Diabetes Prevention

PDM: Metabolic Syndrome (2013)

• Assessment
  In adults with metabolic syndrome, what is the impact of macronutrient distribution, independent of weight loss, on glycemic-related outcomes (such as fasting blood glucose, random blood glucose, 2-hour postprandial blood glucose, A1C)?

  • Conclusion

    Research is inconclusive on the effect of macronutrient distribution (as a percentage of energy), independent of weight loss, on glycemic-related outcomes in adults with metabolic syndrome, related to the varying macronutrient distributions in study diets (12% to 30% protein; 20% to 38% fat; 48% to 65% carbohydrate). However, two feeding studies, also with diets of varying macronutrient distributions, report inconclusive results regarding the effect of macronutrient distribution on postprandial glycemia and insulinemia.

    Additional longer-term intervention studies are needed to ascertain an effect of macronutrient distribution on glycemic-related outcomes in adults with metabolic syndrome with or without meeting the metabolic syndrome criteria for impaired glucose tolerance and/or impaired fasting glucose. 

     

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In adults with metabolic syndrome, what is the impact of macronutrient distribution, independent of weight loss, on glycemic-related outcomes (such as fasting blood glucose, random blood glucose, two-hour post-prandial blood glucose, A1C)?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Khoury DE, Hwalla N, Frochot V, Lacorte JM, Chabert M, Kalopissis AD. Postprandial metabolic and hormonal responses of obese dyslipidemic subjects with metabolic syndrome to test meals, rich in carbohydrate, fat or protein. Atherosclerosis. 2010; 210(1): 307-313.
      • Konig D, Muser K, Berg A, Deibert P. Fuel selection and appetite-regulating hormones after intake of a soy protein-based meal replacement. Nutrition. 2012; 28(1): 35-39.
      • Lee K, Lee J, Bae WK, Choi JK, Kim HJ, Cho B. Efficacy of low-calorie, partial meal replacement diet plans on weight and abdominal fat in obese subjects with metabolic syndrome: A double-blind, randomized controlled trial of two diet plans - one high in protein and one nutritionally balanced. Int J Clin Pract. 2009; 63(2): 195-201.
      • Muzio F, Mondazzi L, Harris WS, Sommariva D, Branchi A. Effects of moderate variations in the macronutrient content of the diet on cardiovascular disease risk factors in obese patients with the metabolic syndrome. Am J Clin Nutr. 2007; 86 (4): 946-951.
      • Paniagua JA, Perez-Martinez P, Gjelstad IM, Tierney AC, Delgado-Lista J, Defoort C, Blaak EE, Riserus U, Drevon CA, Kiec-Wilk B, Lovegrove JA, Roche HM, Lopez-Miranda J, LIPGENE Study Investigators. A low-fat high-carbohydrate diet supplemented with long-chain n-3 PUFA reduces the risk of the metabolic syndrome. Atherosclerosis. 2011; 218(2): 443-450.
      • Tierney AC, McMonagle J, Shaw DI, Gulseth HL, Helal O, Saris WH, Paniagua JA, Golabek-Leszczynska I, Defoort C, Williams CM, Karlstrom B, Vessby B, Dembinska-Kiec A, Lopez-Miranda J, Blaak EE, Drevon CA, Gibney MJ, Lovegrove JA, Roche HM. Effects of dietary fat modification on insulin sensitivity and on other risk factors of the metabolic syndrome--LIPGENE: A European randomized dietary intervention study. Int J Obes (Lond). 2011; 35(6): 800-809.
      • Zhang SX, Guo HW, Wan WT, Xue K. Nutrition education guided by Dietary Guidelines for Chinese Residents on metabolic syndrome characteristics, adipokines and inflammatory markers. Asia Pac J Clin Nutr. 2011; 20(1): 77-86.
  • Search Plan and Results: PDM: Macronutrient Distribution and Metabolic Syndrome 2012
     
  In adults with metabolic syndrome, what is the impact of macronutrient distribution, independent of weight loss, on lipid outcomes (TG, HDL)?

  • Conclusion

    Research is inconclusive on the effect of macronutrient distribution (as a percentage of energy), independent of weight loss, on lipid outcomes in adults with metabolic syndrome, related to the varying macronutrient distributions in study diets (12% to 30% protein; 20% to 38% fat; 48% to 65% carbohydrate).

    Additional longer-term intervention studies are needed to ascertain an effect of macronutrient distribution on lipid outcomes in adults with metabolic syndrome with or without meeting the metabolic syndrome criteria for lipid levels.

