Skip to main content
Top
Published in: Acta Diabetologica 3/2013

01-06-2013 | Original Article

Body composition changes and cardiometabolic benefits of a balanced Italian Mediterranean Diet in obese patients with metabolic syndrome

Authors: Nicola Di Daniele, Luigi Petramala, Laura Di Renzo, Francesca Sarlo, Domenico Giovanni Della Rocca, Mariagiovanna Rizzo, Valentina Fondacaro, Leonardo Iacopino, Carl J. Pepine, Antonino De Lorenzo

Published in: Acta Diabetologica | Issue 3/2013

Login to get access

Abstract

Metabolic syndrome (MS) is a cluster of metabolic alteration associated with a higher risk of cardiovascular disease and overall mortality than the single alterations alone. The Italian Mediterranean Diet (IMD) can exert a positive effect on cardiovascular risk and related morbidity and mortality. The aim was to evaluate the benefits of dietary intervention based on a typical IMD on body composition, cardiometabolic changes and reduction in cardiovascular disease in patients with MS. Eighty White Italian subjects with MS were prescribed a balanced hypocaloric IMD. We investigated dietary habits and impact of the diet on health status, blood biochemical markers, anthropometric measurements and body composition during a 6-month follow-up period. Body composition, fat mass and distribution were assessed by Dual X-ray absorptiometry. Adherence to the IMD led to a decrease in body weight (102.59 ± 16.82 to 92.39 ± 15.94 kg, p < 0.001), body mass index (BMI) (38.57 ± 6.94 to 35.10 ± 6.76, <0.001) and waist circumference (112.23 ± 12.55 vs 92.42 ± 18.17 cm, p < 0.001). A significant loss of total body fat especially in waist region was observed. The MS was resolved in 52 % of the patients. Significant improvements in systolic and diastolic blood pressure and fasting glucose occurred. Low-density lipoprotein cholesterol was reduced from 128.74 ± 33.18 to 108.76 ± 38.61 mg/dl (p < 0.001), triglycerides from 169.81 ± 80.80 to 131.02 ± 63.88 mg/dl (p < 0.001). The present results suggest that a dietary intervention based on a typical IMD effectively promotes weight loss and reduces the growing burden of cardiovascular risk factors that typifies patients with MS.
Literature
1.
go back to reference World Health Organization (2009) Global health risks: mortality and burden of disease attributable to selected major risk factors. World Health Organization, Geneva, Switzerland World Health Organization (2009) Global health risks: mortality and burden of disease attributable to selected major risk factors. World Health Organization, Geneva, Switzerland
2.
go back to reference Wang YC, McPherson K, Marsh T, Gortmaker SL, Brown M. (2011) Health and economic burden of the projected obesity trends in the USA and the UK. Lancet. 27; 378 (9793): 815–825 Wang YC, McPherson K, Marsh T, Gortmaker SL, Brown M. (2011) Health and economic burden of the projected obesity trends in the USA and the UK. Lancet. 27; 378 (9793): 815–825
3.
go back to reference Janghorbani M, Amini M (2011) Associations of hip circumference and height with incidence of type 2 diabetes: the Isfahan diabetes prevention study. Acta Diabetol. doi:10.1007/s00592-011-0351-4 Janghorbani M, Amini M (2011) Associations of hip circumference and height with incidence of type 2 diabetes: the Isfahan diabetes prevention study. Acta Diabetol. doi:10.​1007/​s00592-011-0351-4
4.
go back to reference Wannamethee SG, Shaper AG, Lennon L, Morris RW (2005) Metabolic syndrome vs Framingham Risk Score for prediction of coronary heart disease, stroke, and type 2 diabetes mellitus. Arch Intern Med 165(22):2644–2650PubMedCrossRef Wannamethee SG, Shaper AG, Lennon L, Morris RW (2005) Metabolic syndrome vs Framingham Risk Score for prediction of coronary heart disease, stroke, and type 2 diabetes mellitus. Arch Intern Med 165(22):2644–2650PubMedCrossRef
