 26 Alberti, K.G., Eckel, R.H., Grundy, S.M., Zimmet, P.Z., Cleeman, J.I., Donato, K.A., Fruchart, J.C., et al. (2009) Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity Circulation 120, 1640–1645. First citation in articleCrossref MedlineGoogle Scholar

  • 27 Root, M.M., & Dawson, H.R. (2013) DASH-like diets high in protein or monounsaturated fats improve metabolic syndrome and calculated vascular risk Int. J. Vitam. Nutr. Res. 83(4), 224–31. First citation in articleLinkGoogle Scholar

  • 28 Kris-Etherton, P., Eckel, R.H., Howard, B.V., St, J.S., & Bazzarre, T.L. (2001) AHA Science Advisory: Lyon Diet Heart Study. Benefits of a Mediterranean-style, National Cholesterol Education Program/American Heart Association Step I Dietary Pattern on Cardiovascular Disease Circulation 103, 1823–1825. First citation in articleCrossref MedlineGoogle Scholar

  • 29 Martinez-Gonzalez, M.A., & Sanchez-Villegas, A. (2004) The emerging role of Mediterranean diets in cardiovascular epidemiology: monounsaturated fats, olive oil, red wine or the whole pattern? Eur. J. Epidemiol. 19, 9–13. First citation in articleCrossref MedlineGoogle Scholar

  • 30 Ros, E. (2003) Dietary cis-monounsaturated fatty acids and metabolic control in type 2 diabetes Am. J. Clin. Nutr. 78, 617S–625S. First citation in articleCrossref MedlineGoogle Scholar

  • 31 Berry, E.M., Eisenberg, S., Haratz, D., Friedlander, Y., Norman, Y., Kaufmann, N.A., & Stein, Y. (1991) Effects of diets rich in monounsaturated fatty acids on plasma lipoproteins – the Jerusalem Nutrition Study: high MUFAs vs high PUFAs Am. J. Clin. Nutr. 53, 899–907. First citation in articleCrossref MedlineGoogle Scholar

  • 32 Ríos-Hoyo, A., Cortés, M.J., Ríos-Ontiveros, H., Meaney, E., Ceballos, G., & GutiérrezSalmeán, G. (2014) Obesity, metabolic syndrome, and dietary therapeutical approaches with a special focus on nutraceuticals (polyphenols): a mini-review Int. J. Vitam. Nutr. Res. 84(3–4), 113–23. First citation in articleLinkGoogle Scholar

  • 33 Jakobsen, M.U., O’Reilly, E.J., Heitmann, B.L., Pereira, M.A., Balter, K., Fraser, G.E., Goldbourt, U., Hallmans, G., Knekt, P., Liu, S., Pietine, P., Spiegelman, D., Stevens, J., Virtamo, J., Willett, W.C., & Aschiero, A. (2009) Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies Am. J. Clin. Nutr. 89, 1425–1432. First citation in articleCrossref MedlineGoogle Scholar

  • 34 Domenech, M., Roman, P., Lapetra, J., Garcia de la Corte, F.J., Sala-Vila, A., de la Torre, R., Corella, D., Salas-Salvado, J., Ruiz-Gutierrez, V., Lamuela-Raventos, R.M., Toledo, E., Estruch, R., Coca, & A., Ros, E. (2014) Mediterranean diet reduces 24-hour ambulatory blood pressure, blood glucose, and lipids: one-year randomized, clinical trial Hypertension 64, 69–76. First citation in articleCrossref MedlineGoogle Scholar

  • 35 Appel, L.J., Moore, T.J., Obarzanek, E., Vollmer, W.M., Svetkey, L.P., Sacks, F.M., Bray, G.A., Vogt, T.M., Cutler, J.A., Windhauser, M.M., Lin, P.H., & Karanja, N. (1997) A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group N. Engl. J. Med. 336, 1117–1124. First citation in articleCrossref MedlineGoogle Scholar

  • 36 Appel, L.J., Sacks, F.M., Carey, V.J., Obarzanek, E., Swain, J.F., Miller, E.R., Conlin, P.R., Erlinger, T.P., Rosner, B.A., Laranjo, N.M., Charleston, J., McCarron, P., & Bishop, L.M. (2005) Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial JAMA 294, 2455–2464. First citation in articleCrossref MedlineGoogle Scholar

