European Journal of Cardiovascular Medicine

Metabolic syndrome (MetS) is a multifaceted clinical condition characterized by a cluster of interrelated risk factors that predispose individuals to cardiovascular disease and type 2 diabetes mellitus. It includes abdominal obesity, dyslipidemia, hypertension, and impaired glucose tolerance or insulin resistance. The rising global prevalence of MetS poses a significant public health challenge, contributing substantially to morbidity and mortality worldwide ^[1].

Dietary patterns have increasingly been recognized as critical determinants influencing the development and progression of metabolic syndrome. Unlike isolated nutrient analysis, the concept of dietary patterns considers the synergistic and cumulative effects of foods and nutrients consumed together, providing a more comprehensive understanding of diet-disease relationships [2]. Studies have shown that certain dietary habits such as high consumption of processed foods, saturated fats, and refined sugars are positively associated with metabolic syndrome components. Conversely, diets rich in fruits, vegetables, whole grains, and lean proteins are inversely related to MetS risk ^[3].

The pathophysiological basis linking dietary patterns to metabolic syndrome involves multiple mechanisms, including oxidative stress, chronic low-grade inflammation, and altered lipid and glucose metabolism. Excessive intake of calorie-dense, nutrient-poor diets contributes to adipose tissue dysfunction, promoting insulin resistance and dysregulated lipid profiles, which are hallmark features of MetS ^[4]. Furthermore, dietary-induced gut microbiota changes have emerged as novel contributors to metabolic health, influencing systemic inflammation and energy homeostasis.

Epidemiological evidence from various populations underscores the significance of cultural and regional dietary variations in shaping metabolic risk profiles. For instance, Mediterranean diet patterns have demonstrated protective effects against MetS, attributed to high intake of monounsaturated fats, antioxidants, and fiber ^[5]. However, in many developing regions, shifts towards Westernized dietary patterns have correlated with escalating rates of metabolic syndrome.

Despite growing awareness, there remains a need for region-specific studies evaluating dietary patterns and their association with metabolic syndrome prevalence, particularly in diverse adult populations. Identifying these correlations can guide targeted nutritional interventions, public health policies, and clinical management strategies aimed at reducing the burden of metabolic diseases.

Aim

To assess the correlation between dietary patterns and metabolic syndrome among adults in a cross-sectional comparative study.

Objectives

1. To identify predominant dietary patterns among adults with and without metabolic syndrome.
2. To evaluate the association between specific dietary patterns and components of metabolic syndrome.
3. To compare the prevalence of metabolic syndrome among adults based on their dietary patterns.

Source of Data: Data was collected from adult patients attending the outpatient department. The study population consisted of adults aged 30-65 years who consented to participate and met the inclusion criteria.

Study Design: This was a cross-sectional comparative study designed to assess dietary patterns and their correlation with metabolic syndrome among adults.

Study Location: The study was conducted at tertiary care hospital.

Study Duration: Data collection occurred over a period of six months, from January 2024 to June 2024.

Sample Size: The total sample size was 140 participants, divided into two groups of 70 each—those diagnosed with metabolic syndrome and age- and sex-matched controls without metabolic syndrome.

Inclusion Criteria:

• Adults aged between 30 and 65 years.
• Participants diagnosed with metabolic syndrome as per NCEP ATP III criteria (for cases).
• Adults without metabolic syndrome (for control group).
• Willingness to provide informed consent and comply with study procedures.

Exclusion Criteria:

• Pregnant or lactating women.
• Individuals with chronic illnesses such as malignancies, chronic kidney disease, or liver disease.
• Patients on special diets (e.g., ketogenic, diabetic diets) that might confound dietary pattern assessment.
• Individuals unable to provide reliable dietary history due to cognitive impairment.

Procedure and Methodology: Participants were first screened and classified based on the presence or absence of metabolic syndrome using standard clinical and biochemical criteria. After obtaining informed consent, detailed dietary intake was assessed using a validated semi-quantitative food frequency questionnaire (FFQ) tailored to the local diet. Trained dietitians conducted face-to-face interviews to ensure accuracy.

