Elsevier

Diabetes & Metabolism

Volume 39, Issue 2, April 2013, Pages 99-110
Diabetes & Metabolism

Review
Dietary patterns, inflammation and the metabolic syndromeComportements alimentaires, inflammation, et syndrome métabolique

https://doi.org/10.1016/j.diabet.2012.08.007Get rights and content

Abstract

Aim

The study of dietary patterns offers a comprehensive, real-life approach towards examining the complex diet and disease relationship. The simultaneous association of dietary patterns with inflammation and the metabolic syndrome (MetS) has not been extensively reviewed. This report reviews the association of dietary patterns with inflammation in the context of the MetS.

Methods

Original English-language research studies with humans were identified via MEDLINE, using inflammation, MetS, whole diets and dietary patterns as keywords. The findings were carefully examined and synthesized along consistent axes.

Results

Many observational and a few prospective studies, as well as some randomized controlled trials (RCTs), support an inverse association between a Mediterranean dietary pattern and markers of inflammation. The link is generally independent of traditional cardiovascular disease (CVD) risk factors and weight loss. The few studies that have examined the association between following a healthy dietary pattern, evaluated using various diet quality scores, and inflammation report an inverse association; however, this association was attenuated upon adjusting for CVD risk factors. A Mediterranean dietary pattern has also been associated with a reduced risk of the MetS in several cross-sectional studies and a few prospective studies conducted with healthy people. Few RCTs (lasting 1–2 years) have confirmed the benefits of following a Mediterranean diet on MetS risk in obese individuals, in those with the MetS or in those at CVD risk. The evidence, albeit limited, for a link between healthy diets based on other diet quality scores and the MetS supports a similar inverse association for the primary and secondary prevention of the MetS.

Conclusion

Adhering to healthy diets such as the Mediterranean diet and/or national dietary guidelines can reduce inflammation and the MetS.

Résumé

Objectif

L’étude des comportements alimentaires constitue une approche globale et réaliste pour analyser les relations entre nutrition et pathologies. L’association des comportements alimentaires avec à la fois l’inflammation et le syndrome métabolique n’a pas été recensée en détail à ce jour. Tel est l’objectif de cette revue.

Méthodes

Les mots clés « inflammation, syndrome métabolique, alimentation globale et comportements alimentaires » ont été utilisés pour identifier dans Medline les articles pertinents en langue anglaise portant chez l’homme. Ils ont été soigneusement examinés et synthétisés en plusieurs axes.

Résultats et conclusion

De nombreuses études d’observation dont quelques études prospectives et essais contrôlés randomisés suggèrent une association inverse entre des typologies alimentaires de type méditerranéen et des marqueurs de l’inflammation. Ce lien est indépendant des facteurs de risque cardiovasculaire (CV) et de la perte de poids. Quelques études ont trouvé une association inverse entre les comportements alimentaires favorables à la santé (évalués par différents scores de qualité nutritionnelle) et le statut inflammatoire, mais cette association est atténuée après ajustement sur les facteurs de risque CV. Une alimentation de type méditerranéen a été également trouvée associée à une fréquence moindre de syndrome métabolique dans plusieurs études transversales et quelques études prospectives réalisées chez des sujets sains. Quelques essais randomisés d’une durée d’un ou de deux ans confirment le bénéfice du modèle d’alimentation méditerranéen sur le risque de syndrome métabolique chez les sujets obèses, les patients à risque de syndrome métabolique ou de maladies CV. Globalement le lien entre alimentation saine (évaluée par des scores de qualité nutritionnelle) et le risque de syndrome métabolique suggère une possibilité de prévention primaire et secondaire du syndrome métabolique.

Section snippets

Dietary patterns

Many studies have focused on the role of specific food groups, and individual foods and nutrients, to evaluate the diet–disease link. However, such research is subject to certain limitations such as the synergistic or interactive effects among nutrients, confounding by other dietary variables, multiple testing and insufficient statistical power related to the small effect sizes [9], [10], [11], [12]. For this reason, attention has been shifting to the study of overall dietary or food patterns

Dietary patterns and low-grade inflammation

Inflammation results from tissue injury or infection, and a state of chronic low-grade inflammation has been associated with insulin resistance, diabetes, atherosclerosis, obesity, the MetS and CVD [2], [8], [31], [32], [33], [34], [35], [36], [37], [38]. The postulated mechanisms involve increased levels of proinflammatory, and decreased levels of anti-inflammatory, adipokines and cytokines, thereby creating a proinflammatory environment with an increase in reactive oxygen and nitrogen species

Dietary patterns and the metabolic syndrome

The MetS is a cluster of risk factors for CVD and type 2 diabetes, including dysglycaemia, elevated blood pressure, dyslipidaemia (high triglyceride and low high-density lipoprotein [HDL] cholesterol levels) and obesity, particularly central adiposity. The first definition of the MetS, proposed in 1998 by a consultation group working on a definition of diabetes for the World Health Organization (WHO), required evidence of insulin resistance in conjunction with other metabolic manifestations [70]

Conclusion and future needs

MetS prevalence is increasing worldwide with increasing obesity, sedentary behaviours and population ageing. The aetiology of the MetS involves a complex interaction of genetic, metabolic and environmental factors, including dietary habits. At present, there is no consensus on the most appropriate dietary recommendations for the prevention and treatment of the MetS [104], although various diets are recommended for each of its components.

Over the past decade, research has focused on dietary

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.

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