     

     

     

    
     

     

     

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In adults with metabolic syndrome, what is the impact of macronutrient distribution, independent of weight loss, on lipid outcomes (TG, HDL)?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Camhi SM, Stefanick ML, Katzmarzyk PT, Young DR. Metabolic syndrome and changes in body fat from a low-fat diet and/or exercise randomized controlled trial. Obesity (Silver Spring). 2010; 18(3): 548-554.
      • Khoury DE, Hwalla N, Frochot V, Lacorte JM, Chabert M, Kalopissis AD. Postprandial metabolic and hormonal responses of obese dyslipidemic subjects with metabolic syndrome to test meals, rich in carbohydrate, fat or protein. Atherosclerosis. 2010; 210(1): 307-313.
      • Kolovou GD, Anagnostopoulou KK, Pavlidis AN, Salpea KD, Hoursalas IS, Manolis A, Cokkinos DV. Postprandial lipaemia in menopausal women with metabolic syndrome. Maturitas. 2006; 55(1): 19-26.
      • Lee K, Lee J, Bae WK, Choi JK, Kim HJ, Cho B. Efficacy of low-calorie, partial meal replacement diet plans on weight and abdominal fat in obese subjects with metabolic syndrome: A double-blind, randomized controlled trial of two diet plans - one high in protein and one nutritionally balanced. Int J Clin Pract. 2009; 63(2): 195-201.
      • Muzio F, Mondazzi L, Harris WS, Sommariva D, Branchi A. Effects of moderate variations in the macronutrient content of the diet on cardiovascular disease risk factors in obese patients with the metabolic syndrome. Am J Clin Nutr. 2007; 86 (4): 946-951.
      • Paniagua JA, Perez-Martinez P, Gjelstad IM, Tierney AC, Delgado-Lista J, Defoort C, Blaak EE, Riserus U, Drevon CA, Kiec-Wilk B, Lovegrove JA, Roche HM, Lopez-Miranda J, LIPGENE Study Investigators. A low-fat high-carbohydrate diet supplemented with long-chain n-3 PUFA reduces the risk of the metabolic syndrome. Atherosclerosis. 2011; 218(2): 443-450.
      • Tierney AC, McMonagle J, Shaw DI, Gulseth HL, Helal O, Saris WH, Paniagua JA, Golabek-Leszczynska I, Defoort C, Williams CM, Karlstrom B, Vessby B, Dembinska-Kiec A, Lopez-Miranda J, Blaak EE, Drevon CA, Gibney MJ, Lovegrove JA, Roche HM. Effects of dietary fat modification on insulin sensitivity and on other risk factors of the metabolic syndrome--LIPGENE: A European randomized dietary intervention study. Int J Obes (Lond). 2011; 35(6): 800-809.
      • Zhang SX, Guo HW, Wan WT, Xue K. Nutrition education guided by Dietary Guidelines for Chinese Residents on metabolic syndrome characteristics, adipokines and inflammatory markers. Asia Pac J Clin Nutr. 2011; 20(1): 77-86.
  • Search Plan and Results: PDM: Macronutrient Distribution and Metabolic Syndrome 2012
     
  In adults with metabolic syndrome, what is the impact of macronutrient distribution, independent of weight loss, on anthropometric outcomes (WC, WHR)?

  • Conclusion

    Research is inconclusive on the effect of macronutrient distribution (as a percentage of energy), independent of weight loss, on waist circumference (WC), independent of weight loss, in adults with metabolic syndrome, related to the varying macronutrient distributions in study diets (12% to 30% protein; 20% to 38% fat; 48% to 65% carbohydrate). Although not significant, there was a trend that macronutrient distribution may lead to a decrease in WC, when fat content was at least 30%. However, in one study with fat less than 30%, there was a positive effect on waist-to-hip ratio after one year. 

    Additional longer-term intervention studies are needed to ascertain an effect of macronutrient distribution on anthropometric outcomes in adults with metabolic syndrome with or without meeting the metabolic syndrome criteria for anthropometric measures.

     

     

     

