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Bahrami, Mina, Cheraghpour, Makan, Jafarirad, Sima, Alavinejad, Pejman, & Cheraghian, Bahman. (2019). The role of melatonin supplement in metabolic syndrome. Nutrition and Food Science, Nutrition and food science, 2019-04-09.

This study is important because metabolic syndrome is affecting a growing number of the American population, and bringing with it multiple co-morbidities and increasing health complications. Studies on ways to reduce the prevalence of metabolic syndrome are a step toward fixing the problem and thereby reducing mortality.
One key finding of this study was that through the supplementation of a simple, over the counter product, an  improvement in almost all markers of metabolic syndrome was found, including a reduced waist size,  decreased blood pressure, and increased HDL cholesterol.
Participants were found to have increased levels of adiponectin when compared to before the implementation in the melatonin group, and levels were found to be higher in the melatonin group compared to the placebo group as well. Adiponectin levels are generally lower in obese people, and higher levels are thought to be cardioprotective. This cardioprotective aspect is thought the be attributed to it's anti-inflammatory properties, which can also help improve insulin resistance (another factor in metabolic syndrome). Further studies with larger groups (this study was only 70 people) would be interesting, as melatonin has generally mild side effects (such as headaches, irritability and nausea) and is fairly well tolerated by most.

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Mohd Ramli ES, Sukalingam K, Kamaruzzaman MA, Soelaiman IN, Pang KL, Chin KY. Direct and Indirect Effect of Honey as a Functional Food Against Metabolic Syndrome and Its Skeletal Complications. Diabetes Metab Syndr Obes. 2021;14:241-256. Published 2021 Jan 18. doi:10.2147/DMSO.S291828

Although metabolic syndrome is always discussed with visceral obesity, hypertension, dyslipidemia or hyper glycemia, this study focuses on MetS and MetS-induced osteoporosis. This study is important because it interestingly suggests honey as a treatment of both.

The key finding of this study is that honey is beneficial on MetS and bone metabolism because of its antioxidant, anti-inflammation, anti-obesity, anti-adipogenic, hypolipidemic, inhibition of α-amylase and α-glucosidase, antihypertensive, antidiabetic, and hypotensive effects.

While diagnosis of MetS is evaluated if a patient’s levels are out of normal ranges in three or more out of five categories: fasting blood glucose, blood pressure, serum triglycerides, serum LDL/HDL, or central obesity, this study reports that by consuming honey, blood glucose levels, total cholesterol, triglycerides and LDL will be reduced, HDL will be increased and weight gain is hindered. Moreover, honey supports bone homeostasis by interfering effects of MetS.

This study’s clinical implication is that honey can be used as preventive and therapeutic interventions for MetS and MetS-induced osteoporosis.

It sounds too good to be true, and the study repeatedly mentions that "The underlying mechanisms of effects of honey are not clear." However, natural remedies are important in today’s world which relies on too much pharmaceutical drugs. Also, honey will be appreciated by MedS patients who have to avoid other sweetness.

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Rajpal A, Ismail‐Beigi F. Intermittent fasting and “metabolic switch”: Effects on metabolic syndrome, prediabetes and type 2 diabetes. Diabetes, Obesity and Metabolism. Published online June 3, 2020. doi:10.1111/dom.14080

I found this article very interesting as a non-pharmacologic treatment regimen for obesity, metabolic syndrome, and type 2 diabetes.

There are very few studies evaluating the effect of intermittent fasting (IF) on metabolic syndrome, prediabetes, and type 2 diabetes (T2D), but this review summarizes some of the  studies and outlines the mechanisms behind the efficacy and safety of IF. Since calorie restriction diets  to reduce weight is the main treatment plan of metabolic sydrome, prediabetes, and T2D, and since IF protocols usually lead to calorie reduction overall, it is reasonable to consider IF as a dietary regimen for these patients. The aim of this review was to determine if the positive effects of IF exceed those of calorie restriction (CR) alone.

Although the reviewers did not find enough evidence to support recommendation of IF, they did find some evidence suggesting that  time restricted eating can reduce the desire and capacity to eat and increases the sensations of fullness. Small studies have indicated that IF, more than CR, could improve (or boost) metabolism. The adaptability of the various IF regimens may also increase sustainability of the diet.

If intermittent fasting  proves to be more efficacious (than calorie restriction alone)  at combating  some of the underlying reasons for obesity and its health risks, could we see multiple public health benefits.

