Mediterranean-style dietary pattern, reduced risk of metabolic syndrome traits, and incidence in the Framingham Offspring Cohort
Open accessAbstract
Background The benefit of the Mediterranean-style dietary pattern in mitigating metabolic risk factors for type 2 diabetes and cardiovascular disease has not been well investigated among nondiabetic Americans.Objective The aim of this study was to examine the prospective association between the Mediterranean-style dietary pattern and metabolic syndrome.Design The Mediterranean-style dietary pattern score (MSDPS) was used to characterize a Mediterranean-style dietary pattern in the Framingham Heart Study Offspring Cohort. We examined the longitudinal association between MSDPS and metabolic syndrome traits (including homeostasis model assessment-insulin resistance, fasting glucose, waist circumference, triglyceride, HDL cholesterol, and systolic and diastolic blood pressure) among 2730 participants of the Framingham Heart Study Offspring Cohort without type 2 diabetes (baseline median age: 54 y; 55% women), who were followed from the fifth (baseline) to the seventh study examinations (mean follow-up time: 7 y), and metabolic syndrome incidence (according to the National Cholesterol Education Program Adult Treatment Panel III definition) in 1918 participants free of the condition at baseline.Results A higher MSDPS was associated with lower homeostasis model assessment-insulin resistance (P = 0.02), waist circumference (P < 0.001), fasting plasma glucose (P = 0.03), and triglycerides (P < 0.001) and higher HDL cholesterol (P = 0.02) after adjustment for the corresponding baseline values and for several confounding factors associated with type 2 diabetes risk. Participants in the highest quintile category of the MSDPS had a lower incidence of metabolic syndrome than those in the lowest quintile category (38.5% compared with 30.1%; P = 0.01).Conclusion Our study suggests that the consumption of a diet consistent with the principles of the Mediterranean-style diet may protect against metabolic syndrome in Americans.
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A Mediterranean diet reduces plasma TG levels by 10%-15%.
“10%-15% reduction in plasma TG levels with Mediterranean diet”
From The Forgotten Lipids: Triglycerides, Remnant Cholesterol, and Atherosclerotic Cardiovascular Disease Risk (2019) · cites this paper as [135]
Table 2 (page unavailable) reports triglyceride levels of 114 mg/dL in the lowest Mediterranean-diet-score quintile and 103 mg/dL in the highest—about 9.6% lower. The study supports an association near the low end of the claimed range, but does not establish a 10%–15% reduction caused by the diet. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMediterranean-style dietary pattern is associated with decreased triglyceride levels.
“Epidemiological and clinical trial evidence suggests that the Mediterranean-style dietary pattern 398,399 is associated with decreased triglyceride levels.”
From Triglycerides and Cardiovascular Disease: A Scientific Statement From the American Heart Association (2011) · cites this paper as [399]
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“with those in the lowest quintile category (38·5 %; P1⁄40·01)((26)).”
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“The food pattern was comparable to a Mediterranean-style diet, for which there is a body of evidence that it is effective for weight reduction and ameliorates the global cardiovascular risk in healthy overweight subjects and high-risk patients((17,39,44,45)).”
MethodA perspective on vegetarian dietary patterns and risk of metabolic syndrome
Sabaté, J., & Wien, M. (2015) · British Journal Of Nutrition · doi:10.1017/s0007114514004139 · Cited by 89 · see citing works
“Western((1,2)), healthy or prudent((3)), Mediterranean((4))) are associated with an increased or decreased risk for developing metabolic disorders and chronic diseases, the primary focus of the present study will be limited to presenting the existing evidence on vegetarian dietary patterns and the risk of developing t…”
BackgroundHutchins-Wiese, H., Bales, C. W., & Starr, K. N. P. (2021) · British Journal Of Nutrition · doi:10.1017/s0007114521002476 · Cited by 89 · see citing works
“While this scoring systemattempts to remove the limitations of prior MedD adherence scores for a non-Mediterranean population, it is a complex calculation that, to date, has only been applied by one group outside of the original application studies(94,95).”
