The metabolic syndrome is a complex condition characterized by dyslipidaemia, high blood pressure, impaired glucose tolerance and abdominal fat accumulation. Subjects with the metabolic syndrome are at high risk of atherosclerosis and coronary heart disease. A comprehensive approach is required for patients suffering this cluster of clinical manifestations. Indeed, subjects with the metabolic syndrome could benefit from life-style modifications, particularly through exercise and diet. In this article, the evidence regarding the role of diet, in particular the role of food patterns based on the Mediterranean-style diet, in preventing and treating the metabolic syndrome are reviewed. Keywords Mediterranean diet · Metabolic syndrome · Diet IntroductionThere are many definitions of the metabolic syndrome, being still a matter of debate ( Table 1). The metabolic syndrome has its origins in 1923 when Kylin described a syndrome involving hypertension, hyperglycaemia and hyperuricaemia [1]. Later, Vague in 1947 linked abdominal obesity to metabolic abnormalities (i.e. diabetes, atherosclerosis, gout and calculi) [2]. In 1967, Avogaro et al. described six obese patients with diabetes, hypercholesterolaemia, and marked hypertriglyceridaemia, all of whom improved on a hypocaloric and low-carbohydrate diet [3]. In the 1970s, Phillips suggested associations of aging, obesity and sex hormone-associated clinical manifestations with heart disease [4,5]. In the late 1980s, Reaven proposed insulin resistance as the critical factor and coined the name syndrome-X [6].However, the most extensive definitions were established by the World Health Organization (WHO) and the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII). In these definitions an enhanced cholesterol/high-density lipoprotein (HDL) ratio is considered a factor in the metabolic syndrome as well as elevated low-density lipoprotein cholesterol, atherogenic dyslipidaemia, insulin resistance, hypertension, abdominal obesity and elevated levels of several inflammatory markers [7,8]. In 2005 the International Diabetes Federation (IDF) emphasized abdominal obesity as the initiating factor in metabolic syndrome [9]. Although the definition of the metabolic syndrome makes little difference to prognosis [10,11], the IDF definition appears to be the most useful in clinical practice and considers different ethnic-related definitions of obesity.Each of the abnormalities promotes atherosclerosis independently, but the clustering of risk factors signifi- cantly reduces the quality of life [12] and increases the risk of cardiovascular morbidity and mortality. Indeed, the metabolic syndrome has been associated with an approximate twofold increased risk of cardiovascular morbidity and mortality in a European population [13]. The risk of cardiovascular morbidity and mortality is significantly higher among people with metabolic syndrome [14] even in the absence of baseline health conditions such as cardiovascular disease (CVD) and diabetes [15].The INTER...

The metabolic syndrome is a complex condition characterized by dyslipidaemia, high blood pressure, impaired glucose tolerance and abdominal fat accumulation. Subjects with the metabolic syndrome are at high risk of atherosclerosis and coronary heart disease. A comprehensive approach is required for patients suffering this cluster of clinical manifestations. Indeed, subjects with the metabolic syndrome could benefit from life-style modifications, particularly through exercise and diet. In this article, the evidence regarding the role of diet, in particular the role of food patterns based on the Mediterranean-style diet, in preventing and treating the metabolic syndrome are reviewed.