The effects of a whole grain-enriched hypocaloric diet on cardiovascular disease risk factors in men and women with metabolic syndrome.

BACKGROUND Whole-grain foods are associated in observational studies with a lower body mass index and lower cardiovascular disease (CVD) risk. However, few clinical trials have tested whether incorporating whole grains into a hypocaloric diet increases weight loss and improves CVD risk factors. OBJECTIVE The aim of this study was to determine whether including whole-grain foods in a hypocaloric (reduced by 500 kcal/d) diet enhances weight loss and improves CVD risk factors. DESIGN Obese adults (25 M, 25 F) with metabolic syndrome were randomly assigned to receive dietary advice either to avoid whole-grain foods or to obtain all of their grain servings from whole grains for 12 wk. All participants were given the same dietary advice in other respects for weight loss. RESULTS Body weight, waist circumference, and percentage body fat decreased significantly (P<0.001) in both groups over the study period, but there was a significantly (P=0.03) greater decrease in percentage body fat in the abdominal region in the whole-grain group than in the refined-grain group. C-reactive protein (CRP) decreased 38% in the whole-grain group independent of weight loss but was unchanged in the refined-grain group (P=0.01 for group x time interaction). Total, LDL, and HDL cholesterol decreased in both diet groups (P<0.05). Dietary fiber and magnesium intakes increased in the whole-grain but not the refined-grain group (P=0.007 and P<0.001, respectively, for group x time interaction). CONCLUSIONS Both hypocaloric diets were effective means of improving CVD risk factors with moderate weight loss. There were significantly (P<0.05) greater decreases in CRP and percentage body fat in the abdominal region in participants consuming whole grains than in those consuming refined grains.

[1]  Geert Molenberghs,et al.  Random Effects Models for Longitudinal Data , 2010 .

[2]  S B Roberts,et al.  Dietary fiber and weight regulation. , 2009, Nutrition reviews.

[3]  Judith Wylie-Rosett,et al.  Nutrition Recommendations and Interventions for Diabetes , 2008, Diabetes Care.

[4]  G. Di Fede,et al.  Abdominal fat quantity and distribution in women with polycystic ovary syndrome and extent of its relation to insulin resistance. , 2007, The Journal of clinical endocrinology and metabolism.

[5]  L. Niskanen,et al.  Dietary carbohydrate modification induces alterations in gene expression in abdominal subcutaneous adipose tissue in persons with the metabolic syndrome: the FUNGENUT Study. , 2007, The American journal of clinical nutrition.

[6]  J. Slavin,et al.  Nutrition Journal BioMed Central , 2006 .

[7]  Arch G Mainous,et al.  Effect of a high-fiber diet vs a fiber-supplemented diet on C-reactive protein level. , 2007, Archives of internal medicine.

[8]  M. Hanefeld,et al.  Anti-inflammatory effects of pioglitazone and/or simvastatin in high cardiovascular risk patients with elevated high sensitivity C-reactive protein: the PIOSTAT Study. , 2007, Journal of the American College of Cardiology.

[9]  N. Paynter,et al.  The effect of weight loss on C-reactive protein: a systematic review. , 2007, Archives of internal medicine.

[10]  S. Daniels,et al.  Summary of American Heart Association Diet and Lifestyle Recommendations Revision 2006 , 2006, Arteriosclerosis, thrombosis, and vascular biology.

[11]  J. Rippe,et al.  Consumption of whole-grain cereals during weight loss: effects on dietary quality, dietary fiber, magnesium, vitamin B-6, and obesity. , 2006, Journal of the American Dietetic Association.

[12]  E. Schaefer,et al.  Low-carbohydrate or low-fat diets for the metabolic syndrome? , 2006, Current diabetes reports.

[13]  P. Ridker,et al.  Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER)--can C-reactive protein be used to target statin therapy in primary prevention? , 2006, The American journal of cardiology.

[14]  R. Krauss,et al.  Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement , 2005, Current opinion in cardiology.

[15]  E. Ford.  Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. , 2005, Diabetes care.

[16]  W. M. Miller,et al.  Effects of weight loss and pharmacotherapy on inflammatory markers of cardiovascular disease , 2005, Expert review of cardiovascular therapy.

[17]  A. Kunselman,et al.  Changes in glucose tolerance over time in women with polycystic ovary syndrome: a controlled study. , 2005, The Journal of clinical endocrinology and metabolism.

[18]  E. Schaefer,et al.  Effects of atorvastatin versus other statins on fasting and postprandial C-reactive protein and lipoprotein-associated phospholipase A2 in patients with coronary heart disease versus control subjects. , 2005, The American journal of cardiology.

[19]  J. Douketis,et al.  Obesity and cardiovascular disease: pathogenic mechanisms and potential benefits of weight reduction. , 2005, Seminars in vascular medicine.

