Metabolic Syndrome & Its Dietary Management; A REVIEW

Metabolic Syndrome & Its Dietary Management


  • Maria Aslam University Institute of Diet and Nutritional Sciences UIDNS, The University of Lahore UOL, Lahore, Pakistan
  • Roman Ahmad Shahroz University Institute of Diet and Nutritional Sciences UIDNS, The University of Lahore UOL, Lahore, Pakistan
  • Shoaib Ramzan University Institute of Diet and Nutritional Sciences UIDNS, The University of Lahore UOL, Lahore, Pakistan.
  • Sajid Ali University Institute of Diet and Nutritional Sciences UIDNS, The University of Lahore UOL, Lahore, Pakistan.
  • Faisal Shehzad University Institute of Diet and Nutritional Sciences UIDNS, The University of Lahore UOL, Lahore, Pakistan
  • Adnan Shafi University Institute of Diet and Nutritional Sciences UIDNS, The University of Lahore UOL, Lahore, Pakistan
  • Komal Ajmal University Institute of Diet and Nutritional Sciences UIDNS, The University of Lahore UOL, Lahore, Pakistan.
  • Nimra Rehman University Institute of Diet and Nutritional Sciences UIDNS, The University of Lahore UOL, Lahore, Pakistan
  • Saher Iqbal University Institute of Diet and Nutritional Sciences UIDNS, The University of Lahore UOL, Lahore, Pakistan
  • Shehzil Tanveer University Institute of Diet and Nutritional Sciences UIDNS, The University of Lahore UOL, Lahore, Pakistan
  • Eman Fatima University Institute of Diet and Nutritional Sciences UIDNS, The University of Lahore UOL, Lahore, Pakistan



Metabolic Syndrome or MetS is a multifactorial disease consisting of obesity, hypertension, dyslipidemia, and hyperglycemia. It’s common in 25% of the general population in the Northern US and Western Europe. In Pakistan, the statistics of MetS are unknown, however, it is expected to be twice that of the US. The middle age group and the geriatrics population have the highest number of MetS cases with risk factors such as obesity, sedentary lifestyle, alcohol, inadequate, inadequate sleep, and a non-vegetarian diet. The complications of MetS include obesity, diabetes, and cardiovascular events. A Meditteranean diet rich in fruits and vegetables, whole grains, and olive oil as the source of fat is considered to be the only effective dietary management in MetS. Moreover, a high lean protein, low and complex carbohydrate and moderate unsaturated fats have also shown positive progress in MetS, especially with long-term weight reduction. Micronutrients requirements also increase in MetS. Fulfilling these increased requirements has been shown to regulate and improve the metabolism of fats and carbohydrates. Vitamin C and E, flavonoids, vitamin D, conjugated linoleic acid, omega-3 fatty acids, minerals such as magnesium and chromium, α-lipoic acid, phytoestrogens, and dietary fiber all have been studied to support the treatment of MetS along with aloe vera and other herbal products, yoga and aerobic exercises.


Kaur, J.J.C.r. and practice, A comprehensive review on metabolic syndrome. 2014. 2014.

Eckel, R.H., et al., The metabolic syndrome. 2010. 375(9710): p. 181-183.

Weiss, R., A.A. Bremer, and R.H.J.A.o.t.N.Y.A.o.S. Lustig, What is metabolic syndrome, and why are children getting it? 2013. 1281(1): p. 123.

El-Serag, H.B., T. Tran, and J.E.J.G. Everhart, Diabetes increases the risk of chronic liver disease and hepatocellular carcinoma. 2004. 126(2): p. 460-468.

Fiatarone, J., et al., Non‐alcoholic steatohepatitis: impaired antipyrine metabolism and hypertriglyceridaemia may be clues to its pathogenesis. 1991. 6(6): p. 585-590.

Ratziu, V., et al., Liver fibrosis in overweight patients. 2000. 118(6): p. 1117-1123.