5.
go back to reference Ervin RB (2009) Prevalence of metabolic syndrome among adults 20 years of age and over, by sex, age, race and ethnicity, and body mass index: United States, 2003–2006. Natl Health Stat Report 13:1–7PubMed Ervin RB (2009) Prevalence of metabolic syndrome among adults 20 years of age and over, by sex, age, race and ethnicity, and body mass index: United States, 2003–2006. Natl Health Stat Report 13:1–7PubMed
6.
go back to reference Alberti KG, Zimmet P, Shaw J (2005) IDF epidemiology task force consensus group: the metabolic syndrome a new worldwide definition. Lancet 366:1059–1062PubMedCrossRef Alberti KG, Zimmet P, Shaw J (2005) IDF epidemiology task force consensus group: the metabolic syndrome a new worldwide definition. Lancet 366:1059–1062PubMedCrossRef
7.
go back to reference Panagiotakos DB, Polychronopoulos E (2005) The role of Mediterranean diet in the epidemiology of metabolic syndrome; converting epidemiology to clinical practice. Lipids Health Dis 12:4–7 Panagiotakos DB, Polychronopoulos E (2005) The role of Mediterranean diet in the epidemiology of metabolic syndrome; converting epidemiology to clinical practice. Lipids Health Dis 12:4–7
8.
go back to reference Keys A, Menotti A, Karvonen MJ et al (1986) The diet and 15-year death rate in the seven countries study. Am J Epidemiol 124(6):903–915PubMed Keys A, Menotti A, Karvonen MJ et al (1986) The diet and 15-year death rate in the seven countries study. Am J Epidemiol 124(6):903–915PubMed
9.
go back to reference Alberti KG, Zimmet PZ (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 15(7):539–553PubMedCrossRef Alberti KG, Zimmet PZ (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 15(7):539–553PubMedCrossRef
10.
go back to reference Grundy SM, Cleeman JI, Daniels SR et al (2005) Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 112(17):2735–2752PubMedCrossRef Grundy SM, Cleeman JI, Daniels SR et al (2005) Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 112(17):2735–2752PubMedCrossRef
11.
go back to reference Expert Panel on Detection (2001) Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 285(19):2486–2497CrossRef Expert Panel on Detection (2001) Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 285(19):2486–2497CrossRef
12.
go back to reference Chrysohoou C, Panagiotakos DB, Pitsavos C, Das UN, Stefanadis C (2004) Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults: the ATTICA Study. J Am Coll Cardiol 44(1):152–158PubMedCrossRef Chrysohoou C, Panagiotakos DB, Pitsavos C, Das UN, Stefanadis C (2004) Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults: the ATTICA Study. J Am Coll Cardiol 44(1):152–158PubMedCrossRef
13.
go back to reference Knoops KT, de Groot LC, Kromhout D et al (2004) Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA 292(12):1433–1439PubMedCrossRef Knoops KT, de Groot LC, Kromhout D et al (2004) Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA 292(12):1433–1439PubMedCrossRef
14.
go back to reference Sofi F, Cesari F, Abbate R, Gensini GF, Casini A (2008) Adherence to Mediterranean diet and health status: meta-analysis. BMJ 337:a1344PubMedCrossRef Sofi F, Cesari F, Abbate R, Gensini GF, Casini A (2008) Adherence to Mediterranean diet and health status: meta-analysis. BMJ 337:a1344PubMedCrossRef
15.
go back to reference Rallidis LS, Lekakis J, Kolomvotsou A et al (2009) Close adherence to a Mediterranean diet improves endothelial function in subjects with abdominal obesity. Am J Clin Nutr 90(2):263–268PubMedCrossRef Rallidis LS, Lekakis J, Kolomvotsou A et al (2009) Close adherence to a Mediterranean diet improves endothelial function in subjects with abdominal obesity. Am J Clin Nutr 90(2):263–268PubMedCrossRef
