The overall goal is to compare the efficacy of two intervention approaches to dietary change among patients with the metabolic syndrome. Metabolic syndrome, which affects nearly 27% of US adults, is a national priority for prevention of CHD as described by the National Cholesterol Education Program's Adult Treatment Panel III. Weight loss is paramount in recommendations for metabolic syndrome. Results from three recent review articles agreed that adding dietary fiber can aid weight loss and weight loss maintenance;dietary fiber also exerts clinical benefits on several components of the metabolic syndrome, including waist circumference, glucose and lipid homeostasis, and insulin control. Despite this, the average fiber intake of adults in the United States is less than half recommended levels. In addition, interventions that target dietary change have typically not been successful with adherence to all recommendations in the short term, and with maintaining changes in diet over the longer term. A contributing factor to poor dietary adherence is likely of the complexity of dietary guidelines. We propose that a simplified dietary intervention strategy that focuses on a key aspect of dietary quality, fiber intake, will overcome the poor adherence typically associated with dietary interventions and improve overall diet quality. We will recruit 240 overweight and obese adults from a primary care setting who meet diagnostic criteria for metabolic syndrome. The efficacy of the two dietary change interventions will be compared in a randomized controlled trial, with 120 patients per group. The two approaches are 1) the American Heart Association (AHA) Dietary Guidelines;and 2) a simple dietary change condition that focuses on increasing fiber. Patients in both conditions will receive intensive dietary instruction for 3 months, followed by a 9 month maintenance phase. Both conditions will receive dietary instructions via individual and group sessions led by registered dietitians. Assessments, including diet, anthropometrics, blood pressure, fasting blood glucose, glycosylated hemoglobin (HbA1c), blood lipids, insulin, inflammatory markers, medication use, depression, quality of life, and physical activity will be conducted at baseline and at 6-, and 12-months after randomization. A 3-month post-intensive intervention assessment will measure short-term changes in body weight, diet, and metabolic syndrome indicators. We hypothesize that participants randomized to the higher fiber condition will have significantly greater weight loss, improvements in metabolic health, and dietary quality at follow-up, compared to those randomized to the AHA diet condition. Such a simple message, if found efficacious for weight loss, metabolic health, dietary quality and adherence in a clinical setting might then be ideal for testing as a public health message.

Public Health Relevance

Identifying a simple dietary recommendation for weight loss and metabolic health may demonstrate potential for a simple public health message to impact CHD prevention and metabolic syndrome. In a randomized clinical trial, we propose to compare the efficacy of two intervention approaches to dietary change for CHD prevention among persons with metabolic syndrome. The two approaches are 1) the AHA Dietary Guidelines;and 2) a simple dietary change condition that focuses on increasing fiber. We hypothesize that a message promoting high fiber intake may be the simple message that has potential to produce broad impact.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Kidney, Nutrition, Obesity and Diabetes (KNOD)
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Arteaga, Sonia M
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University of Massachusetts Medical School Worcester
Internal Medicine/Medicine
Schools of Medicine
United States
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Zhang, Lijuan; Pagoto, Sherry; May, Christine et al. (2018) Effect of AHA dietary counselling on added sugar intake among participants with metabolic syndrome. Eur J Nutr 57:1073-1082
Zhang, Lijuan; Cordeiro, Lorraine S; Liu, Jinghua et al. (2017) The Association between Breakfast Skipping and Body Weight, Nutrient Intake, and Metabolic Measures among Participants with Metabolic Syndrome. Nutrients 9:
Whited, Matthew C; Olendzki, Effie; Ma, Yunsheng et al. (2016) Obstructive sleep apnea and weight loss treatment outcome among adults with metabolic syndrome. Health Psychol 35:1316-1319
Tabung, Fred K; Steck, Susan E; Ma, Yunsheng et al. (2015) The association between dietary inflammatory index and risk of colorectal cancer among postmenopausal women: results from the Women's Health Initiative. Cancer Causes Control 26:399-408
Wedick, Nicole M; Ma, Yunsheng; Olendzki, Barbara C et al. (2015) Access to healthy food stores modifies effect of a dietary intervention. Am J Prev Med 48:309-17
Ma, Yunsheng; Olendzki, Barbara C; Wang, Jinsong et al. (2015) Single-component versus multicomponent dietary goals for the metabolic syndrome: a randomized trial. Ann Intern Med 162:248-57
Olendzki, Barbara C; Silverstein, Taryn D; Persuitte, Gioia M et al. (2014) An anti-inflammatory diet as treatment for inflammatory bowel disease: a case series report. Nutr J 13:5
Shivappa, Nitin; Steck, Susan E; Hurley, Thomas G et al. (2014) A population-based dietary inflammatory index predicts levels of C-reactive protein in the Seasonal Variation of Blood Cholesterol Study (SEASONS). Public Health Nutr 17:1825-33
Whited, Matthew C; Schneider, Kristin L; Appelhans, Bradley M et al. (2014) Severity of depressive symptoms and accuracy of dietary reporting among obese women with major depressive disorder seeking weight loss treatment. PLoS One 9:e90361
Qiao, Yongxia; Tinker, Lesley; Olendzki, Barbara C et al. (2014) Racial/ethnic disparities in association between dietary quality and incident diabetes in postmenopausal women in the United States: the Women's Health Initiative 1993-2005. Ethn Health 19:328-47

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