  • 37 Grossman, E. (2011) Blood pressure: the lower, the better: the con side Diabetes Care 34, S308–S312. First citation in articleCrossref MedlineGoogle Scholar

  • 38 Clarke, R., Frost, C., Collins, R., Appleby, P., & Peto, R. (1997) Dietary lipids and blood cholesterol: quantitative meta-analysis of metabolic ward studies BMJ 314, 112–117. First citation in articleCrossref MedlineGoogle Scholar

  • 39 Mensink, R.P., Zock, P.L., Kester, A.D., & Katan, M.B. (2003) Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials Am. J. Clin. Nutr. 77, 1146–1155. First citation in articleCrossref MedlineGoogle Scholar

  • 40 Pelkman, C.L., Fishell, V.K., Maddox, D.H., Pearson, T.A., Mauger, D.T., & Kris-Etherton, P.M. (2004) Effects of moderate-fat (from monounsaturated fat) and low-fat weight-loss diets on the serum lipid profile in overweight and obese men and women Am. J. Clin. Nutr. 79, 204–212. First citation in articleCrossref MedlineGoogle Scholar

  • 41 Jensen, M.D., Ryan, D.H., Apovian, C.M., Ard, J.D., Comuzzie, A.G., Donato, K.A., et al. (2014) 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society J. Am. Coll. Cardiol. 63, 2985–3023. First citation in articleCrossref MedlineGoogle Scholar

  • 42 Obarzanek, E., Sacks, F.M., Vollmer, W.M., Bray, G.A., Miller, E.R., Lin, P.H., Karanja, N.M., Most-Windhauser, M.M., Moore, T.J., Swain, J.F., Bales, C.W., & Proschan, M.A. (2001) Effects on blood lipids of a blood pressure-lowering diet: The Dietary Approaches to Stop Hypertension (DASH) Trial Am. J. Clin. Nutr. 74, 80–89. First citation in articleCrossref MedlineGoogle Scholar

  • 43 Sacks, F.M., Svetkey, L.P., Vollmer, W.M., Appel, L.J., Bray, G.A., Harsha, D., Obarzanek, E., Conlin, P.R., Miller, E.R., Simons-Morton, D.G., Karanja, N., & Lin, P.H. (2001) Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group N. Engl. J. Med. 344, 3–10. First citation in articleCrossref MedlineGoogle Scholar

  • 44 Esposito, K., Marfella, R., Ciotola, M., Di, P.C., Giugliano, F., Giugliano, G., D’Armiento, M., D’Andrea, F., & Giugliano, D. (2004) Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial JAMA 292, 1440–1446. First citation in articleCrossref MedlineGoogle Scholar

  • 45 Tuomilehto, J., Lindstrom, J., Eriksson, J.G., Valle, T.T., Hamalainen, H., Ilanne-Parikka, P., Keinanen-Kiukaanniemi, S., Laakso, M., Louheranta, A., Rastas, M., Salminen, V., & Uusitupa, M. (2001) Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance N. Engl. J. Med. 344, 1343–1350. First citation in articleCrossref MedlineGoogle Scholar

  • 46 Samieri, C., Feart, C., Proust-Lima, C., Peuchant, E., Tzourio, C., Stapf, C., Berr, C., & Barberger-Gateau, P. (2011) Olive oil consumption, plasma oleic acid, and stroke incidence: the Three-City Study Neurol. 77, 418–425. First citation in articleCrossref MedlineGoogle Scholar

  • 47 Casas-Agustench, P., Lopez-Uriarte, P., Ros, E., Bullo, M., & Salas-Salvado, J. (2011) Nuts, hypertension and endothelial function Nutr. Metab. Carbiovasc. Dis. 21, S21–S33. First citation in articleCrossref MedlineGoogle Scholar

  • 48 Pitsavos, C., Panagiotakos, D.B., Chrysohoou, C., Kokkinos, P.F., Skoumas, J., Papaioannou, I., Stefanadis, C., & Toutouzas, P. (2002) The effect of the combination of Mediterranean diet and leisure time physical activity on the risk of developing acute coronary syndromes, in hypertensive subjects J. Hum. Hypertens. 16, 517–524. First citation in articleCrossref MedlineGoogle Scholar