Nutraceutical approaches to metabolic syndrome

Figures & data

Table 1. Risk factors for the clinical diagnosis of metabolic syndrome.

	Value	Alternative indicator
Waist circumference	^a> 94 cm in males, >80 cm in females ^b>102 cm in males, >88 cm in females
Raised blood pressure	Systolic ≥130 and/or diastolic ≥85 mm Hg	Treatment of previously diagnosed hypertension
Raised FPG	≥100 mg/dl (5.6 mmol/l)	Previously diagnosed of T2DM
Raised TG	>150 mg/dl (1.7 mmol/l)	Specific pharmacological treatment
Reduced HDL-C	<40 mg/dl (1.0 mmol/l) in males <50 mg/dl (1.3 mmol/l) in females	Specific pharmacological treatment

^a Based on the International Diabetes Federation (IDF) threshold for Europid population.

^b Based on the AHA/NHLBI (ATP III) threshold for USA population.

FPG: fasting plasma glucose; TG: triglycerides; HDL-C: high-density lipoprotein-cholesterol; T2DM: type 2 diabetes mellitus.

Conversion factors: (i) mg/dl cholesterol = mmol/l × 38.6; (ii) mg/dl triglycerides = mmol/l × 88.5 and (iii) mg/dl glucose = mmol/l × 18. Reproduced with permission of Elsevier [64].

Figure 1. Percentage median changes of non-HDL-C. Subjects randomly assigned to receive the experimental diet, containing whole soy foods corresponding to 30 g/day soy protein in substitution of animal foods containing the same amount of protein or the control diet containing the animal foods, for 12 weeks [with permission of Elsevier [78]].

Figure 2. The development of obesity, insulin resistance, type 2 diabetes and metabolic syndrome in general are the consequence of a complex multidirectional interaction between host genetics, environment, diet and the gut microbiota [with permission of Elsevier [86]].

Figure 3. Main mechanisms of action of berberine on the components of metabolic syndrome. AMPK: 5' AMP-activated protein kinase; GLP-1: gut hormone glucagon-like peptide; LDL: low-density lipoprotein; PCSK9: proprotein convertase subtilisin/kexin type 9; SREBP-2: sterol regulatory element-binding transcription factor 2 [adapted with permission of Elsevier [205]].

Table 2. Effects of nutraceuticals on the features of metabolic syndrome: evidence from randomized-controlled trials and meta-analysis.

Nutraceuticals	Waist circumference	Blood pressure	Triglycerides	HDL-C	Fasting plasma glucose
Lupin					↓ [54]
Soy	↓ [75,76,78]	↔ [51]	↓ [72]		↓ [71]
Probiotics	↔ [93] and ↓ [96]^a	↓ [101]	↔ [91] and ↓ [102]^a	↔ [91] and ↔ [102]^a	↔ [106] and ↓ [107]^a
Prebiotics and synbiotics			↔ [115] and ↓ [118]^a	↑ [118]^a	↔ [106]
Vitamin D		↔ [137]
Curcumin			↓ [151,152]	↑ [151,152]	↓ [148,149,150]
Berberine			↓ [166,169]		↓ [163,166,169]
Red Yeast Rice		↓ [191,192]

^a Data extrapolated from a sub-analysis taking into consideration duration of treatment, number of metabolic syndrome features, source of probiotics or prebiotics and daily dose consumption [96,102,107,118]. HDL-C: high-density lipoprotein cholesterol; ↓: reduction; ↑: increment; ↔: no effects.

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