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Gupta Jain, S., Puri, S., Misra, A., Gulati, S., & Mani, K. (2017, June 12). Effect of oral Cinnamon intervention on metabolic profile and body composition of Asian Indians with metabolic Syndrome: A randomized Double -BLIND control trial. Retrieved March 03, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5469078/

Importance/ Key Findings
This study is important because it shows a significant decrease in measurements of glycemia, adiposity, lipids, blood pressure and (major decrease) in those with metabolic syndrome upon ingestion of 3g of cinnamon each day for 6 months. This double-blind randomized controlled trial assessed overall body composition, blood pressure, and metabolic parameters for comparative analysis. There was a significant difference in the fasting blood glucose levels, BMI, and glycosylated hemoglobin in the control group (those consuming cinnamon) as compared to the placebo group.

Clinical Relevance
Dietary options and such as this provide a valuable option for those with metabolic syndrome. While this study is limited to Asian Indian population of only 116 subjects, the design and execution of this research provides an understandable, easy suggestion to inhibit symptoms of metabolic disease. Cinnamon is relatively accessible to the common population, so this provides a very usable information for the common person and something that many people will be able to utilize. If the strong data associated with this research were ever strong enough by increasing the subject size and making it more inclusive, then I could most certainly see a doctor or clinician recommend cinnamon.

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Asemi, Zatollah & Samimi, Mansooreh & Tabassi, Zohreh & Sabihi, Sima-Sadat & Esmaillzadeh, Ahmad. (2013). A randomized controlled clinical trial investigating the effect of DASH diet on insulin resistance, inflammation, and oxidative stress in gestational diabetes. Nutrition (Burbank, Los Angeles County, Calif.). 29. 619-24. 10.1016/j.nut.2012.11.020.

This study is important because they did a randomized controlled clinical trial to look at how DASH (Dietary Approaches to Stop Hypertension) impacted insulin resistance, inflammation, and oxidative stress among 32 pregnant women with gestational diabetes mellitus. I think that this is an interesting study because in our lecture for this module we learned that inflammation, insulin resistance, and oxidative stress are all correlated with metabolic syndrome. The sample of women were assigned to use either the DASH diet or a control diet (16 women for each diet) for four weeks.

One key finding in this study was that the women on the DASH diet had improved fasting plasma glucose, improved serum insulin levels, improved total antioxidant capacity (protect against free radical damage), and improved GSH (protective against oxidative damage). This article is important clinically because inflammation, insulin resistance, and oxidative stress are correlated with metabolic syndrome. According to the data in this article, the DASH diet can act as a protective factor for metabolic syndrome or even help manage the symptoms of a patient who is already diagnosed with this condition.

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Citation: Van Dyken P and Lacoste B (2018) Impact of Metabolic Syndrome on Neuroinflammation and the Blood–Brain Barrier. Front. Neurosci. 12:930. doi: 10.3389/fnins.2018.00930

Obesity is known to be a contributing factor to many diseases. High levels of adipose tissue secrete adipokines and cytokines that affect nearly every organ in the body. One part of this review focuses on how these hormones contribute to Alzheimer’s disease (AD) pathology.

Cognitive decline can be seen in animals that are fed a high fight diet (HFD). The hippocampus in these mice seems to be impaired by the HFD. Control mice and HFD-fed mice performed the same during hippocampus-independent tasks, but HFD-fed mice performed poorly compared to control counterparts in hippocampus-dependent tasks. Cognitive deficits and blood-brain barrier disruption were seen as early as 24 days after the start of the HFD.

Increased inflammation causes the BBB to open and allows an influx of leukocytes, the anti-inflammatory molecule adiponectin is decreased with obesity, and Aβ (a key component of AD pathology) accumulates in the brain. The damaged BBB is not able to remove the plaques and this results in cognitive decline. It is clear that promoting lifestyle changes in regard to obesity can help more just your cardiovascular system!

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Pradeep Yarra

Citation: Akhlaghi M. Dietary Approaches to Stop Hypertension (DASH): potential mechanisms of action against risk factors of the metabolic syndrome. Nutr Res Rev. 2020;33(1):1-18. doi:10.1017/S0954422419000155

Question 1:   Why is this study important?