16.
go back to reference Psaltopoulou T, Naska A, Orfanos P, Trichopoulos D, Mountokalakis T, Trichopoulou A (2004) Olive oil, the Mediterranean diet, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study. Am J Clin Nutr 80(4):1012–1018PubMed Psaltopoulou T, Naska A, Orfanos P, Trichopoulos D, Mountokalakis T, Trichopoulou A (2004) Olive oil, the Mediterranean diet, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study. Am J Clin Nutr 80(4):1012–1018PubMed
17.
go back to reference Fidanza F, Alberti A, Fruttini D (2005) The Nicotera diet: the reference Italian Mediterranean diet. World Rev Nutr Diet 95:115–121PubMedCrossRef Fidanza F, Alberti A, Fruttini D (2005) The Nicotera diet: the reference Italian Mediterranean diet. World Rev Nutr Diet 95:115–121PubMedCrossRef
18.
go back to reference De Lorenzo A, Noce A, Bigioni M et al (2010) The effects of Italian Mediterranean organic diet (IMOD) on health status. Curr Pharm Des 16(7):814–824PubMedCrossRef De Lorenzo A, Noce A, Bigioni M et al (2010) The effects of Italian Mediterranean organic diet (IMOD) on health status. Curr Pharm Des 16(7):814–824PubMedCrossRef
19.
go back to reference Shai I, Shahar DR, Vardi H, Fraser D (2004) Selection of food items for inclusion in a newly developed food-frequency questionnaire. Public Health Nutr 7(6):745–749PubMedCrossRef Shai I, Shahar DR, Vardi H, Fraser D (2004) Selection of food items for inclusion in a newly developed food-frequency questionnaire. Public Health Nutr 7(6):745–749PubMedCrossRef
20.
go back to reference De Lorenzo A, Tagliabue A, Andreoli A, Testolin G, Comelli M, Deurenberg P (2001) Measured and predicted resting metabolic rate in Italian males and females, aged 18–59 year. Eur J Clin Nutr 55(3):208–214PubMedCrossRef De Lorenzo A, Tagliabue A, Andreoli A, Testolin G, Comelli M, Deurenberg P (2001) Measured and predicted resting metabolic rate in Italian males and females, aged 18–59 year. Eur J Clin Nutr 55(3):208–214PubMedCrossRef
21.
go back to reference Alberti-Fidanza A, Fidanza F (2004) Mediterranean adequacy index of Italian diets. Public Health Nutr 7(7):937–941PubMedCrossRef Alberti-Fidanza A, Fidanza F (2004) Mediterranean adequacy index of Italian diets. Public Health Nutr 7(7):937–941PubMedCrossRef
22.
go back to reference Millàn J, Pintò X, Munoz A et al (2009) Lipoprotein ratios: physiological significance and clinical usefulness in cardiovascular prevention. Vasc Health Risk Manag 5:757–765PubMed Millàn J, Pintò X, Munoz A et al (2009) Lipoprotein ratios: physiological significance and clinical usefulness in cardiovascular prevention. Vasc Health Risk Manag 5:757–765PubMed
23.
go back to reference Sofi F, Abbate R, Gensini GF, Casini A (2010) Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr 92(5):1189–1196PubMedCrossRef Sofi F, Abbate R, Gensini GF, Casini A (2010) Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr 92(5):1189–1196PubMedCrossRef
24.
go back to reference Panagiotakos DB, Tzima N, Pitsavos C et al (2007) The association between adherence to the Mediterranean diet and fasting indices of glucose homeostasis: the ATTICA Study. J Am Coll Nutr 26:32–38PubMed Panagiotakos DB, Tzima N, Pitsavos C et al (2007) The association between adherence to the Mediterranean diet and fasting indices of glucose homeostasis: the ATTICA Study. J Am Coll Nutr 26:32–38PubMed
25.
go back to reference De Lorenzo A, Andreoli A, Sorge RP et al (1999) Modification of dietary habits (Mediterranean diet) and cancer mortality in a southern Italian village from 1960 to 1996. Ann N Y Acad Sci 889:224–229PubMedCrossRef De Lorenzo A, Andreoli A, Sorge RP et al (1999) Modification of dietary habits (Mediterranean diet) and cancer mortality in a southern Italian village from 1960 to 1996. Ann N Y Acad Sci 889:224–229PubMedCrossRef
