Dietary Approaches to Prevent the Metabolic Syndrome
Quality versus quantity of carbohydrates
- Matthias B. Schulze, DRPH1 and
- Frank B. Hu, MD123
- 1Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
- 2Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
- 3Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Address correspondence to Matthias B. Schulze, Department of Nutrition, Harvard School of Public Health, 655 Huntington Ave. #315, Boston, MA 02115. E-mail: mschulze{at}hsph.harvard.edu
The metabolic syndrome refers to a cluster of specific abnormalities with insulin resistance as the underlying pathophysiological defect. Its clinical identification is based on measures of abdominal obesity, atherogenic dyslipidemia, raised blood pressure, and glucose intolerance (1). About one-fourth of U.S. adults have the metabolic syndrome, according to the criteria defined by the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP ATP III) (2). Given the continuing epidemic of overweight and obesity, it is likely that the prevalence of the metabolic syndrome will continue to grow. The metabolic syndrome is a precursor to type 2 diabetes and a strong risk factor for coronary heart disease (CHD) and stroke (1).
The metabolic syndrome has been identified as a target for dietary therapies to reduce cardiovascular disease risk other than LDL cholesterol lowering by the NCEP ATP III (1). Although clear evidence from metabolic studies, epidemiological studies, and clinical trials supports the consumption of unsaturated fats from natural liquid vegetable oils and nuts at the expense of saturated and trans fats (rather than simply lowering total fat) in the treatment of various components of the metabolic syndrome (e.g., dyslipidemia, insulin resistance, and glucose intolerance) and in the prevention of CHD (3), the optimal types and amounts of carbohydrates in the diet remain controversial. It is now well established that low-fat, high-carbohydrate diets not only …