Gholam, P.M., et al., Nonalcoholic fatty liver disease in severely obese subjects. 2007. 102(2): p. 399-408.

Mottillo, S., et al., The metabolic syndrome and cardiovascular risk: a systematic review and meta-analysis. 2010. 56(14): p. 1113-1132.

Alberti, K.G., et al., Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; national heart, lung, and blood institute; American heart association; world heart federation; international atherosclerosis society; and international association for the study of obesity. 2009. 120(16): p. 1640-1645.

Esposito, K., et al., Metabolic syndrome and risk of cancer: a systematic review and meta-analysis. 2012. 35(11): p. 2402-2411.

Ali, N.S., A.K. Khuwaja, and K.J.I.j.o.f.m. Nanji, Retrospective analysis of metabolic syndrome: Prevalence and distribution in executive population in urban Pakistan. 2012. 2012.

Ervin, R.B., Prevalence of Metabolic Syndrome Among Adults 20 years of age and over, by sex, age, race and ethnicity, and body mass index; United States, 2003-2006. 2009.

Kaur, J., Assessment and Screening of the Risk Factors in Metabolic Syndrome. 2014. 2(3): p. 140-152.

Ogbera, A.O., Prevalence and gender distribution of the metabolic syndrome. Diabetology & Metabolic Syndrome, 2010. 2(1): p. 1.

Ogbera, A.O.J.D. and M. Syndrome, Prevalence and gender distribution of the metabolic syndrome. 2010. 2(1): p. 1-5.

Weiss, R., A.A. Bremer, and R.H. Lustig, What is metabolic syndrome, and why are children getting it? Annals of the New York Academy of Sciences, 2013. 1281(1): p. 123-140.

Antonini-Canterin, F., et al., Association Between Carotid Atherosclerosis and Metabolic Syndrome: Results From the ISMIR Study. 2010. 61(5): p. 443-448.

Momiyama, Y., et al., Inflammation, Atherosclerosis and Coronary Artery Disease. 2014. 8s3: p. CMC.S39423.

Novo, S., et al., Preclinical atherosclerosis and metabolic syndrome increase cardio- and cerebrovascular events rate: a 20-year follow up. Cardiovascular Diabetology, 2013. 12(1): p. 155.

Mottillo, S., et al., The Metabolic Syndrome and Cardiovascular Risk. 2010. 56(14): p. 1113-1132.

Martínez-González, M.A., et al., Benefits of the Mediterranean Diet: Insights From the PREDIMED Study. Progress in Cardiovascular Diseases, 2015. 58(1): p. 50-60.

Ros, E., Olive oil and CVD: accruing evidence of a protective effect. British Journal of Nutrition, 2012. 108(11): p. 1931-1933.

Braun, S., K. Bitton-Worms, and D. LeRoith, The link between the metabolic syndrome and cancer. International journal of biological sciences, 2011. 7(7): p. 1003-1015.

Kastorini, C.-M., et al., The Effect of Mediterranean Diet on Metabolic Syndrome and its Components. 2011. 57(11): p. 1299-1313.

Radulian, G., et al., Metabolic effects of low glycaemic index diets. Nutrition Journal, 2009. 8(1): p. 5.

Abete, I., et al., Obesity and the metabolic syndrome: role of different dietary macronutrient distribution patterns and specific nutritional components on weight loss and maintenance. 2010. 68(4): p. 214-231.

Pirozzo, S.L., et al., Advice on low‐fat diets for obesity. 2002(2).

Sacks, F.M., et al., Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. 2009. 360(9): p. 859-873.

Petersen, M., et al., Randomized, multi-center trial of two hypo-energetic diets in obese subjects: high-versus low-fat content. 2006. 30(3): p. 552-560.

Due, A., et al., Comparison of the effects on insulin resistance and glucose tolerance of 6-mo high-monounsaturated-fat, low-fat, and control diets. 2008. 87(4): p. 855-862.