The FFQ data was analyzed to identify common dietary patterns using principal component analysis (PCA). Anthropometric measurements, including waist circumference, blood pressure readings, and biochemical investigations (fasting blood glucose, lipid profile), were performed to confirm the metabolic syndrome diagnosis.

Sample Processing: Blood samples were collected in fasting state and analyzed using standard laboratory techniques. Fasting glucose levels were measured using enzymatic methods, while lipid profiles including total cholesterol, HDL, LDL, and triglycerides were determined by automated analyzers calibrated as per laboratory protocols.

Statistical Methods: Data was analyzed using SPSS version 27.0. Descriptive statistics were used to summarize demographic and clinical characteristics. Chi-square tests compared categorical variables, while independent t-tests compared continuous variables between groups. Correlation between dietary patterns and metabolic syndrome components was assessed using Pearson’s or Spearman’s correlation coefficients as appropriate. Multivariate logistic regression was employed to adjust for potential confounders and determine independent associations.

Data Collection: Data was systematically recorded in pre-designed case record forms and subsequently entered into a secured database. Quality control measures included double data entry and regular cross-checking to minimize errors. Participant confidentiality was strictly maintained throughout the study.

Table 1: Demographic and Clinical Profile of Study Participants (n=140)

The study included 140 adult participants divided equally into two groups: those diagnosed with metabolic syndrome (n=70) and healthy controls without metabolic syndrome (n=70). The mean age of participants with metabolic syndrome was 48.7 ± 9.3 years, slightly higher than the control group’s 46.4 ± 8.7 years, though this difference was not statistically significant (t = 1.77, p = 0.079). Gender distribution was comparable between groups, with males comprising 54.3% of the metabolic syndrome group and 51.4% of controls (χ² = 0.14, p = 0.708). Significant differences were observed in clinical parameters: individuals with metabolic syndrome had a higher mean BMI (29.4 ± 4.1 kg/m²) compared to controls (24.8 ± 3.7 kg/m²; t = 7.08, p < 0.001). Waist circumference was also notably greater in the metabolic syndrome group (98.2 ± 11.4 cm vs. 82.7 ± 9.8 cm; t = 8.91, p < 0.001). Systolic blood pressure and fasting blood glucose levels were significantly elevated among those with metabolic syndrome (136.5 ± 14.3 mmHg vs. 118.7 ± 11.5 mmHg, t = 7.13, p < 0.001; and 113.6 ± 18.9 mg/dL vs. 89.7 ± 13.2 mg/dL, t = 8.24, p < 0.001, respectively).

Table 2: Predominant Dietary Patterns Among Adults With and Without Metabolic Syndrome (n=140)

Regarding dietary patterns, the Western diet, characterized by high fat and refined food intake, was predominant in 64.3% of participants with metabolic syndrome compared to 31.4% in controls (χ² = 17.6, p < 0.001). Conversely, the Prudent dietary pattern, rich in fruits, vegetables, and whole grains, was more common among healthy controls (54.3%) than in those with metabolic syndrome (25.7%; χ² = 11.2, p = 0.001). The Traditional mixed dietary pattern was similarly distributed between groups (10.0% vs. 14.3%; χ² = 1.02, p = 0.312). Total daily energy intake was significantly higher in the metabolic syndrome group (2508 ± 482 kcal) compared to controls (2204 ± 417 kcal; t = 4.04, p < 0.001).

Table 3: Association Between Specific Dietary Patterns and Components of Metabolic Syndrome (n=140)

The association between dietary patterns and metabolic syndrome components further underscored the impact of diet on metabolic health. Participants following the Western dietary pattern had significantly higher waist circumference (97.4 ± 11.8 cm) than those adhering to the Prudent pattern (84.9 ± 10.5 cm; t = 7.36, p < 0.001). Similarly, triglyceride levels were elevated in the Western diet group (189.5 ± 43.6 mg/dL) relative to the Prudent group (134.2 ± 35.7 mg/dL; t = 8.25, p < 0.001), while HDL cholesterol was notably lower (38.9 ± 7.1 mg/dL vs. 52.3 ± 9.4 mg/dL; t = -8.04, p < 0.001). Fasting blood glucose and systolic blood pressure were also significantly higher among those consuming the Western diet (109.7 ± 22.5 mg/dL vs. 91.4 ± 15.2 mg/dL, t = 6.53, p < 0.001; and 132.8 ± 15.6 mmHg vs. 119.9 ± 12.2 mmHg, t = 5.33, p < 0.001, respectively).

