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Cited by 2,126Nutritional Studies and DietFatty Acid Research and HealthNitric Oxide and Endothelin Effects

The DOI matches its Crossref record; 30 of the 30 references it cites were found in a registry or an index.

Effect of a Mediterranean-Style Diet on Endothelial Dysfunction and Markers of Vascular Inflammation in the Metabolic Syndrome: A Randomized Trial

Esposito, Katherine, Marfella, Raffaele, Ciotola, Miryam, Di Palo, Carmen, Giugliano, Francesco, Giugliano, Giovanni, D'Armiento, Massimo, D'Andrea, Francesco, Giugliano, Dario·2004·JAMA
DOI 10.1001/jama.292.12.1440
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Abstract

CONTEXT: The metabolic syndrome has been identified as a target for dietary therapies to reduce risk of cardiovascular disease; however, the role of diet in the etiology of the metabolic syndrome is poorly understood. OBJECTIVE: To assess the effect of a Mediterranean-style diet on endothelial function and vascular inflammatory markers in patients with the metabolic syndrome. DESIGN, SETTING, AND PATIENTS: Randomized, single-blind trial conducted from June 2001 to January 2004 at a university hospital in Italy among 180 patients (99 men and 81 women) with the metabolic syndrome, as defined by the Adult Treatment Panel III. INTERVENTIONS: Patients in the intervention group (n = 90) 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; patients in the control group (n = 90) followed a prudent diet (carbohydrates, 50%-60%; proteins, 15%-20%; total fat, <30%). MAIN OUTCOME MEASURES: Nutrient intake; endothelial function score as a measure of blood pressure and platelet aggregation response to l-arginine; lipid and glucose parameters; insulin sensitivity; and circulating levels of high-sensitivity C-reactive protein (hs-CRP) and interleukins 6 (IL-6), 7 (IL-7), and 18 (IL-18). RESULTS: After 2 years, patients following the Mediterranean-style diet consumed more foods rich in monounsaturated fat, polyunsaturated fat, and fiber and had a lower ratio of omega-6 to omega-3 fatty acids. Total fruit, vegetable, and nuts intake (274 g/d), whole grain intake (103 g/d), and olive oil consumption (8 g/d) were also significantly higher in the intervention group (P<.001). The level of physical activity increased in both groups by approximately 60%, without difference between groups (P =.22). Mean (SD) body weight decreased more in patients in the intervention group (-4.0 [1.1] kg) than in those in the control group (-1.2 [0.6] kg) (P<.001). Compared with patients consuming the control diet, patients consuming the intervention diet had significantly reduced serum concentrations of hs-CRP (P =.01), IL-6 (P =.04), IL-7 (P = 0.4), and IL-18 (P = 0.3), as well as decreased insulin resistance (P<.001). Endothelial function score improved in the intervention group (mean [SD] change, +1.9 [0.6]; P<.001) but remained stable in the control group (+0.2 [0.2]; P =.33). At 2 years of follow-up, 40 patients in the intervention group still had features of the metabolic syndrome, compared with 78 patients in the control group (P<.001). CONCLUSION: A Mediterranean-style diet might be effective in reducing the prevalence of the metabolic syndrome and its associated cardiovascular risk.

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Metadata

Authors
Esposito, K., Marfella, R., Ciotola, M., Di Palo, C., Giugliano, F., Giugliano, G., D'Armiento, M., D'Andrea, F., & Giugliano, D.
Affiliations
University of Campania "Luigi Vanvitelli" (IT)
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2004-09-22
Volume
292
Issue
12
Pages
1440
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.292.12.1440
OpenAlex
W2058699849
Cited by
2,126
References
30
Citations by year
2026: 32 · 2025: 58 · 2024: 79 · 2023: 63 · 2022: 76 · 2021: 87 · 2020: 141 · 2019: 79 · 2018: 101 · 2017: 92 · 2016: 96 · 2015: 111 · 2014: 125 · 2013: 99 · 2012: 111
FWCI
106.96
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
  • Health Sciences › Medicine › Physiology (medical) › Nitric Oxide and Endothelin Effects
Keywords
Mediterranean diet, metabolic syndrome, endothelial dysfunction, vascular inflammation, C-reactive protein, interleukin-6, IL-7, IL-18, n-6/n-3 ratio, olive oil, whole grains, fruit and vegetable intake, nuts, dietary intervention, weight loss, insulin sensitivity, cardiovascular risk reduction, physical activity
MeSH terms
Adult, Blood Glucose, Blood Pressure, C-Reactive Protein, Endothelium, Vascular, Female, Humans, Inflammation, Insulin, Interleukins, Lipids, Male, Middle Aged, Platelet Aggregation, Single-Blind Method, Metabolic Syndrome, Diet, Mediterranean

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