26.
go back to reference McKeown NM, Meigs JB, Liu S et al (2004) Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care 27:538–5346PubMedCrossRef McKeown NM, Meigs JB, Liu S et al (2004) Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care 27:538–5346PubMedCrossRef
27.
go back to reference Perez-Jimenez F, Lopez-Miranda J, Pinillos MD et al (2001) A mediterranean and a high-carbohydrate diet improve glucose metabolism in healthy young persons. Diabetologia 44:2038–2043PubMedCrossRef Perez-Jimenez F, Lopez-Miranda J, Pinillos MD et al (2001) A mediterranean and a high-carbohydrate diet improve glucose metabolism in healthy young persons. Diabetologia 44:2038–2043PubMedCrossRef
28.
go back to reference Shai I, Schwarzfuchs D, Henkin Y et al (2008) Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 359(3):229–241PubMedCrossRef Shai I, Schwarzfuchs D, Henkin Y et al (2008) Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 359(3):229–241PubMedCrossRef
29.
go back to reference Martínez-González MA, Sánchez-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(1):9–13PubMedCrossRef Martínez-González MA, Sánchez-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(1):9–13PubMedCrossRef
30.
go back to reference Brunner EJ, Wunsch H, Marmot MG (2001) What is an optimal diet? Relationship of macronutrient intake to obesity, glucose tolerance, lipoprotein cholesterol levels and the metabolic syndrome in the Whitehall II Study. Int J Obes Relat Metab Disord 25:45–53PubMedCrossRef Brunner EJ, Wunsch H, Marmot MG (2001) What is an optimal diet? Relationship of macronutrient intake to obesity, glucose tolerance, lipoprotein cholesterol levels and the metabolic syndrome in the Whitehall II Study. Int J Obes Relat Metab Disord 25:45–53PubMedCrossRef
31.
go back to reference Skulas-Ray AC, West SG, Davidson MH, Kris-Etherton PM (2008) Omega-3 fatty acid concentrates in the treatment of moderate hypertriglyceridemia. Expert Opin Pharmacother 9:1237–1248PubMedCrossRef Skulas-Ray AC, West SG, Davidson MH, Kris-Etherton PM (2008) Omega-3 fatty acid concentrates in the treatment of moderate hypertriglyceridemia. Expert Opin Pharmacother 9:1237–1248PubMedCrossRef
32.
go back to reference Rizza S, Tesauro M, Cardillo C, Galli A, Iantorno M, Gigli F, Sbraccia P, Federici M, Quon MJ, Lauro D (2009) Fish oil supplementation improves endothelial function in normoglycemic offspring of patients with type 2 diabetes. Atherosclerosis 206(2):569–574PubMedCrossRef Rizza S, Tesauro M, Cardillo C, Galli A, Iantorno M, Gigli F, Sbraccia P, Federici M, Quon MJ, Lauro D (2009) Fish oil supplementation improves endothelial function in normoglycemic offspring of patients with type 2 diabetes. Atherosclerosis 206(2):569–574PubMedCrossRef
33.
go back to reference Rasmussen BM, Vessby B, Uusitupa M & the KANWU Study Group. (2006). Effects of dietary saturated, monounsaturated, and n-3 fatty acids on BP in healthy subjects. Am J Clin Nutr; 83: 221–226 Rasmussen BM, Vessby B, Uusitupa M & the KANWU Study Group. (2006). Effects of dietary saturated, monounsaturated, and n-3 fatty acids on BP in healthy subjects. Am J Clin Nutr; 83: 221–226
34.
go back to reference George A, Deemer SE, Dixie L (2010) Thompson Adiponectin is associated with risk of the metabolic syndrome and insulin resistance in women. Acta Diabetol 2010:8. doi:10.1007/s00592-010-0192-6 George A, Deemer SE, Dixie L (2010) Thompson Adiponectin is associated with risk of the metabolic syndrome and insulin resistance in women. Acta Diabetol 2010:8. doi:10.​1007/​s00592-010-0192-6
35.