Lejeune, M.P., et al., Ghrelin and glucagon-like peptide 1 concentrations, 24-h satiety, and energy and substrate metabolism during a high-protein diet and measured in a respiration chamber. 2006. 83(1): p. 89-94.

Psota, T. and D. Layman, A Moderate-Protein Diet Produces Sustained Weight Loss and Long-Term Changes in Body Composition and Blood Lipid.

Krauss, R.M., et al., AHA Dietary Guidelines: revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. 2000. 102(18): p. 2284-2299.

Layman, D.K.J.J.o.t.A.C.o.N., Protein quantity and quality at levels above the RDA improves adult weight loss. 2004. 23(sup6): p. 631S-636S.

Pencharz, P.B. and R.O.J.A.r.o.n. Ball, Different approaches to define individual amino acid requirements. 2003. 23(1): p. 101-116.

Wolfe, R.R.J.T.A.j.o.c.n., The underappreciated role of muscle in health and disease. 2006. 84(3): p. 475-482.

Pascual, R.W., et al., Diet Quality and Micronutrient Intake among Long-Term Weight Loss Maintainers. Nutrients, 2019. 11(12).

Astrup, A. and S.J.I.j.o.o. Bügel, Overfed but undernourished: recognizing nutritional inadequacies/deficiencies in patients with overweight or obesity. 2019. 43(2): p. 219-232.

Agarwal, S., et al., Comparison of prevalence of inadequate nutrient intake based on body weight status of adults in the United States: an analysis of NHANES 2001-2008. 2015. 34(2): p. 126-134.

Via, M.J.I.S.R.N., The malnutrition of obesity: micronutrient deficiencies that promote diabetes. 2012. 2012.

Steele, E.M., et al., The share of ultra-processed foods and the overall nutritional quality of diets in the US: evidence from a nationally representative cross-sectional study. 2017. 15(1): p. 1-11.

Marriott, B.P., et al., Intake of added sugars and selected nutrients in the United States, National Health and Nutrition Examination Survey (NHANES) 2003-2006. 2010. 50(3): p. 228-258.

Kaidar-Person, O., et al., Nutritional deficiencies in morbidly obese patients: a new form of malnutrition? 2008. 18(7): p. 870-876.

García, O.P., K.Z. Long, and J.L.J.N.r. Rosado, Impact of micronutrient deficiencies on obesity. 2009. 67(10): p. 559-572.

Goncalves, A. and M.-J. Amiot, Fat-soluble micronutrients and metabolic syndrome. Current opinion in clinical nutrition and metabolic care, 2017. 20(6): p. 492-497.

Khosravi-Boroujeni, H., F. Ahmed, and N. Sarrafzadegan, Is the Association between Vitamin D and Metabolic Syndrome Independent of Other Micronutrients? 2015. 85(5-6): p. 245-260.

Panchal, S.K., S. Wanyonyi, and L. Brown, Selenium, Vanadium, and Chromium as Micronutrients to Improve Metabolic Syndrome. Current Hypertension Reports, 2017. 19(3): p. 10.

Desai, M., J. Jellyman, and M.J.I.j.o.o. Ross, Epigenomics, gestational programming and risk of metabolic syndrome. 2015. 39(4): p. 633-641.

Tarrade, A., et al., Placental contribution to nutritional programming of health and diseases: epigenetics and sexual dimorphism. 2015. 218(1): p. 50-58.

Brenseke, B., et al., Current thoughts on maternal nutrition and fetal programming of the metabolic syndrome. 2013. 2013.

Knip, M., H.K.J.E.N. Åkerblom, and i.L.C.N. Opportunities, Early nutrition and later diabetes risk. 2005: p. 142-150.

DeBoer, M.D., et al., Early childhood growth failure and the developmental origins of adult disease: do enteric infections and malnutrition increase risk for the metabolic syndrome? 2012. 70(11): p. 642-653.

