Skip to main content

Body composition changes and cardiometabolic benefits of a balanced Italian Mediterranean Diet in obese patients with metabolic syndrome


Metabolic syndrome (MS) is a cluster of metabolic alteration associated with a higher risk of cardiovascular disease and overall mortality than the single alterations alone. The Italian Mediterranean Diet (IMD) can exert a positive effect on cardiovascular risk and related morbidity and mortality. The aim was to evaluate the benefits of dietary intervention based on a typical IMD on body composition, cardiometabolic changes and reduction in cardiovascular disease in patients with MS. Eighty White Italian subjects with MS were prescribed a balanced hypocaloric IMD. We investigated dietary habits and impact of the diet on health status, blood biochemical markers, anthropometric measurements and body composition during a 6-month follow-up period. Body composition, fat mass and distribution were assessed by Dual X-ray absorptiometry. Adherence to the IMD led to a decrease in body weight (102.59 ± 16.82 to 92.39 ± 15.94 kg, p < 0.001), body mass index (BMI) (38.57 ± 6.94 to 35.10 ± 6.76, <0.001) and waist circumference (112.23 ± 12.55 vs 92.42 ± 18.17 cm, p < 0.001). A significant loss of total body fat especially in waist region was observed. The MS was resolved in 52 % of the patients. Significant improvements in systolic and diastolic blood pressure and fasting glucose occurred. Low-density lipoprotein cholesterol was reduced from 128.74 ± 33.18 to 108.76 ± 38.61 mg/dl (p < 0.001), triglycerides from 169.81 ± 80.80 to 131.02 ± 63.88 mg/dl (p < 0.001). The present results suggest that a dietary intervention based on a typical IMD effectively promotes weight loss and reduces the growing burden of cardiovascular risk factors that typifies patients with MS.

This is a preview of subscription content, access via your institution.


  1. 1.

    World Health Organization (2009) Global health risks: mortality and burden of disease attributable to selected major risk factors. World Health Organization, Geneva, Switzerland

    Google Scholar 

  2. 2.

    Wang YC, McPherson K, Marsh T, Gortmaker SL, Brown M. (2011) Health and economic burden of the projected obesity trends in the USA and the UK. Lancet. 27; 378 (9793): 815–825

    Google Scholar 

  3. 3.

    Janghorbani M, Amini M (2011) Associations of hip circumference and height with incidence of type 2 diabetes: the Isfahan diabetes prevention study. Acta Diabetol. doi:10.1007/s00592-011-0351-4

    Google Scholar 

  4. 4.

    Wannamethee SG, Shaper AG, Lennon L, Morris RW (2005) Metabolic syndrome vs Framingham Risk Score for prediction of coronary heart disease, stroke, and type 2 diabetes mellitus. Arch Intern Med 165(22):2644–2650

    PubMed  Article  Google Scholar 

  5. 5.

    Ervin RB (2009) 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. Natl Health Stat Report 13:1–7

    PubMed  Google Scholar 

  6. 6.

    Alberti KG, Zimmet P, Shaw J (2005) IDF epidemiology task force consensus group: the metabolic syndrome a new worldwide definition. Lancet 366:1059–1062

    PubMed  Article  Google Scholar 

  7. 7.

    Panagiotakos DB, Polychronopoulos E (2005) The role of Mediterranean diet in the epidemiology of metabolic syndrome; converting epidemiology to clinical practice. Lipids Health Dis 12:4–7

    Google Scholar 

  8. 8.

    Keys A, Menotti A, Karvonen MJ et al (1986) The diet and 15-year death rate in the seven countries study. Am J Epidemiol 124(6):903–915

    PubMed  CAS  Google Scholar 

  9. 9.

    Alberti KG, Zimmet PZ (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 15(7):539–553

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Grundy SM, Cleeman JI, Daniels SR et al (2005) Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 112(17):2735–2752

    PubMed  Article  Google Scholar 

  11. 11.

    Expert Panel on Detection (2001) Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 285(19):2486–2497

    Article  Google Scholar 

  12. 12.

    Chrysohoou C, Panagiotakos DB, Pitsavos C, Das UN, Stefanadis C (2004) Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults: the ATTICA Study. J Am Coll Cardiol 44(1):152–158

    PubMed  Article  Google Scholar 

  13. 13.