MethodBaik, I., Lee, M., Jun, N.-R., Lee, J.-Y., & Shin, C. (2013) · Nutrition Research and Practice · doi:10.4162/nrp.2013.7.3.233 · Cited by 89 · see citing works
“population supported the previous findings [13].”
Rummo, P. E., Meyer, K. A., Boone‐Heinonen, J., Jacobs, D. R., Kiefe, C. I., Lewis, C. E., Steffen, L. M., & Gordon‐Larsen, P. (2015) · American Journal of Public Health · doi:10.2105/ajph.2014.302435 · Cited by 87 · see citing works
Vanillin Alleviates High Fat Diet-Induced Obesity and Improves the Gut Microbiota Composition
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“(2009)((24)) T: 1918; M: 798; F: 1120; mean age 54 years; 7-year FUP; longitudinal; USA Mediterranean-style dietary pattern score; based on the Mediterranean; diet pyramid; thirteen components; score ranges from 0 to 100 points Age, sex, EI, smoking dose, BMI, and change in BMI among participants without MetS at the b…”
MethodSyauqy, A., Hsu, C., Rau, H.-H., & Chao, J. C.-J. (2018) · Nutrients · doi:10.3390/nu10020143 · Cited by 76 · see citing works
Beneficial Effects of Korean Traditional Diets in Hypertensive and Type 2 Diabetic Patients
Jung, S., Park, S., Choi, E.-K., Cha, Y., Cho, B.-H., Kim, Y.-G., Kim, M., Song, W. O., Park, T.-S., Ko, J., et al. (2014) · Journal of Medicinal Food · doi:10.1089/jmf.2013.3042 · Cited by 76 · see citing works
Kim, J., & Lee, S. (2012) · Nutrition Research and Practice · doi:10.4162/nrp.2012.6.3.221 · Cited by 72 · see citing works
“Diet compositions and dietary patterns vary according to age, gender, and ethnicity [26], and previous studies have demonstrated that food compositions and dietary patterns are associated with components of metabolic syndrome, that is, abdominal obesity, blood pressure, and lipid levels [16,27].”
BackgroundSubstrate conformal imprint lithography for nanophotonics
Verschuuren, M. A. (2010) · AMOLF Institutional Repository (AMOLF) · Cited by 70 · see citing works
Bottcher, M. R., Marincic, P. Z., Nahay, K. L., Baerlocher, B. E., Willis, A. W., Park, J., Gaillard, P., & Greene, M. W. (2016) · Appetite · doi:10.1016/j.appet.2016.12.029 · Cited by 69 · see citing works
Sarsangi, P., Salehi‐Abargouei, A., Ebrahimpour‐Koujan, S., & Esmaillzadeh, A. (2022) · Advances in Nutrition · doi:10.1093/advances/nmac046 · Cited by 68 · see citing works
Middleton, G., Keegan, R. J., Smith, M. F., AlKhatib, A. H., & Klonizakis, M. (2015) · The journal of nutrition health & aging · doi:10.1007/s12603-015-0663-0 · Cited by 68 · see citing works
Xiao, Y., Xiao, X., Zhang, X., Yi, D., Li, T., Hao, Q., Zhang, F., Xu, L., & Wang, N. (2024) · The EPMA Journal · doi:10.1007/s13167-024-00360-w · Cited by 64 · see citing works
Mediterranean diet and carotid atherosclerosis in the Northern Manhattan Study
Gardener, H. E., Wright, C. B., Cabral, D., Scarmeas, N., Gu, Y., Cheung, K., Elkind, M. S. V., Sacco, R. L., & Rundek, T. (2014) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2014.03.011 · Cited by 66 · see citing works
“In fact, protective factors for atherosclerosis that have been previously associated with a MeDi and are likely biological mechanisms underlying the proposed atheroprotective effect of a MeDi include better blood lipid levels [57], lower blood pressure [58], adiposity [59], improved insulin resistance [60], and decrea…”
Dietary nutrient intake and metabolic syndrome risk in Chinese adults: a case–control study
Bian, S., Gao, Y., Zhang, M., Wang, X., Liu, W., Zhang, D., & Huang, G. (2013) · Nutrition Journal · doi:10.1186/1475-2891-12-106 · Cited by 63 · see citing works
“In recent years, research studies have examined the effect of specific foods and dietary patterns on MetS [12-16].”
