The concept of the
metabolic syndrome, although controversial, continues to gain acceptance. Whereas each risk factor of the
metabolic syndrome (
visceral obesity, atherogenetic
dyslipidemia, elevated blood pressure, and dysglycemia) can be dealt with individually, the recommended initial therapeutic approach is to focus on reversing its root causes of atherogenetic diet, sedentary lifestyle, and
overweight or
obesity. No single diet is currently recommended for patients with the
metabolic syndrome, although epidemiologic evidence suggests a lower prevalence of the
metabolic syndrome associated with dietary patterns rich in fruit, vegetables, whole grains, dairy products, and
unsaturated fats. We conducted a literature search to identify clinical trials specifically dealing with the resolution of the
metabolic syndrome by lifestyle, drugs, or
obesity surgery. Criteria used for study selection were English language, randomized trials with a placebo or control group (except for surgery), a follow-up lasting>or=6 mo, and a time frame of 5 y. We identified 3 studies based on lifestyle interventions, 5 studies based on
drug therapy, and 3 studies based on laparoscopic
weight-reduction surgery The striking resolution of the
metabolic syndrome with
weight-reduction surgery (93%) as compared with lifestyle (25%) and drugs (19%) strongly suggests that
obesity is the driving force for the occurrence of this condition. Although there is no "all-inclusive" diet yet, it seems plausible that a Mediterranean-style diet has most of the desired attributes, including a lower content of refined
carbohydrates, a high content of fiber, a moderate content of fat (mostly unsaturated), and a moderate-to-high content of
vegetable proteins.