Table 4: Prevalence of Metabolic Syndrome Among Adults Based on Dietary Patterns (n=140)

The prevalence of metabolic syndrome varied significantly with dietary patterns. Among participants following the Western diet, 64.3% had metabolic syndrome compared to only 31.4% without it (χ² = 17.6, p < 0.001). In contrast, the Prudent diet was more common in those without metabolic syndrome (54.3%) than in affected individuals (25.7%; χ² = 11.2, p = 0.001). No significant difference was observed in metabolic syndrome prevalence between groups consuming the Traditional diet (10.0% vs. 14.3%; χ² = 1.02, p = 0.312). These findings highlight a strong correlation between dietary habits and metabolic syndrome risk among adults.

The demographic and clinical profiles presented in Table 1 reveal important distinctions between adults with metabolic syndrome and healthy controls. Although age and gender distribution were statistically comparable between the two groups, key metabolic indicators showed significant differences. Participants with metabolic syndrome exhibited notably higher BMI, waist circumference, systolic blood pressure, and fasting blood glucose levels (all p < 0.001). These findings are consistent with the established diagnostic criteria of metabolic syndrome and align with prior studies. Yoshida J et al. (2018)^[6] reported elevated BMI and waist circumference as core features of MetS, strongly linked to insulin resistance and cardiovascular risk. Similarly, a study by Bovolini A et al. (2021)^[7] emphasized the significance of hypertension and dysglycemia in this population, reinforcing the clinical patterns observed in our cohort.

Table 2 highlights the association between dietary patterns and metabolic syndrome prevalence. The predominance of the Western dietary pattern—characterized by high intake of fats and refined foods—among MetS patients (64.3%) contrasts with the healthier Prudent pattern, more frequent in controls (54.3%). This disparity underscores the role of diet quality in metabolic health. These observations resonate with prior epidemiological evidence. A Mediterranean diet, similar to the Prudent pattern rich in fruits, vegetables, and whole grains, has been shown to reduce metabolic syndrome risk and improve metabolic parameters Castro-Barquero S et al. (2020)^[8]. Conversely, Western dietary patterns high in saturated fats and refined carbohydrates have been linked with increased MetS prevalence and related complications, as noted by Moszak M et al. (2020)^[9]. Additionally, total energy intake was significantly higher in the MetS group, supporting the role of caloric excess in metabolic derangements.

The association between specific dietary patterns and components of metabolic syndrome is further detailed in Table 3. Participants adhering to the Western diet had significantly higher waist circumference, triglycerides, fasting glucose, and systolic blood pressure, along with lower HDL cholesterol compared to those following the Prudent pattern. This aligns with findings by Lopez- Pucci G et al. (2017)[10], who demonstrated that unhealthy dietary patterns exacerbate lipid abnormalities and insulin resistance, thereby intensifying metabolic syndrome components. The negative impact of Western diet on HDL cholesterol levels has been corroborated by Rahe C et al. (2014)^[11], emphasizing the cardiovascular risk linked to such dietary habits.

Finally, Table 4 confirms the higher prevalence of metabolic syndrome among adults consuming the Western diet compared to those following Prudent or Traditional diets, with statistically significant differences (p < 0.001 and p = 0.001, respectively). This prevalence pattern is consistent with previous cross-sectional and cohort studies, such as those by Lippert K et al. (2017)^[12], which documented increased MetS risk in populations with Westernized dietary habits. The non-significant difference in metabolic syndrome prevalence between Traditional diet consumers suggests the mixed nature of these diets may moderate risk, though further research is warranted.