Dietary Approaches to Stop Hypertension (DASH) is a dietary pattern rich in fruits, vegetables and low-fat dairy products, and low in meats and sweets. DASH provides good amounts of fibre, K, Ca and Mg, and limited quantities of total fat, saturated fat, cholesterol and Na. Although DASH was initially designed for the prevention or control of hypertension, using a DASH diet has other metabolic benefits. This study outlines the effects of DASH not just on HTN but also on other components of metabolic syndrome

Due to emphasis on the consumption of whole grains and low-fat dairy products and caution in consuming red meats and salt, DASH may provide a better diet composition than the Mediterranean dietary pattern against metabolic diseases.

Identify one key finding of this study and describe how it relates to nutritional sciences

Effect of DASH diet based on multiple studies are as follows.

A meta-analysis by Siervo et al. indicates that DASH causes small reductions in systolic (–5·2 mmHg) and diastolic (–2·6 mmHg) blood pressure, total cholesterol (–7·73 mg/dl; –0·20 mmol/l) and LDL-cholesterol (–3·87 mg/dl; –0·10 mmol/l). Evidence is also promising for fasting insulin levels and fasting blood glucose. The magnitude of the change in any single risk factor is small and far to be clinically important per se. But the cumulative alterations in these risk factors can produce noticeable effects. Authors from same meta-analysis predicted that the above-mentioned changes lead to approximately 13 % decrease in the 10-year Framingham risk score for CVD.

DASH is a good alternative for Mediterranean diet specifically if they have Cardiovascular risk and Hypertension.

What are the clinical implications of this study?

I rarely see patients with no CVD risk but have metabolic syndrome. Almost all of them with time will develop HTN or DM, specifically with increase in obesity. Dietary choices in DASH diet likely will sync more with our population than the choices from other alternatives.  In U.S population, DASH diet will have good buy-in than Mediterranean diet.

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Godos, J., Zappalà, G., Bernardini, S., Giambini, I., Bes-Rastrollo, M., & Martinez-Gonzalez, M. (2017). Adherence to the Mediterranean diet is inversely associated with metabolic syndrome occurrence: a meta-analysis of observational studies. International Journal of Food Sciences & Nutrition, 68(2), 138–148. https://doi-org.ezproxy.uky.edu/10.1080/09637486.2016.1221900

This is an important systematic review because it aimed to investigate the relation between

adoption of a Mediterranean dietary pattern and the prevalence or the risk of metabolic syndrome. In addition, this was the first study performed a quantitative meta-analysis using the overall metabolic syndrome as the outcome, and a large number of individuals were involved.

An important key finding of this study was that the researchers found a significant and consistent

inverse association between adherence to the Mediterranean diet and the risk of metabolic syndrome. However, long-term large-scale clinical trials are needed.

The clinical implication of the study is that an RD should recommend Mediterranean diet for patients with metabolic syndrome or at risk of having metabolic syndrome. Moreover, by considering adopting Mediterranean diet for long-term, an RD should consider the cost and food availability of this diet during counseling session with patients

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Lee, MK., Han, K., Kim, M.K. et al. Changes in metabolic syndrome and its components and the risk of type 2 diabetes: a nationwide cohort study. Sci Rep 10, 2313 (2020). https://doi.org/10.1038/s41598-020-59203-z

Metabolic syndrome is when various conditions mesh together to increase the risk of developing other disorders. These conditions usually include things like abnormal cholesterol levels, or high blood sugar/blood pressure. The study I selected looked at the components of metabolic syndrome that increase the risk of developing type 2 diabetes. This study is important in that it reinforces the idea that more severe issues can arise from metabolic syndrome. It studies the connections between genetics and environment along with other associative factors that relate to type 2 diabetes. There is a strong association between these, and the study takes into consideration that individuals experiencing it should focus on multifactorial interventions. When studying the subject, a strong connection between abdominal obesity and T2D was concluded. With this being the case, nutritional sciences are very critical. Diet and eating the right foods recommended for the person can improve their diagnosis. This can be used for clinical implications of making sure the patient knows how important their diet is, and how they can better/worsen their conditions depending on what they change.

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Citation: da Cunha de Sá RDC, Cruz MM, de Farias TM, et al. Fish oil reverses metabolic syndrome, adipocyte dysfunction, and altered adipokines secretion triggered by high-fat diet-induced obesity. Physiol Rep. 2020;8(4):e14380. doi:10.14814/phy2.14380

Obesity is characterized by energy imbalance between consumption and calorie expenditure that entails potential health risk. Diet quality is one of the main factors associated with metabolic syndrome (MS) components including hyperglycemia, hypertriglyceridemia, hypertension, etc. This study shows relevant effects of fish oil (FO) treatment in reversing metabolic syndrome induced by high-fat diet (HF) and the changes in subcutaneous and viceral adipocytes such as glucose uptake, lipolysis, lipogenesis.