Alvisi, P., et al., Recommendations on complementary feeding for healthy, full-term infants. 2015. 41(1): p. 1-9.

Yin, J., et al., Traditional Chinese medicine in treatment of metabolic syndrome. 2008. 8(2): p. 99-111.

Hollander, J.M. and J.I.J.J.o.t.A.D.A. Mechanick, Complementary and alternative medicine and the management of the metabolic syndrome. 2008. 108(3): p. 495-509.

Sui, Y., et al., A systematic review on use of Chinese medicine and acupuncture for treatment of obesity. 2012. 13(5): p. 409-430.

Jang, S., et al., Herbal medicines for treating metabolic syndrome: a systematic review of randomized controlled trials. 2016. 2016.

Yeh, G.Y., et al., Systematic review of herbs and dietary supplements for glycemic control in diabetes. 2003. 26(4): p. 1277-1294.

Sahebkar, A., et al., Nigella sativa (black seed) effects on plasma lipid concentrations in humans: A systematic review and meta-analysis of randomized placebo-controlled trials. 2016. 106: p. 37-50.

Tiwari, P., B. Mishra, and N.S.J.B.r.i. Sangwan, Phytochemical and pharmacological properties of Gymnema sylvestre: an important medicinal plant. 2014. 2014.

Davì, G., F. Santilli, and C. Patrono, Nutraceuticals in Diabetes and Metabolic Syndrome. 2010. 28(4): p. 216-226.

Franzini, L., et al., Dietary antioxidants and glucose metabolism. 2008. 11(4): p. 471-476.

Riccioni, G., et al., Antioxidant vitamin supplementation in cardiovascular diseases. 2007. 37(1): p. 89-95.

Chen, H., et al., High-dose oral vitamin C partially replenishes vitamin C levels in patients with Type 2 diabetes and low vitamin C levels but does not improve endothelial dysfunction or insulin resistance. 2006. 290(1): p. H137-H145.

Davì, G., et al., Lipid peroxidation in diabetes mellitus. 2005. 7(1-2): p. 256-268.

Sesso, H.D., et al., Vitamins E and C in the prevention of cardiovascular disease in men: the Physicians' Health Study II randomized controlled trial. 2008. 300(18): p. 2123-2133.

Patrignani, P., et al., Effects of vitamin E supplementation on F2-isoprostane and thromboxane biosynthesis in healthy cigarette smokers. 2000. 102(5): p. 539-545.

Kris-Etherton, P.M., et al., Antioxidant vitamin supplements and cardiovascular disease. 2004. 110(5): p. 637-641.

Vivekananthan, D.P., et al., Use of antioxidant vitamins for the prevention of cardiovascular disease: meta-analysis of randomised trials. 2003. 361(9374): p. 2017-2023.

Eidelman, R.S., et al., Randomized trials of vitamin E in the treatment and prevention of cardiovascular disease. 2004. 164(14): p. 1552-1556.

Miller III, E.R., et al., Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. 2005. 142(1): p. 37-46.

Bjelakovic, G., et al., Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. 2007. 297(8): p. 842-857.

House, A.A., et al., Effect of B-vitamin therapy on progression of diabetic nephropathy: a randomized controlled trial. 2010. 303(16): p. 1603-1609.

Sanyal, A.J., et al., Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. 2010. 362(18): p. 1675-1685.

Palomer, X., et al., Role of vitamin D in the pathogenesis of type 2 diabetes mellitus. 2008. 10(3): p. 185-197.

Danescu, L.G., S. Levy, and J.J.E. Levy, Vitamin D and diabetes mellitus. 2009. 35(1): p. 11-17.

Diabetologia, E.S.S.G.J., Vitamin D supplement in early childhood and risk for Type I (insulin-dependent) diabetes mellitus. 1999. 42: p. 51-54.

McCarty, M.F.J.M.h., Nutraceutical resources for diabetes prevention-an update. 2005. 64(1): p. 151-158.