    Knoops KT, de Groot LC, Kromhout D et al (2004) Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA 292(12):1433–1439

    PubMed  Article  Google Scholar 

  14. 14.

    Sofi F, Cesari F, Abbate R, Gensini GF, Casini A (2008) Adherence to Mediterranean diet and health status: meta-analysis. BMJ 337:a1344

    PubMed  Article  Google Scholar 

  15. 15.

    Rallidis LS, Lekakis J, Kolomvotsou A et al (2009) Close adherence to a Mediterranean diet improves endothelial function in subjects with abdominal obesity. Am J Clin Nutr 90(2):263–268

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Psaltopoulou T, Naska A, Orfanos P, Trichopoulos D, Mountokalakis T, Trichopoulou A (2004) Olive oil, the Mediterranean diet, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study. Am J Clin Nutr 80(4):1012–1018

    PubMed  CAS  Google Scholar 

  17. 17.

    Fidanza F, Alberti A, Fruttini D (2005) The Nicotera diet: the reference Italian Mediterranean diet. World Rev Nutr Diet 95:115–121

    PubMed  Article  Google Scholar 

  18. 18.

    De Lorenzo A, Noce A, Bigioni M et al (2010) The effects of Italian Mediterranean organic diet (IMOD) on health status. Curr Pharm Des 16(7):814–824

    PubMed  Article  Google Scholar 

  19. 19.

    Shai I, Shahar DR, Vardi H, Fraser D (2004) Selection of food items for inclusion in a newly developed food-frequency questionnaire. Public Health Nutr 7(6):745–749

    PubMed  Article  Google Scholar 

  20. 20.

    De Lorenzo A, Tagliabue A, Andreoli A, Testolin G, Comelli M, Deurenberg P (2001) Measured and predicted resting metabolic rate in Italian males and females, aged 18–59 year. Eur J Clin Nutr 55(3):208–214

    PubMed  Article  Google Scholar 

  21. 21.

    Alberti-Fidanza A, Fidanza F (2004) Mediterranean adequacy index of Italian diets. Public Health Nutr 7(7):937–941

    PubMed  Article  Google Scholar 

  22. 22.

    Millàn J, Pintò X, Munoz A et al (2009) Lipoprotein ratios: physiological significance and clinical usefulness in cardiovascular prevention. Vasc Health Risk Manag 5:757–765

    PubMed  Google Scholar 

  23. 23.

    Sofi F, Abbate R, Gensini GF, Casini A (2010) Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr 92(5):1189–1196

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Panagiotakos DB, Tzima N, Pitsavos C et al (2007) The association between adherence to the Mediterranean diet and fasting indices of glucose homeostasis: the ATTICA Study. J Am Coll Nutr 26:32–38

    PubMed  Google Scholar 

  25. 25.

    De Lorenzo A, Andreoli A, Sorge RP et al (1999) Modification of dietary habits (Mediterranean diet) and cancer mortality in a southern Italian village from 1960 to 1996. Ann N Y Acad Sci 889:224–229

    PubMed  Article  Google Scholar 

  26. 26.

    McKeown NM, Meigs JB, Liu S et al (2004) Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care 27:538–5346

    PubMed  Article  Google Scholar 

  27. 27.

    Perez-Jimenez F, Lopez-Miranda J, Pinillos MD et al (2001) A mediterranean and a high-carbohydrate diet improve glucose metabolism in healthy young persons. Diabetologia 44:2038–2043

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Shai I, Schwarzfuchs D, Henkin Y et al (2008) Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 359(3):229–241

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Martínez-González MA, Sánchez-Villegas A (2004) The emerging role of Mediterranean diets in cardiovascular epidemiology: monounsaturated fats, olive oil, red wine or the whole pattern? Eur J Epidemiol 19(1):9–13

    PubMed  Article  Google Scholar 

  30. 30.

    Brunner EJ, Wunsch H, Marmot MG (2001) What is an optimal diet? Relationship of macronutrient intake to obesity, glucose tolerance, lipoprotein cholesterol levels and the metabolic syndrome in the Whitehall II Study. Int J Obes Relat Metab Disord 25:45–53

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Skulas-Ray AC, West SG, Davidson MH, Kris-Etherton PM (2008) Omega-3 fatty acid concentrates in the treatment of moderate hypertriglyceridemia. Expert Opin Pharmacother 9:1237–1248

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Rizza S, Tesauro M, Cardillo C, Galli A, Iantorno M, Gigli F, Sbraccia P, Federici M, Quon MJ, Lauro D (2009) Fish oil supplementation improves endothelial function in normoglycemic offspring of patients with type 2 diabetes. Atherosclerosis 206(2):569–574

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Rasmussen BM, Vessby B, Uusitupa M & the KANWU Study Group. (2006). Effects of dietary saturated, monounsaturated, and n-3 fatty acids on BP in healthy subjects. Am J Clin Nutr; 83: 221–226

    Google Scholar 

  34. 34.