Major finding of this study is that FO treatment reverses the deleterious effects caused by excessive intake of HF diet and the mechanisms involves direct and differential effects on adipocytes. These effects prevent adipocyte hypertrophy caused by HF diet and reflected in decreased adoposity. FO treatment also decreased gene and protein expression of inflammation-related factors. In short, the main results show that, even with partial reduction in body mass, FO administration simultaneously with continuous intake of HF diet was able to reverse glucose intolerance, insulin resistance, and dyslipidemia.

The finding provides guidance into effectiveness of a low-cost agent to treat the metabolic and inflammatory disorders triggered by obesity. In summary, this study observes that low food intake concomitant to high fat intake for 16 weeks resulted in obesity and its complications. Because FO exhibits antiobesogenic effect, it’s found that FO treatment 3 times per week with 5:1 EPA/DHA ratio might represent potential therapeutic alternative to treat MS caused by excessive intake of HF diet.

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Tørris, C., Småstuen, M. C., & Molin, M. (2018). Nutrients in Fish and Possible Associations with Cardiovascular Disease Risk Factors in Metabolic Syndrome. Nutrients, 10(7), 952. https://doi.org/10.3390/nu10070952

Metabolic syndrome refers to a number of different cardiovascular health risk factors such as high triglyceride levels, low HDL levels, and high value waste circumference. A common recommendation for patients with more than three of the constituents of metabolic syndrome is to decrease total calories and increase nutrient dense foods. Incorporating fish into the diet is something that can be highly beneficial for metabolic syndrome patients in outlooks against cardiovascular disease. This study is important because it looks at the cardioprotective effects of fish in metabolic syndrome. Some key findings of this study include fish diets decreased waste circumference, decreased blood pressure, decreased serum triglyceride levels, all of which are cardioprotective and are beneficial for patients with metabolic syndrome. Nutritionally this is very important especially as clinicians, because we know that we want to bring all of these cardiovascular risk factors back in check through lifestyle changes, one of those being diet. Increasing fish in the diet can help improve these patients. Fish is something that can prepared in many different ways and has a high level of protein, so it is not a hard sell to patients to increase fish consumption.

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Eriksen AK, Brunius C, Mazidi M, Hellström PM, Risérus U, Iversen KN, Fristedt R, Sun L, Huang Y, Nørskov NP, Knudsen KEB, Kyrø C, Olsen A, Tjønneland A, Dicksved J, Landberg R. Effects of whole-grain wheat, rye, and lignan supplementation on cardiometabolic risk factors in men with metabolic syndrome: a randomized crossover trial. Am J Clin Nutr. 2020 Apr 1;111(4):864-876. doi: 10.1093/ajcn/nqaa026. PMID: 32097450.

Research suggests that a diet rich in whole grains has the potential to prevent and treat metabolic syndrome. Different whole grains have different health affects but whole grain rye can improve glucose homeostasis and blood lipid levels through fermentable dietary fiber and lignans. Whole grains also play a role in gut microbiota. The objective of this research study was to investigate whole grain rye alone and with lignan supplements as well as whole grain wheat diets on glucose tolerance. This research study also evaluated the role of gut microbiota enterotypes in response to intervention diets. In this 8-week crossover study, 40 men with metabolic syndrome were randomly assigned to whole grain diets. They rye diet supplemented with 280 mg secoisolariciresinol diglucoside (SDG) at 4-8 weeks. The effects of treatment were evaluated as well as the effects on microbiota composition and the role of the gut microbiota as a predictor of response to treatment were analyzed. The whole grain rye diet alone or with SDG supplementation compared with whole grain wheat did not affect glucose metabolism but reduced LDL cholesterol levels. This research study suggests that increased consumption of whole grain wheat and rye can make an impact on cardiometabolic risk factors including improved levels of LDL cholesterol.

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Citation:  Mansoori S, Kushner N, Suminski RR, Farquhar WB, Chai SC. Added Sugar Intake is Associated with Blood Pressure in Older Females. Nutrients. 2019 Sep 3;11(9):2060. doi: 10.3390/nu11092060. PMID: 31484293; PMCID: PMC6770020.