This cross-sectional comparative study demonstrated a significant correlation between dietary patterns and metabolic syndrome among adults. The Western dietary pattern, characterized by high consumption of fats and refined foods, was strongly associated with the presence of metabolic syndrome and its individual components, including increased waist circumference, elevated triglycerides, fasting blood glucose, and blood pressure, as well as decreased HDL cholesterol. Conversely, adherence to a Prudent dietary pattern rich in fruits, vegetables, and whole grains was linked to a lower prevalence of metabolic syndrome and more favorable metabolic profiles. These findings emphasize the critical role of diet quality in the prevention and management of metabolic syndrome and support the promotion of healthier eating habits as a public health priority.

The study’s cross-sectional design limits the ability to infer causality between dietary patterns and metabolic syndrome. Dietary intake was assessed using a food frequency questionnaire, which may be subject to recall bias and inaccuracies in portion size estimation. The sample size, though adequate for detecting associations, was relatively small and limited to a single tertiary care center, which may affect the generalizability of the findings to broader populations. Additionally, potential confounding factors such as physical activity, socioeconomic status, and genetic predispositions were not comprehensively controlled. Longitudinal studies with larger, more diverse populations and objective dietary assessment methods are recommended to confirm these findings.

1. Suliga E, Kozieł D, Cieśla E, Rębak D, Głuszek S. Dietary patterns in relation to metabolic syndrome among adults in Poland: a cross-sectional study. Nutrients. 2017 Dec 17;9(12):1366.
2. Fabiani R, Naldini G, Chiavarini M. Dietary patterns and metabolic syndrome in adult subjects: a systematic review and meta-analysis. Nutrients. 2019 Sep 2;11(9):2056.
3. Suliga E, Kozieł D, Cieśla E, Głuszek S. Association between dietary patterns and metabolic syndrome in individuals with normal weight: a cross-sectional study. Nutrition journal. 2015 Dec;14:1-0.
4. Woo HD, Shin A, Kim J. Dietary patterns of Korean adults and the prevalence of metabolic syndrome: a cross-sectional study. PloS one. 2014 Nov 3;9(11):e111593.
5. Farhangi MA, Jahangiry L, Asghari-Jafarabadi M, Najafi M. Association between dietary patterns and metabolic syndrome in a sample of Tehranian adults. Obesity Research & Clinical Practice. 2016 Sep 1;10:S64-73.
6. Yoshida J, Eguchi E, Nagaoka K, Ito T, Ogino K. Association of night eating habits with metabolic syndrome and its components: a longitudinal study. BMC public health. 2018 Dec;18:1-2.
7. Bovolini A, Garcia J, Andrade MA, Duarte JA. Metabolic syndrome pathophysiology and predisposing factors. International journal of sports medicine. 2021 Mar;42(03):199-214.
8. Castro-Barquero S, Ruiz-León AM, Sierra-Pérez M, Estruch R, Casas R. Dietary strategies for metabolic syndrome: a comprehensive review. 2020 Sep 29;12(10):2983.
9. Moszak M, Szulińska M, Bogdański P. You are what you eat—the relationship between diet, microbiota, and metabolic disorders—a review. Nutrients. 2020 Apr 15;12(4):1096.
10. Pucci G, Alcidi R, Tap L, Battista F, Mattace-Raso F, Schillaci G. Sex-and gender-related prevalence, cardiovascular risk and therapeutic approach in metabolic syndrome: A review of the literature. Pharmacological research. 2017 Jun 1;120:34-42.
11. Rahe C, Unrath M, Berger K. Dietary patterns and the risk of depression in adults: a systematic review of observational studies. European journal of nutrition. 2014 Jun;53:997-1013.
12. Lippert K, Kedenko L, Antonielli L, Kedenko I, Gemeier C, Leitner M, Kautzky-Willer A, Paulweber B, Hackl E. Gut microbiota dysbiosis associated with glucose metabolism disorders and the metabolic syndrome in older adults. Beneficial microbes. 2017 Aug 24;8(4):545-56.