BackgroundCarter, P., Achana, F. A., Troughton, J., Gray, L. J., Khunti, K. K., & Davies, M. J. (2013) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.12138 · Cited by 62 · see citing works
Mediterranean Diet and Its Association with Cardiovascular Disease Risk Factors: A Scoping Review
Richardson, L. A., Izuora, K. E., & Basu, A. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191912762 · Cited by 63 · see citing works
“5 for Atherosclerosis Risk in Communities (mean ± SD)) [10,94].”
BackgroundFuntikova, A. N., Benitez-Arciniega, A. D., Gómez, S. F., Fitó, M., Elosúa, R., & Schröder, H. (2014) · British Journal Of Nutrition · doi:10.1017/s0007114513003966 · Cited by 61 · see citing works
“Among the prospective observational studies, only three surveys((11,25,26)) evaluated the association between the Medi-”
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Diet quality and cardiovascular outcomes: A systematic review and meta‐analysis of cohort studies
Taylor, R., Haslam, R. L., Herbert, J., Whatnall, M. C., Trijsburg, L. E., de Vries, J. H. M., Josefsson, M. S., Koochek, A., Nowicka, P., Neuman, N., et al. (2023) · Nutrition & Dietetics · doi:10.1111/1747-0080.12860 · Cited by 62 · see citing works
Latest Evidence of the Effects of the Mediterranean Diet in Prevention of Cardiovascular Disease
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The Metabolic Syndrome and Risk of Prostate Cancer in Italy
Pelucchi, C., Serraino, D., Negri, E., Montella, M., Dellanoce, C., Talamini, R., & Vecchia, C. L. (2011) · Annals of Epidemiology · doi:10.1016/j.annepidem.2011.07.007 · Cited by 51 · see citing works
Maghsoudi, Z., & Azadbakht, L. (2012) · Europe PMC (PubMed Central) · Cited by 49 · see citing works
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Metabolic syndrome: a brain disease
Singh, R. B., Gupta, S. S., Dherange, P., Meester, F. D., Wilczyńska, A., Alam, S. E., Pella, D., & Wilson, D. W. (2012) · Canadian Journal of Physiology and Pharmacology · doi:10.1139/y2012-122 · Cited by 47 · see citing works
“…modulation of neural and cardiovascular mechanisms (Liese et al. 2003; Furukawa et al. 2004; Heine et al. 2004; Lawrence et al. 2004; McKeown et al. 2004; Möhlig et al. 2004; Schulze and Hu 2004; He et al. 2006; Mechirova et al. 2009; Singh et al. 2009c; Rumawas et al. 2009; Sawada and Yokoi 2010).”
Trimarco, B., Benvenuti, C., Rozza, F., Cimmino, C. S., Giudice, R., & Crispo, S. (2011) · Mediterranean Journal of Nutrition and Metabolism · doi:10.1007/s12349-010-0043-6 · Cited by 47 · see citing works
“As final conclusion, the variety of the available data supports the rationale for recommending the PN combination of nutraceuticals with lifestyle changes and a balanced diet as an effective approach to dyslipidemic patients [4, 5, 17].”
BackgroundThe association between diet quality indices and obesity: Tehran Lipid and Glucose Study.
Asghari, G., Mirmiran, P., Rashidkhani, B., Jafarabadi, M. A., Mehran, M., & Azizi, F. (2012) · PubMed · Cited by 47 · see citing works
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“In the Framingham Heart Study Offspring Cohort between 1991 and 2008, the prevalence of obesity and insulin resistance increased substantially in association with increases in total fat and protein intake in adults aged 25 years (Franco et al. 2009; Rumawas et al. 2009).”