Importance:  Hypertension is one criteria for metabolic syndrome  and  is a risk factor for cardiovascular events .  Elevated blood pressure is highly prevalent in adults over 60 and  dietary factors are known to have an association with adequate blood pressure control.

Key Findings:  This was a cross-sectional study looking at adults age 65-80 and specifically whether  dietary associations were found to be a factor in blood pressure.   Study participants were found to have dietary added sugar intake. In this study, most participants consumed about 10% or more of their daily calories from added sugar, with a mean intake of 9.1 teaspoons of added sugar per day and no significant difference in intake between males and females.
With reduction of  2.3 teaspoon decrease in added sugar intake results in a 8.4 mmHg drop in systolic BP and a 3.7 mmHg drop in diastolic BP in females.
The mechanism of blood pressure effect from sugar  is not  completely understood but possibilities include inhibition of  urine sodium excretion, increased intravascular calcium, and also promotion of increased body weight and adipose tissue as well as possibly a hormonal relationship considering this was only seen in females.

Clinical Application:  The potential negative impacts of sugar on health are becoming more and more well known but  direct association with blood pressure has significant impact in daily  practice simply because hypertension is so prevalent.  This is one more opportunity for nutritional counseling that goes beyond just counting calories, and one more reason to  limit sugar intake

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Citation: Lopez-Moreno J, Quintana-Navarro GM, Camargo A, Jimenez-Lucena R, Delgado-Lista J, Marin C, Tinahones FJ, Striker GE, Roche HM, Perez-Martinez P, Lopez-Miranda J, Yubero-Serrano EM. Dietary fat quantity and quality modifies advanced glycation end products metabolism in patients with metabolic syndrome. Mol Nutr Food Res. 2017 Aug;61(8). doi: 10.1002/mnfr.201601029. Epub 2017 Mar 30. PMID: 28233454.
Metabolic syndrome (MetS) is a critical effect of incidence diabetes, cardiovascular disease, and obesity. In recent years, the prevalence of MetS has increased, especially the western countries. Moreover, the previous studies show that advanced glycation end products (AGEs) lead to Metabolic syndrome incidence. AGEs, a prooxidant and cytotoxic compound are processed by Maillard reaction, and they cause cell damage and inflammation. The study investigated the quantity and quality of dietary fat, 38 percent of energy from fat, influences AGEs pathway, and application of Metabolic syndrome patients.

The important finding is which genes regulate AGEs metabolism (AGER1 and RAGE). AGER1 and RAGE are receptors binding AGEs to control cell response. AGER1 is an antioxidant; in contrast, RAGE induces inflammation and raises reactive oxygen species (ROS). The results exhibit that RAGE mRNA levels decrease in high-monounsaturated fatty acid-rich diet and high-complex carbohydrate-rich diet, including long-chain PUFA, then AGER1 increasing.

The study helps the patients to treat their diet, and those genes manage our metabolism. It could improve other diseases such as diabetes. Besides, the researchers develop the drugs from targeting those genes.

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Razavi Zade M, Telkabadi MH, Bahmani F, Salehi B, Farshbaf S, Asemi Z. The effects of DASH diet on weight loss and metabolic status in adults with non-alcoholic fatty liver disease: a randomized clinical trial. Liver Int. 2016 Apr;36(4):563-71. doi: 10.1111/liv.12990. Epub 2015 Nov 18. PMID: 26503843.

Importance:  NAFLD and metabolic syndrome in general are incredibly common, especially in our population in Kentucky. While there are medications and other interventions that can be useful, prevention and reversal of disease through dietary changes is the safest and cheapest way to manage these conditions.

Key Finding: This study used a RCT design and split patients between a ~2000 calorie DASH diet and a ~2000 calorie standard diet. Both groups did have improvement in their metrics as a 2000 calorie diet was a decrease, but the DASH group had more improvement in BMI, NAFLD grade, greater decrease in waist and hip circumference. It also had an improvement in triglycerides, liver enzymes, insulin levels and CRP/NO (general inflammatory markers)

Clinical Implications: While the DASH diet was originally studied and designed for hypertension, there have been multiple RCTs showing improvement in many other aspects of the metabolic syndrome. In this case, it showed significant improvement in multiple metrics, and this group also did another RCT with the same dietary changes in PCOS patients. So much of our money in healthcare is spent on drug and device development, and while those things are important, dietary modifications like the DASH diet and the Mediterranean diet are cost-effective and safe ways to reverse and prevent many chronic diseases associated with metabolic syndrome.