    George A, Deemer SE, Dixie L (2010) Thompson Adiponectin is associated with risk of the metabolic syndrome and insulin resistance in women. Acta Diabetol 2010:8. doi:10.1007/s00592-010-0192-6

    Google Scholar 

  35. 35.

    Salas-Salvado J, Garcia-Arellano A, Estruch R et al (2008) Components of the Mediterranean-type food pattern and serum inflammatory markers among patients at high risk for cardiovascular disease. Eur J Clin Nutr 62(5):651–659

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Carr DB, Utzschneider KM, Hull RL et al. Intra-abdominal fat is a major determinant of the National Cholesterol Education Program Adult Treatment Panel III criteria for the metabolic syndrome. Diabetes. 2004; 53b(8): 2087–2094

    Google Scholar 

  37. 37.

    De Lorenzo A, Deurenberg P, Pietrantuono M et al (2003) How fat is obese? Acta Diabetol 40(Suppl 1):S254–S257

    PubMed  Article  Google Scholar 

  38. 38.

    Di Renzo L, Galvano F, Orlandi C et al (2010) Oxidative stress in normal-weight obese syndrome. Obesity (Silver Spring) 18(11):2125–2130

    Article  Google Scholar 

  39. 39.

    Cameron AJ, Shaw JE, Zimmet PZ. The metabolic syndrome: prevalence in worldwide populations. Endocrinol Metab Clin North Am 2004; 33: 351–375.] but indicate that between 13 and 30% of people in developing countries

  40. 40.

    Mohan V, Deepa M (2006) The metabolic syndrome in developing countries. Diabet Voice 51:15–17

    Google Scholar 

  41. 41.

    Ford ES, Giles WH, Mokdad AH (2004) Increasing prevalence of the metabolic syndrome among US adults. Diabetes Care 27:2444–2449

    PubMed  Article  Google Scholar 

  42. 42.

    Eckel RH, Grundy SM, Zimmet PZ (2005) The metabolic syndrome. Lancet 365:1415–1428

    PubMed  Article  CAS  Google Scholar 

  43. 43.

    Dunkley AJ, Charles K, Gray LJ, Camosso-Stefinovic J, Davies MJ, Khunti K (2012) Effectiveness of interventions for reducing diabetes and cardiovascular disease risk in people with metabolic syndrome: systematic review and mixed treatment comparison meta-analysis. Diabet Obes Metabol 14:616–625

    Article  CAS  Google Scholar 

Download references


We acknowledge all Italian Mediterranean Diet Study Group, composed by Antonino De Lorenzo, Laura Di Renzo, Leonardo Iacopino, Francesca Sarlo, Luigi Petramala, Domenico Giovanni Della Rocca, Mariagiovanna Rizzo, Emidio Domino, Alberto Carraro, Nicoletta Del Duca, Simona Giglio, Valentina Fondacaro, Roberto Valente, Fabrizio Spataro, Maria Rosaria Lentini, Antonella Pellegrino, Maria Francesca Vidiri, Giuseppe Fortugno, Sara Calamusa, Marta Piazzolla, Federica Fabiocchi, Alessia Bianchi, Gioacchino Paci, Giovanna Maria Paola Tonini.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information



Corresponding author

Correspondence to Antonino De Lorenzo.

Additional information

Nicola Di Daniele, Luigi Petramala, Laura Di Renzo equally contributed to this work.

Communicated by Massimo Federici.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Di Daniele, N., Petramala, L., Di Renzo, L. et al. Body composition changes and cardiometabolic benefits of a balanced Italian Mediterranean Diet in obese patients with metabolic syndrome. Acta Diabetol 50, 409–416 (2013).

Download citation


  • Italian Mediterranean Diet
  • Body composition
  • Metabolic syndrome
  • Cardiovascular disease