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In adults with metabolic syndrome, what is the impact of macronutrient distribution, independent of weight loss, on anthropometric outcomes (WC, WHR)?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Camhi SM, Stefanick ML, Katzmarzyk PT, Young DR. Metabolic syndrome and changes in body fat from a low-fat diet and/or exercise randomized controlled trial. Obesity (Silver Spring). 2010; 18(3): 548-554.
      • Lee K, Lee J, Bae WK, Choi JK, Kim HJ, Cho B. Efficacy of low-calorie, partial meal replacement diet plans on weight and abdominal fat in obese subjects with metabolic syndrome: A double-blind, randomized controlled trial of two diet plans - one high in protein and one nutritionally balanced. Int J Clin Pract. 2009; 63(2): 195-201.
      • Muzio F, Mondazzi L, Harris WS, Sommariva D, Branchi A. Effects of moderate variations in the macronutrient content of the diet on cardiovascular disease risk factors in obese patients with the metabolic syndrome. Am J Clin Nutr. 2007; 86 (4): 946-951.
      • Paniagua JA, Perez-Martinez P, Gjelstad IM, Tierney AC, Delgado-Lista J, Defoort C, Blaak EE, Riserus U, Drevon CA, Kiec-Wilk B, Lovegrove JA, Roche HM, Lopez-Miranda J, LIPGENE Study Investigators. A low-fat high-carbohydrate diet supplemented with long-chain n-3 PUFA reduces the risk of the metabolic syndrome. Atherosclerosis. 2011; 218(2): 443-450.
      • Tierney AC, McMonagle J, Shaw DI, Gulseth HL, Helal O, Saris WH, Paniagua JA, Golabek-Leszczynska I, Defoort C, Williams CM, Karlstrom B, Vessby B, Dembinska-Kiec A, Lopez-Miranda J, Blaak EE, Drevon CA, Gibney MJ, Lovegrove JA, Roche HM. Effects of dietary fat modification on insulin sensitivity and on other risk factors of the metabolic syndrome--LIPGENE: A European randomized dietary intervention study. Int J Obes (Lond). 2011; 35(6): 800-809.
      • Zhang SX, Guo HW, Wan WT, Xue K. Nutrition education guided by Dietary Guidelines for Chinese Residents on metabolic syndrome characteristics, adipokines and inflammatory markers. Asia Pac J Clin Nutr. 2011; 20(1): 77-86.
  • Search Plan and Results: PDM: Macronutrient Distribution and Metabolic Syndrome 2012
     
  In adults with metabolic syndrome, what is the impact of macronutrient distribution, independent of weight loss, on blood pressure?

  • Conclusion

    Research is inconclusive on the effect of macronutrient distribution (as a percentage of energy), independent of weight loss, on blood pressure in adults with metabolic syndrome, related to the varying macronutrient distributions in study diets (12% to 19% protein; 22% to 38% fat; 48% to 65% carbohydrate).

    Additional longer-term intervention studies are needed to ascertain an effect of macronutrient distribution on blood pressure in adults with metabolic syndrome with or without meeting the metabolic syndrome criteria for blood pressure.

     

     

     

     

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In adults with metabolic syndrome, what is the impact of macronutrient distribution, independent of weight loss, on blood pressure?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Gulseth HL, Gjelstad IM, Tierney AC, Shaw DI, Helal O, Hees AM, Delgado-Lista J, Leszczynska-Golabek I, Karlstrom B, Lovegrove J, Defoort C, Blaak EE, Lopez-Miranda J, Dembinska-Kiec A, Riserus U, Roche HM, Birkeland KI, Drevon CA. Dietary fat modifications and blood pressure in subjects with the metabolic syndrome in the LIPGENE dietary intervention study. Br J Nutr. 2010; 104(2): 160-163.
      • Muzio F, Mondazzi L, Harris WS, Sommariva D, Branchi A. Effects of moderate variations in the macronutrient content of the diet on cardiovascular disease risk factors in obese patients with the metabolic syndrome. Am J Clin Nutr. 2007; 86 (4): 946-951.
      • Paniagua JA, Perez-Martinez P, Gjelstad IM, Tierney AC, Delgado-Lista J, Defoort C, Blaak EE, Riserus U, Drevon CA, Kiec-Wilk B, Lovegrove JA, Roche HM, Lopez-Miranda J, LIPGENE Study Investigators. A low-fat high-carbohydrate diet supplemented with long-chain n-3 PUFA reduces the risk of the metabolic syndrome. Atherosclerosis. 2011; 218(2): 443-450.
      • Tierney AC, McMonagle J, Shaw DI, Gulseth HL, Helal O, Saris WH, Paniagua JA, Golabek-Leszczynska I, Defoort C, Williams CM, Karlstrom B, Vessby B, Dembinska-Kiec A, Lopez-Miranda J, Blaak EE, Drevon CA, Gibney MJ, Lovegrove JA, Roche HM. Effects of dietary fat modification on insulin sensitivity and on other risk factors of the metabolic syndrome--LIPGENE: A European randomized dietary intervention study. Int J Obes (Lond). 2011; 35(6): 800-809.
      • Zhang SX, Guo HW, Wan WT, Xue K. Nutrition education guided by Dietary Guidelines for Chinese Residents on metabolic syndrome characteristics, adipokines and inflammatory markers. Asia Pac J Clin Nutr. 2011; 20(1): 77-86.
  • Search Plan and Results: PDM: Macronutrient Distribution and Metabolic Syndrome 2012
     
  In adults with metabolic syndrome, what is the impact of macronutrient distribution, independent of weight loss, on renal outcomes?

  • Conclusion

    There were no studies identified to evaluate the impact of macronutrient distribution (as a percentage of energy), independent of weight loss, on renal outcomes in adults with metabolic syndrome.

    Intervention studies are needed to ascertain an effect of macronutrient distribution on renal outcomes in adults with metabolic syndrome with or without meeting the metabolic syndrome criteria for renal measures.
     

  • Grade: V
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Search Plan and Results: PDM: Macronutrient Distribution and Metabolic Syndrome 2012