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Citation: Nakagawa T, Hu H, Zharikov S, Tuttle KR, Short RA, Glushakova O, Ouyang X, Feig DI, Block ER, Herrera-Acosta J, Patel JM, Johnson RJ. A causal role for uric acid in fructose-induced metabolic syndrome. Am J Physiol Renal Physiol. 2006 Mar;290(3):F625-31. doi: 10.1152/ajprenal.00140.2005. Epub 2005 Oct 18. PMID: 16234313.
This study is important because it showed that nitric oxide inhibition caused by elevated serum uric acid induced metabolic syndrome in rat models. Uric acid interferes with nitric oxide, which is critical for the secretion of insulin into the bloodstream. Also, endothelial functioning may be hindered through the effects of uric acid, which would also amplify the effects of metabolic syndrome.

One key finding from this study is that elevated consumption of fructose raises serum uric acid. Many of the food products that we consume today have high levels of fructose-containing sugar, notably high-fructose corn syrup. It would be worth noting that monitoring the intake of fructose could pose a remedy to some aspects of metabolic syndrome including hyperinsulinemia and hypertriglyceridemia.

In this study, the investigators noted that the use of uric acid lowering compounds was able to prevent and reverse features of metabolic syndrome. Of these were allopurinol and benzbromarone. This suggests that there are certain aspects of metabolic syndrome that can be targeted with the use of medicine. Combining medication and lifestyle modification can be quite effective treatments of metabolic syndrome.

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Citation: Gabel, Kelsey et al. ‘Effects of 8-hour Time Restricted Feeding on Body Weight and Metabolic Disease Risk Factors in Obese Adults: A Pilot Study’. 1 Jan. 2018 : 345 – 353.

Study Importance: Metabolic syndrome is of high prevalence in Western society. Any impact we can have on metabolic associated diseases would be beneficial.

Key Findings: This study evaluated the effect of an 8-hour time restricted diet on body weight and metabolic disease risk factors in obese participants. Since intermittent fasting is a popular food trend compliance may be higher. The study ran for 12 weeks an the participants fasted for 8 hours a day. They found that body weight, energy intake, and systolic blood pressure significantly decreased in the time restricted group. However, there was no significant change in fat mass, lean mass, visceral fat mass, diastolic blood pressure, LDL cholesterol, HDL cholesterol, triglycerides, fasting glucose and fasting insulin. Participants diets were not changed except for the eating time in the experimental group. If a healthful diet was implemented with the time restricted eating the more metabolic factors may have been positively effected. Research suggests that an overall healthy diet positively effects all metabolic factors.

Clinical Application: A variety of different approaches to MNT for metabolic syndrome can be beneficial. Ideally we want our patients to develop a healthy diet and lifestyle, however for some people this may not happen. Patients may be more willing to eat within a set timeframe without changing what they are eating. This diet may be appropriate for that individual. I think that a overall healthful diet and lifestyle is the ideal way to go, but this is a clinical options that may offer some benefits.

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Citation: Adherence to the DASH Diet Is Inversely Associated With Incidence of Type 2 Diabetes: The Insulin Resistance Atherosclerosis Study. Angela D. Liese, Michele Nichols, Xuezheng Sun, Ralph B. D'Agostino, Steven M. Haffner

Diabetes Care Aug 2009, 32 (8) 1434-1436; DOI: 10.2337/dc09-0228

Study importance:

This study evaluated the association of the DASH diet with incidence of type 2 diabetes. The DASH diet is widely promoted for the management of hypertension but little is known about its impact on type 2 diabetes. Also, hypertension and diabetes often co-exist, and focussing on one diet may be easier for patients than following multiple and often confusing recommended diets.

Key clinical finding:

An inverse association was observed in whites (tertile 2 vs. tertile 1, OR 0.66 [95% CI 0.29–1.48]) that became significant for the most extreme contrast (tertile 3 vs. tertile 1, 0.31 [0.13–0.75]), with adjustment for covariates. No association was observed in blacks or Hispanics. The magnitude of this study’s results is noteworthy with an OR of 0.25 in the highest adherence tertile compared with the lowest. These results suggest that adherence to the DASH dietary pattern, which is based on a priori defined amounts of specific food groups, namely rich in vegetables, fruit, and low-fat dairy products, may have the potential to prevent diabetes.