Gómez-Delgado, F., Alcala-Diaz, J. F., García‐Ríos, A., Delgado‐Lista, J., Ortiz-Morales, A. M., Rangel-Zúñiga, O. A., Tinahones, F. J., González-Guardia, L., Malagón, M. M., Bellido‐Muñoz, E., et al. (2014) · Molecular Nutrition & Food Research · doi:10.1002/mnfr.201300723 · Cited by 46 · see citing works
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“The Mediterranean diet, high in fruits, vegetables, nuts, cereals, fish, and olive oil with moderate red wine consumption and minimal amounts of red meat and dairy products, has been linked to beneficial effects on vascular disease, blood pressure, glycemic control, and lipids [82, 83].”
Bruno, E., Gargano, G., Villarini, A., Traina, A., Johansson, H. A., Mano, M. P., de Magistris, M. S., Simeoni, M., Consolaro, E., Mercandino, A., et al. (2015) · International Journal of Cancer · doi:10.1002/ijc.29689 · Cited by 45 · see citing works
“In this study, the authors found that women who adhered to more dietary recommendations for preventing cancer were also less likely to develop MetS.”
BackgroundInfluentialMcCourt, H. J., Draffin, C. R., Woodside, J. V., Cardwell, C. R., Young, I. S., Hunter, S. J., Murray, L., Boreham, C. A., Gallagher, A. M., Neville, C. E., et al. (2014) · British Journal Of Nutrition · doi:10.1017/s0007114514002682 · Cited by 48 · see citing works
“The Mediterranean diet has long been reported to be associated with the attenuation of CVD risk factors, such as decreased total cholesterol, TAG, blood pressure, homeostasis model assessment-estimated insulin resistance (HOMA-IR), BMI and C-reactive protein levels and increased HDL levels, in randomised intervention…”
Grosso, G., Stepaniak, U., Micek, A., Topór‐Mądry, R., Stefler, D., Szafraniec, K., Bobák, M., & Pająk, A. (2015) · Metabolism · doi:10.1016/j.metabol.2015.02.007 · Cited by 44 · see citing works
“For each participant, daily intakes (in grams) of vegetables, legumes, fruits and nuts, cereals, fish and seafood, dairy products, meat and meat products (including red meat, poultry, and processed meat), and alcohol were estimated.”
BackgroundDiet, the Global Obesity Epidemic, and Prevention
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'Mediterranean' dietary pattern for the primary prevention of cardiovascular disease
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Neuhouser, M. L., Howard, B. V., Lu, J., Tinker, L. F., Horn, L. V., Caan, B. J., Rohan, T. E., Stefanick, M. L., & Thomson, C. A. (2012) · Metabolism · doi:10.1016/j.metabol.2012.04.007 · Cited by 40 · see citing works
“[14] Rumawas ME, Meigs JB, Dwyer JT, et al.”