[20]  P. Kris-Etherton,et al.  Dietary α-Linolenic Acid Reduces Inflammatory and Lipid Cardiovascular Risk Factors in Hypercholesterolemic Men and Women , 2004 .

[21]  Ali H Mokdad,et al.  Increasing prevalence of the metabolic syndrome among u.s. Adults. , 2004, Diabetes care.

[22]  R. Marfella,et al.  Effect of a mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. , 2004, JAMA.

[23]  M. Rodríguez-Moran,et al.  Oral magnesium supplementation improves insulin sensitivity in non-diabetic subjects with insulin resistance. A double-blind placebo-controlled randomized trial. , 2004, Diabetes & metabolism.

[24]  S. Grundy,et al.  Clinical management of metabolic syndrome: report of the American Heart Association/National Heart, Lung, and Blood Institute/American Diabetes Association conference on scientific issues related to management. , 2004, Arteriosclerosis, thrombosis, and vascular biology.

[25]  P. Wilson,et al.  Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. , 2004, Diabetes care.

[26]  J. Manson,et al.  Relation between changes in intakes of dietary fiber and grain products and changes in weight and development of obesity among middle-aged women. , 2003, The American journal of clinical nutrition.

[27]  E. Mayer-Davis,et al.  Whole-grain intake and insulin sensitivity: the Insulin Resistance Atherosclerosis Study. , 2003, The American journal of clinical nutrition.

[28]  D. Frankenfield,et al.  Validation of several established equations for resting metabolic rate in obese and nonobese people. , 2003, Journal of the American Dietetic Association.

[29]  M. Rodríguez-Moran,et al.  Oral magnesium supplementation improves insulin sensitivity and metabolic control in type 2 diabetic subjects: a randomized double-blind controlled trial. , 2003, Diabetes care.

[30]  E. Rimm,et al.  Whole grain consumption and weight gain: a review of the epidemiological evidence, potential mechanisms and opportunities for future research , 2003, Proceedings of the Nutrition Society.

[31]  Lawrence A Leiter,et al.  Effect of wheat bran on glycemic control and risk factors for cardiovascular disease in type 2 diabetes. , 2002, Diabetes care.

[32]  S. Heymsfield,et al.  Are dual-energy X-ray absorptiometry regional estimates associated with visceral adipose tissue mass? , 2002, International Journal of Obesity.

[33]  R. Krauss,et al.  Reduced LDL particle size in children consuming a very-low-fat diet is related to parental LDL-subclass patterns. , 2000, The American journal of clinical nutrition.

[34]  D. Jacobs,et al.  Plausible mechanisms for the protectiveness of whole grains. , 1999, The American journal of clinical nutrition.

[35]  M. Matsuda,et al.  Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. , 1999, Diabetes care.

[36]  M. Kenward,et al.  Small sample inference for fixed effects from restricted maximum likelihood. , 1997, Biometrics.

[37]  G. Paolisso,et al.  Changes in glucose turnover parameters and improvement of glucose oxidation after 4-week magnesium administration in elderly noninsulin-dependent (type II) diabetic patients. , 1994, The Journal of clinical endocrinology and metabolism.

[38]  R. Krauss,et al.  Production of polyacrylamide gradient gels for the electrophoretic resolution of lipoproteins. , 1992, Journal of lipid research.

[39]  A. Dattilo,et al.  Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. , 1992, The American journal of clinical nutrition.

[40]  G. Paolisso,et al.  Improved Insulin Response and Action by Chronic Magnesium Administration in Aged NIDDM Subjects , 1989, Diabetes Care.

[41]  J. Ware,et al.  Random-effects models for longitudinal data. , 1982, Biometrics.

[42]  R. Levy,et al.  Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. , 1972, Clinical chemistry.

[43]  N. Rifai,et al.  C-reactive protein: a nontraditional serum marker of cardiovascular risk. , 2007, Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology.

[44]  P. Jacques,et al.  Whole-grain intake is inversely associated with the metabolic syndrome and mortality in older adults. , 2006, The American journal of clinical nutrition.

[45]  H. Minuk,et al.  Metabolic syndrome. , 2005, Journal of insurance medicine.

[46]  P. Kris-Etherton,et al.  Dietary alpha-linolenic acid reduces inflammatory and lipid cardiovascular risk factors in hypercholesterolemic men and women. , 2004, The Journal of nutrition.

[47]  R. W. Ball,et al.  Acute Phase Responses and Cytokine Secretion in Chronic Fatigue Syndrome , 2004, Journal of Clinical Immunology.

[48]  J. Mckenney,et al.  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). , 2001, JAMA.

[49]  Claude Bouchard,et al.  Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: Executive summary , 1998 .