Hartweg, J., et al., Meta-analysis of the effects of n-3 polyunsaturated fatty acids on lipoproteins and other emerging lipid cardiovascular risk markers in patients with type 2 diabetes. 2007. 50(8): p. 1593-1602.

Fedor, D., D.S.J.C.O.i.C.N. Kelley, and M. Care, Prevention of insulin resistance by n-3 polyunsaturated fatty acids. 2009. 12(2): p. 138-146.

Beecher, G.R.J.T.J.o.n., Overview of dietary flavonoids: nomenclature, occurrence and intake. 2003. 133(10): p. 3248S-3254S.

Jiang, F. and G.J.J.C.v.p. Dusting, Natural phenolic compounds as cardiovascular therapeutics: potential role of their antiinflammatory effects. 2003. 1(2): p. 135-156.

Di Castelnuovo, A., et al., Meta-analysis of wine and beer consumption in relation to vascular risk. 2002. 105(24): p. 2836-2844.

Di Castelnuovo, A., et al., Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies. 2006. 166(22): p. 2437-2445.

Hertog, M.G., et al., Flavonoid intake and long-term risk of coronary heart disease and cancer in the seven countries study. 1995. 155(4): p. 381-386.

Knekt, P., et al., Flavonoid intake and risk of chronic diseases. 2002. 76(3): p. 560-568.

Mukamal, K.J., et al., Tea consumption and mortality after acute myocardial infarction. 2002. 105(21): p. 2476-2481.

Lau, F.C., et al., Nutrigenomic basis of beneficial effects of chromium (III) on obesity and diabetes. 2008. 317(1): p. 1-10.

Singh, U. and I.J.N.r. Jialal, Retracted: alpha-lipoic acid supplementation and diabetes. 2008. 66(11): p. 646-657.

Bartlett, H.E., F.J.O. Eperjesi, and p. optics, Nutritional supplementation for type 2 diabetes: a systematic review. 2008. 28(6): p. 503-523.

Ziegler, D., et al., α-Lipoic acid in the treatment of diabetic polyneuropathy in Germany: current evidence from clinical trials. 1999. 107(07): p. 421-430.

Cederroth, C.R., S.J.M. Nef, and c. endocrinology, Soy, phytoestrogens and metabolism: A review. 2009. 304(1-2): p. 30-42.

Papathanasopoulos, A. and M.J.G. Camilleri, Dietary fiber supplements: effects in obesity and metabolic syndrome and relationship to gastrointestinal functions. 2010. 138(1): p. 65-72. e2.

McMurray, R.G. and L. Bo Andersen, The Influence of Exercise on Metabolic Syndrome in Youth: A Review. 2010. 4(2): p. 176-186.

Dieli-Conwright, C.M., et al., Effects of Aerobic and Resistance Exercise on Metabolic Syndrome, Sarcopenic Obesity, and Circulating Biomarkers in Overweight or Obese Survivors of Breast Cancer: A Randomized Controlled Trial. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018. 36(9): p. 875-883.

Touati, S., et al., Exercise reverses metabolic syndrome in high-fat diet-induced obese rats. Medicine and science in sports and exercise, 2011. 43(3): p. 398-407.

Cramer, H., et al., Yoga for metabolic syndrome: A systematic review and meta-analysis. European Journal of Preventive Cardiology, 2020. 23(18): p. 1982-1993.



DOI: 10.54393/pbmj.v4i2.124
Published: 2021-12-26

How to Cite

Aslam, M., Shahroz, R. A., Ramzan, S. ., Ali, S. ., Shehzad, F. ., Shafi, A. ., Ajmal, K. ., Rehman, N. ., Iqbal, S. ., Tanveer, S. ., & Fatima, E. . (2021). Metabolic Syndrome & Its Dietary Management; A REVIEW: Metabolic Syndrome & Its Dietary Management. Pakistan BioMedical Journal, 4(2), 14–20.



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