go back to reference Salas-Salvado J, Garcia-Arellano A, Estruch R et al (2008) Components of the Mediterranean-type food pattern and serum inflammatory markers among patients at high risk for cardiovascular disease. Eur J Clin Nutr 62(5):651–659PubMedCrossRef Salas-Salvado J, Garcia-Arellano A, Estruch R et al (2008) Components of the Mediterranean-type food pattern and serum inflammatory markers among patients at high risk for cardiovascular disease. Eur J Clin Nutr 62(5):651–659PubMedCrossRef
36.
go back to reference Carr DB, Utzschneider KM, Hull RL et al. Intra-abdominal fat is a major determinant of the National Cholesterol Education Program Adult Treatment Panel III criteria for the metabolic syndrome. Diabetes. 2004; 53b(8): 2087–2094 Carr DB, Utzschneider KM, Hull RL et al. Intra-abdominal fat is a major determinant of the National Cholesterol Education Program Adult Treatment Panel III criteria for the metabolic syndrome. Diabetes. 2004; 53b(8): 2087–2094
37.
go back to reference De Lorenzo A, Deurenberg P, Pietrantuono M et al (2003) How fat is obese? Acta Diabetol 40(Suppl 1):S254–S257PubMedCrossRef De Lorenzo A, Deurenberg P, Pietrantuono M et al (2003) How fat is obese? Acta Diabetol 40(Suppl 1):S254–S257PubMedCrossRef
38.
go back to reference Di Renzo L, Galvano F, Orlandi C et al (2010) Oxidative stress in normal-weight obese syndrome. Obesity (Silver Spring) 18(11):2125–2130CrossRef Di Renzo L, Galvano F, Orlandi C et al (2010) Oxidative stress in normal-weight obese syndrome. Obesity (Silver Spring) 18(11):2125–2130CrossRef
39.
go back to reference Cameron AJ, Shaw JE, Zimmet PZ. The metabolic syndrome: prevalence in worldwide populations. Endocrinol Metab Clin North Am 2004; 33: 351–375.] but indicate that between 13 and 30% of people in developing countries Cameron AJ, Shaw JE, Zimmet PZ. The metabolic syndrome: prevalence in worldwide populations. Endocrinol Metab Clin North Am 2004; 33: 351–375.] but indicate that between 13 and 30% of people in developing countries
40.
go back to reference Mohan V, Deepa M (2006) The metabolic syndrome in developing countries. Diabet Voice 51:15–17 Mohan V, Deepa M (2006) The metabolic syndrome in developing countries. Diabet Voice 51:15–17
41.
go back to reference Ford ES, Giles WH, Mokdad AH (2004) Increasing prevalence of the metabolic syndrome among US adults. Diabetes Care 27:2444–2449PubMedCrossRef Ford ES, Giles WH, Mokdad AH (2004) Increasing prevalence of the metabolic syndrome among US adults. Diabetes Care 27:2444–2449PubMedCrossRef
43.
go back to reference Dunkley AJ, Charles K, Gray LJ, Camosso-Stefinovic J, Davies MJ, Khunti K (2012) Effectiveness of interventions for reducing diabetes and cardiovascular disease risk in people with metabolic syndrome: systematic review and mixed treatment comparison meta-analysis. Diabet Obes Metabol 14:616–625CrossRef Dunkley AJ, Charles K, Gray LJ, Camosso-Stefinovic J, Davies MJ, Khunti K (2012) Effectiveness of interventions for reducing diabetes and cardiovascular disease risk in people with metabolic syndrome: systematic review and mixed treatment comparison meta-analysis. Diabet Obes Metabol 14:616–625CrossRef
Metadata
Title
Body composition changes and cardiometabolic benefits of a balanced Italian Mediterranean Diet in obese patients with metabolic syndrome
Authors
Nicola Di Daniele
Luigi Petramala
Laura Di Renzo
Francesca Sarlo
Domenico Giovanni Della Rocca
Mariagiovanna Rizzo
Valentina Fondacaro
Leonardo Iacopino
Carl J. Pepine
Antonino De Lorenzo
Publication date
01-06-2013
Publisher
Springer Milan
Published in
Acta Diabetologica / Issue 3/2013
Print ISSN: 0940-5429
Electronic ISSN: 1432-5233
DOI
https://doi.org/10.1007/s00592-012-0445-7

Other articles of this Issue 3/2013

Acta Diabetologica 3/2013 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.