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Citation: Tsaban G, Yaskolka Meir A, Rinott E, et al.  The effect of green Mediterranean diet on cardiometabolic risk; a randomised controlled trial, Heart Published Online First: 23 November 2020. doi: 10.1136/heartjnl-2020-317802.

Importance of study: This study is important because the results suggest further modifications to the Mediterranean diet that include supplementation with increased amounts of plant-based proteins and inclusion of green tea and Mankai (Duckweed which is a tiny, leafy green -vegetable) may result in additional improvements in cardiometabolic risk factors.  waist circumference, blood pressure, LDL-C and greater weight loss were achieved in this small RCT study.

Key Finding: By replacing more animal-based proteins with plant-based proteins which included green tea and Mankai (containing all 9 essential amino acids) a further reduction in waist circumference, blood pressure, LDL-C and greater weight loss were achieved on the “green Mediterranean diet than with the standard Mediterranean diet in this small randomized control trial.

Clinical Implications: Clinical implications of this study suggest that additional reductions in meat intake and increased consumption of plant-based proteins has an even greater impact on decreasing cardiometabolic risk. Subjects following the green Mediterranean diet achieved an even greater and significant decrease in waist circumference and decrease in blood pressure which are two of the 5 risk factors for MetS.  A separate study published in the Diabetes Care Journal https://doi.org/10.2337/dc18-2319 also found that mankai may have beneficial postprandial glycemic effects.

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Hoyas, I., & Leon-Sanz, M. (2019). Nutritional challenges in metabolic syndrome. Journal of clinical medicine, 8(9), 1301.

This is the same study that I used in my discussion board post. It's a really great read!

Study Importance:
This study compared a list of metabolic panels across a population of patients that had been diagnosed with MetS. It compared panels and dietary changes to determine what was most important in diagnosis and the best treatment. This study focused primarily on insulin resistance and dietary changes as the primary cause for concern in MetS.

One Key Finding:
In patients with MetS, this study determined that dealing with insulin resistance was the primary concern as it was implicated in many other risk factors (like diabetes) and exacerbated only symptoms and pathology of MetS. As expected, this study confirmed that one particular diet is not a good universal diagnosis. Careful consideration of lifestyle and longterm dietary changes are the only way to make lasting improvements to MetS.

Clinical Implications:
This confirms what a lot of the studies that I have read for this class confirm - the only real approach to treating long term and intricate conditions is with a personalized approach to medicine. Choose the dietary and lifestyle changes that best suit your patient and focus on the struggles that need to be addressed first.

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Citation: Yari, Z., Naser-Nakhaee, Z., Karimi‐Shahrbabak, E. et al. Combination therapy of flaxseed and hesperidin enhances the effectiveness of lifestyle modification in cardiovascular risk control in prediabetes: a randomized controlled trial. Diabetol Metab Syndr 13, 3 (2021). https://doi.org/10.1186/s13098-020-00619-y

Why is this study important?

This is a randomized placebo controlled study looking into the effects of two dietary therapies, flaxseed and hesperidia, along with lifestyle intervention, in controlling cardiovascular risk in pre-diabetes.  Given the significant implications of Metabolic Syndrome and its impact on 35% of the US population alone, adding additional dietary solutions to the treatment armamentarium is critical to global healthcare and management strategies.

Key findings related to nutritional sciences:

The study findings are rather interesting.  Flaxseed is known for its beneficial qualities, adding fiber and Omega 3 fatty acids to the diet.  Hesperidin is a flavanone found in the white inner layer of citrus fruits and studies are showing that it improves insulin sensitivity and reduces insulin resistance. Together with a lifestyle intervention plan, this study demonstrated improvements in a number of metabolic factors ( waste circumference, blood pressure, lipid profiles, atherogenic indices, glucose parameters and inflammatory biomarkers).

Clinical implications:

The study included 30g of whole flax-seed and 1g of hesperidia along with lifestyle intervention techniques, which combined, demonstrated a positive impact on the management of metabolic risk factors associated with pre-diabetes. Given the prevalence of metabolic syndrome and its rising rate, finding additional non-pharmacologic solutions that may have an impact on the management of related risk factors is important to the overall treatment and perhaps prevention of of this Metabolic Syndrome.