Effect of Mediterranean-Style Diet on Endothelial Dysfunction and Markers of Vascular Inflammation in the Metabolic Syndrome - Effect of Mediterranean-Style Diet on Endothelial Dysfunction and Markers of Vascular Inflammation in the Metabolic Syndrome


The goal of the study was to evaluate the effect of a Mediterranean-style diet on endothelial function and vascular inflammatory markers in patients with the metabolic syndrome.

Study Design

Study Design:

Patients Enrolled: 180
Mean Follow Up: Two years
Mean Patient Age: Mean age 44 years
Female: 45

Patient Populations:

Presence of metabolic syndrome per the Adult Treatment Panel III, defined as three or more of the following: abdominal adiposity, low levels of serum high-density lipoprotein cholesterol, hypertriglyceridemia, elevated blood pressure, and impaired glucose homeostasis


Cardiovascular disease, psychiatric problems, a history of alcohol abuse, smoking, or medication use

Drug/Procedures Used:

Patients were randomized to the intervention group (n=90) or the control group (n=90). Patients in the intervention group were instructed to follow a Mediterranean-style diet and received detailed advice about how to increase daily consumption of whole grains, fruits, vegetables, nuts, and olive oil. The control group was instructed to follow a diet of 50-60% carbohydrates, 15-20% proteins, and <30% total fat.

Principal Findings:

At baseline, 82% of intervention patients and 84% of control patients had three components of the metabolic syndrome. There was no difference in baseline body mass index (28 each) or endothelial function score (6.0 and 5.9, respectively).

At two-year follow-up, calorie intake decreased in both groups, but the decline was larger in the intervention diet group (-170 kcal per day vs. -70 kcal per day; p<0.001). Other diet parameters improved in the intervention group, including reduction in fat intake, increase in consumption of fiber, complex carbohydrates, and omega-3 fatty acids.

Weight was reduced in both groups (-4 kg for intervention group, p<0.001; and -1.2 kg for control group, p=0.02), but the reduction was larger in the intervention group than the control group (p<0.001). The reduction in total cholesterol was larger in the intervention group compared with the control group (-11 mg/dl vs. -2 mg/dl, p=0.02), as were triglycerides (-18 mg/dl vs. +1 mg/dl, p=0.001).

Endothelial function score increase was greater in the intervention group (1.9 vs. 0.2, p<0.001). hs-CRP reduction was larger in the intervention group (-1.1 mg/l vs. -0.1 mg/l, p=0.01). The metabolic syndrome was still present in 80% of patients in the control group, but only 34% of patients in the intervention group (p<0.001).


Among patients with the metabolic syndrome, an intervention based on a Mediterranean-style diet was associated with improvements in endothelial function and vascular inflammatory markers and reduction in body weight and presence of the metabolic syndrome compared with a control group.

The mechanism explaining the association of the Mediterranean-style diet with reductions in inflammatory markers in the metabolic syndrome is unclear. The authors suggested some of the benefit may be due to potential anti-inflammatory effect of dietary fiber, which was consumed more in the intervention group.

While other studies, including the Lyon Heart Study, have shown a diet intervention is associated with reductions in cardiovascular events, the present study is the first to show a reduction in the metabolic syndrome and cardiovascular risk factors. Additionally, the improvements in endothelial function and vascular inflammatory markers remain even after adjusting for the larger weight reduction associated with the Mediterranean-style diet, suggesting factors other than weight are involved.


Esposito K, Marfella R, Ciotola M, et al. Effect of a mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA 2004;292:1440-6.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Diet

Keywords: Weight Loss, Hypertriglyceridemia, Risk Factors, Blood Pressure, Diet, Mediterranean, Metabolic Syndrome X, Carbohydrates, Cholesterol, Fruit, C-Reactive Protein, Body Mass Index, Fatty Acids, Omega-3, Vegetables, Adiposity, Nuts, Cereals, Homeostasis, Dietary Fiber, Triglycerides

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