BackgroundInfluentialAssociation between dietary patterns and metabolic syndrome in a sample of Tehranian adults
Farhangi, M. A., Jahangiry, L., Jafarabadi, M. A., & Najafi, M. (2015) · Obesity Research & Clinical Practice · doi:10.1016/j.orcp.2015.05.011 · Cited by 38 · see citing works
Cocate, P. G., Natali, A. J., de Oliveira, A., Alfenas, R. D. C. G., & Hermsdorff, H. H. M. (2015) · The journal of nutrition health & aging · doi:10.1007/s12603-015-0521-0 · Cited by 38 · see citing works
Manuel, M., Lesmes, I. B., Marset, J. B., Izquierdo, J. Q. I., Formiguera, X., & Salas‐Salvadó, J. (2012) · PubMed · doi:10.3305/nh.2012.27.3.5680 · Cited by 38 · see citing works
Wang, D., Hawley, N. L., Thompson, A. A., Lameko, V., Reupena, M. S., McGarvey, S. T., & Baylín, A. (2017) · Journal of Nutrition · doi:10.3945/jn.116.243733 · Cited by 37 · see citing works
“To name a few, the Mediterranean-style pattern in America (13) and the traditional pattern in Korea (14) were inversely associated with incidence and prevalence of metabolic syndrome and its individual components, whereas the Western pattern in Mexico (15) and the carbohydrate pattern in Thailand (16) were associated…”
BackgroundHassannejad, R., Kazemi, I., Sadeghi, M., Mohammadifard, N., Roohafza, H., Sarrafzadegan, N., Talaei, M., & Mansourian, M. (2017) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2017.10.025 · Cited by 37 · see citing works
Mediterranean Diet and the Metabolic Syndrome: The End of the Beginning
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Therapies for diabetic dyslipidaemia
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“Specifically, a diet high in vegetables, fruits, nuts, omega-3 fatty acids, olive oil and whole grains but low in refined carbohydrates, saturated fats and trans fats was associated with reduced risks for T2D, including lower levels of insulin resistance, abdominal obesity, fasting glucose and triglycerides, and impro…”
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“Most previous studies reported the possible protective effect of adherence to the MedDiet on MetS prevalence and its progression (5, 6); however, most investigations had preliminary cross-sectional designs (5, 6), and only three studies investigated prospectively the association between adherence to the MedDiet and de…”
BackgroundResultInfluentialA practical approach to the metabolic syndrome: review of current concepts and management
Tota-Maharaj, R., DeFilippis, A. P., Blumenthal, R. S., & Blaha, M. J. (2010) · Current Opinion in Cardiology · doi:10.1097/hco.0b013e32833cd474 · Cited by 35 · see citing works
Adherence to Mediterranean Diet and Metabolic Syndrome in BRCA Mutation Carriers
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Tsai, Y.-T., Liu, J., Tu, Y., Lee, M., Chen, P.-R., Hsu, H., Chen, M.-F., & Chien, K. (2012) · PubMed · Cited by 34 · see citing works
Circulating Retinoic Acid Levels and the Development of Metabolic Syndrome
Liu, Y., Chen, H., Mu, D., Fan, J., Song, J., Yuan, Ž., Li, D., & Xia, M. (2016) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2015-4038 · Cited by 34 · see citing works
Cross-Talk between Diet-Associated Dysbiosis and Hand Osteoarthritis
Silvestre, M., Rodrigues, A., Canhão, H., Marques, C., Teixeira, D., Calhau, C., & Branco, J. (2020) · Nutrients · doi:10.3390/nu12113469 · Cited by 30 · see citing works
- Authors
- Rumawas, M. E., Meigs, J. B., Dwyer, J. T., McKeown, N. M., & Jacques, P. F.
- Affiliations
- Tufts University (US)
- Corresponding author
- Jacques, Paul F
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2009-12
- Volume
- 90
- Issue
- 6
- Pages
- 1608-1614
- ISSN
- 0002-9165 (ISSN-L)
- PMC
- PMC3152203
- OpenAlex
- W2135320605
- Cited by
- 246
- References
- 31
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 10 · 2023: 8 · 2022: 10 · 2021: 15 · 2020: 13 · 2019: 12 · 2018: 11 · 2017: 10 · 2016: 20 · 2015: 22 · 2014: 27 · 2013: 18 · 2012: 26
- FWCI
- 21.75
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- USDA (58-1950-7-707)
- NIH (NO1-HC-25195)
- National Institute of Diabetes and Digestive and Kidney Diseases (K24 DK080140)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Nutrition, Genetics, and Disease
- Keywords
- Mediterranean diet, metabolic syndrome, metabolic syndrome incidence, insulin resistance, waist circumference, fasting blood glucose, triglycerides, HDL cholesterol, blood pressure, Framingham Offspring cohort, type 2 diabetes risk
- MeSH terms
- Female, Humans, Insulin Resistance, Male, Middle Aged, Prospective Studies, Risk, Cohort Studies, Incidence, Metabolic Syndrome, Diet, Mediterranean
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