OBJECTIVE -To determine the effects of a Dietary Approaches to Stop Hypertension (DASH) eating plan on metabolic risks in patients with the metabolic syndrome.RESEARCH DESIGN AND METHODS -This was a randomized controlled outpatient trial conducted on 116 patients with the metabolic syndrome. Three diets were prescribed for 6 months: a control diet, a weight-reducing diet emphasizing healthy food choices, and the DASH diet with reduced calories and increased consumption of fruit, vegetables, low-fat dairy, and whole grains and lower in saturated fat, total fat, and cholesterol and restricted to 2,400 mg Na. The main outcome measures were the components of the metabolic syndrome.RESULTS -Relative to the control diet, the DASH diet resulted in higher HDL cholesterol (7 and 10 mg/dl), lower triglycerides (Ϫ18 and Ϫ14 mg/dl), systolic blood pressure (SBP) (Ϫ12 and Ϫ11 mmHg), diastolic blood pressure (Ϫ6 and Ϫ7 mmHg), weight (Ϫ16 and Ϫ14 kg), fasting blood glucose (FBG) (Ϫ15 and Ϫ8 mg/dl), and weight (Ϫ16 and Ϫ15 kg), among men and women, respectively (all P Ͻ 0.001). The net reduction in triglycerides (Ϫ17 and Ϫ18 mg/dl), SBP (Ϫ11 and Ϫ11 mmHg), diastolic blood pressure (Ϫ5 and Ϫ6 mmHg), and FBG (Ϫ4 and Ϫ6 mg/dl), weight (Ϫ16 and Ϫ15 kg), and increase in HDL (5 and 10 mg/dl) among men and women, respectively, was higher in the DASH group (all P Ͻ 0.05). The weight-reducing diet resulted in significant change in triglycerides (Ϫ13 and Ϫ10 mg/dl), SBP (Ϫ6 and Ϫ6 mmHg), and weight (Ϫ13 and Ϫ12 kg) among men and women, respectively (all P Ͻ 0.05).CONCLUSIONS -The DASH diet can likely reduce most of the metabolic risks in both men and women; the related mechanisms need further study. Diabetes Care 28:2823-2831, 2005T he metabolic syndrome is a clustering of metabolic abnormalities and cardiovascular risk factors that occur in individuals with impaired insulin sensitivity (1,2). Existing data suggest that the incidence is rising at an alarming rate (3,4). In Tehran, Iran, it has been estimated to occur in Ͼ30% of adults (5), a prevalence significantly higher than that of most developed countries (6). In choosing a therapeutic diet for metabolic syndrome, all the abnormalities of the metabolic syndrome should be taken into account (7,8). Most patients with the metabolic syndrome are overweight or obese, especially upper-body obese (9,10). Therefore, basic weight reduction should be recommended (11). Weight reduction usually improves insulin sensitivity and all the metabolic and cardiovascular abnormalities linked with insulin resistance as well (12). Improvement of insulin sensitivity due to weight reduction is reported before (13). Although weight reduction is an effective way for the treatment of the metabolic syndrome, intervention studies are still needed to determine a specific therapeutic diet for the metabolic syndrome (7). Esposito et al. (14) reported that a Mediterraneanstyle diet might be effective in reducing the prevalence of the metabolic syndrome. Riccardi and Rivellese (7) introduced a diet with high amounts...

Background: Although individual foods and nutrients have been associated with the metabolic syndrome, whether dietary patterns identified by factor analysis are also associated with this syndrome is not known. Objective: We aimed to evaluate the association of major dietary patterns characterized by factor analysis with insulin resistance and the metabolic syndrome among women. Design: Usual dietary intakes were assessed in a cross-sectional study of 486 Tehrani female teachers aged 40 -60 y. Anthropometric and blood pressure measurements were performed, and fasting blood samples were taken for biomarker assessment. The metabolic syndrome was defined according to Adult Treatment Panel III guidelines, and insulin resistance was defined as the highest quartile of the homeostasis model assessment scores. Results: We identified 3 major dietary patterns by factor analysis: the healthy dietary pattern, the Western dietary pattern, and the traditional dietary pattern. After control for potential confounders, subjects in the highest quintile of healthy dietary pattern scores had a lower odds ratio for the metabolic syndrome (odds ratio: 0.61; 95% CI: 0.30, 0.79; P for trend 0.01) and insulin resistance (0.51; 0.24, 0.88; P for trend 0.01) than did those in the lowest quintile. Compared with those in the lowest quintile, women in the highest quintile of Western dietary pattern scores had greater odds for the metabolic syndrome (1.68; 1.10, 1.95; P for trend 0.01) and insulin resistance (1.26; 1.00, 1.78; P for trend 0.01). Higher consumption of traditional dietary pattern was significantly associated only with abnormal glucose homeostasis (1.19; 1.04, 1.59; P 0.05). Conclusion: Significant associations exist between dietary patterns identified by factor analysis, the metabolic syndrome, and insulin resistance.Am J Clin Nutr 2007;85:910 -8.

Few studies have examined the contribution of major dietary patterns to markers of systemic inflammation. This study was conducted to evaluate the association of major dietary patterns with markers of systemic inflammation among Iranian women. In a cross-sectional study of 486 healthy women aged 40-60 y, we assessed usual dietary intakes by means of an FFQ. Dietary patterns were identified by factor analysis. Anthropometric measurements were made and blood samples from fasting were taken for measuring inflammatory markers. The healthy pattern (high in fruits, vegetables, tomato, poultry, legumes, tea, fruit juices, and whole grains) was inversely related to plasma concentrations of C-reactive protein (CRP) (beta = -0.09, P < 0.001), E-selectin (beta = -0.07, P < 0.05), and soluble vascular cell adhesion molecule-1 (sVCAM-1) (beta = -0.08, P < 0.001) after control for potential confounders; with further adjustment for BMI and waist circumference (WC), the associations remained significant for CRP (beta = -0.05, P < 0.05) and sVCAM-1 (beta = -0.04, P < 0.05). In contrast, the western pattern score (high in refined grains, red meat, butter, processed meat, high-fat dairy, sweets and desserts, pizza, potato, eggs, hydrogenated fats, and soft drinks) was positively related to CRP (beta = 0.08, P < 0.001), serum amyloid A (SAA) (beta = 0.11, P < 0.05), IL-6 (beta = 0.09, P < 0.001), soluble intercellular adhesion molecule-1 (beta = 0.05, P < 0.05), and sVCAM-1 concentrations (beta = 0.07, P < 0.05). However, after additional control for BMI and WC, the associations remained significant only for SAA (beta = 0.06, P < 0.05) and IL-6 (beta = 0.07, P < 0.001). The traditional dietary pattern (high in refined grains, potato, tea, whole grains, hydrogenated fats, legumes, and casserole) was positively associated with the plasma IL-6 concentration (beta = 0.04, P < 0.05) when we controlled for confounders including BMI and WC. The findings suggest an independent association between major dietary patterns and plasma concentrations of markers of inflammation.

Higher intakes of fruit and vegetables are associated with a lower risk of the metabolic syndrome; the lower risk may be the result of lower CRP concentrations. These findings support current dietary recommendations to increase daily intakes of fruit and vegetables as a primary preventive measure against cardiovascular disease.