Background The Metabolic Syndrome (MetS) is highly prevalent and associated with an increased risk for Type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Lifestyle recommendations to treat MetS often include the replacement of saturated fats (SFA) and monosacharides with unsaturated fat. However, it is unclear whether metabolic parameters will improve more when the saturated fat in American Heart Association (AHA) diets is replaced with higher concentrations of mono or poly-unsaturated fatty acids (MUFA, PUFA). Objective To test the hypothesis that an AHA diet enriched in MUFA improves lipoprotein lipids, insulin resistance, inflammation and endothelial function to a greater extent than a diet enriched in PUFA in middle-aged men and women with MetS. Methods A prospective, open-label, parallel group design with randomization to a hypocaloric MUFA or PUFA enriched diet following weight stabilization on an AHA Step I diet. Participants consumed 3 MUFA or PUFA enriched muffins daily with additional supplementation as required to ensure 25-50% increases in dietary fat intake from these sources at the expense of SFA and the opposing unsaturated fat. Changes in MetS components were measured at baseline and after 6 months of dietary intervention. Results Thirty-nine participants (mean age 60.8 years, 79% African-American, 60% women) with MetS completed the 6-month study. Compared to baseline, assignment to either MUFA (n=23) or PUFA (n=16) both were associated with weight loss (WL) (MUFA: −2.3±1 kg, P=0.06; PUFA: −4.6±2 kg; P=0.002), but PUFA was also associated with reductions in triglycerides (TG) (−30±18 mg/dL, P=0.02), systolic blood pressure (BP) (−7±3 mmHg, P=0.01), diastolic BP (DBP) (−4±2 mmHg, P=0.01) and improved flow mediated dilation (FMD) (7.1±1.8% vs. 13.6±2%, absolute increase; P=0.0001). When compared to MUFA treatment, PUFA intervention was associated with reduced TG (P=0.04) and DBP (P=0.07) as well as increased FMD (P=0.04) even after adjustment for changes in weight. There was no effect on total cholesterol, low-density lipoprotein cholesterol (LDL-C), glucose, high-sensitivity C-reactive protein (hs-CRP) or other inflammatory proteins. Overall, 25% (4 of 16) assigned to PUFA and 13% (3 of 23) to MUFA converted to non-MetS status. Conclusion Substitution of SFA with PUFA in patients with MetS is associated with greater reductions in TG and improvement in endothelial function than MUFA that is independent of WL. These preliminary findings raise the possibility that PUFA may be the unsaturated fat of choice to reduce cardiometabolic risk in patients with MetS.

We present the case of a young obese patient with recent COVID-19 (coronavirus disease 2019) who developed multisystem inflammatory syndrome (MIS) 1 month after spontaneous resolution. A 23-year-old African American man was admitted with a 1-week history of worsening fatigue, myalgias, headache, and dyspnea. Nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was negative by polymerase chain reaction; however, the patient was febrile and had leukocytosis, elevated troponin I, transaminitis, and acute kidney injury. Bedside echocardiogram showed decreased left ventricular ejection fraction (40% to 45%) and global hypokinesis in the setting of a type II non-ST segment myocardial infarction. Despite being on broad spectrum antibiotic therapy, the patient’s clinical condition continued to worsen. The patient was then empirically treated for MIS with intravenous immunoglobulin and methylprednisolone, which led to a rapid resolution of fever and laboratory abnormalities. This case highlights that MIS associated with COVID-19 may present in patients above the age of 21 years and can occur with a delayed onset after mild illness in those with no previous oxygen requirement or hospitalization during SARS-CoV-2 infection.

The cornerstone of initial management for hypertriglyceridemia (HTG) is lifestyle modification. The combination of weight loss through caloric restriction, alteration in macronutrient composition and increased energy expenditure reduces TG levels by approximately 50%. The addition of cinnamon, cacao products and isocaloric substitution of 1 serving of nuts may contribute another 5–15% lowering of TG. This can be particularly beneficial in patients with HTG who are at increased risk of cardiovascular disease.

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