Role of nutrients in metabolic syndrome: a 2017 update

Figures & data

Figure 1 Select nutrients on metabolic syndrome parameters.

Notes: ^aFavorable influence: human data indicate postive influence of a single or group of nutrient(s) on metabolic syndrome parameters. ^bUnfavorable influence: human data indicate negative influence of a single or group of nutrient(s) on metabolic syndrome parameters. ^cInconclusive influence: human data are inconsistent or lacking. ^dArmolipid plus (AP): a commercial dietary supplement combining policosanol, berberine, red yeast rice extract, folic acid, coenzyme Q10, and asthaxantine.

Table S1 Summary of reviews and meta-analyses (2005–2017)

Reference	Metabolic syndrome parameters	Nutrients/factors reviewed	Main findings	Comments
25	Diabetes	Vitamin D	Human clinical trials produced controversial data on the effects of vitamin D supplementation on diabetic parameters both in healthy and diabetic subjects	A review of observational studies and clinical trials
33	Obesity/T2DM/hypertension	CGA	Human studies have revealed positive effects of pure CGA or CGA-rich foods/supplements on obesity/T2DM/hypertension. Human data are needed to evaluate the effects on dyslipidemia	Most studies are done with CGA-rich coffee. More trials are needed for pure CGA
35	Dyslipidemia	AP, a commercial dietary supplement combining policosanol, berberine, red yeast rice extract, folic acid, coenzyme Q10, and astaxanthin	AP significantly improves all lipid parameters (total cholesterol, LDL, HDL, and TG)	Meta-analysis of 11 RCTs among hypercholesterolemic patients (pre 2015 literature). Betweenstudy heterogeneity is substantial
36	MetS	Circadian rhythm	Circadian disruption is associated with metabolic disorders. Feeding is a modulator of the internal circadian clock. Further studies among humans are needed	Nutrients and circadian clocks are from animal, in vitro, or in vivo data
28	Hypertension	Magnesium	Magnesium supplementation at a median dose of 368 mg/day for a median duration of 3 months reduces systolic and diastolic blood pressure by 2 and 1.78 mmHg, respectively	Meta-analysis of RCTs among adults (literature up to February 1, 2016); Benefits are accompanied by elevated levels of serum magnesium
43	Obesity/hypertension	Complementary feeding: EPL, salt, and LCPUFA	The correlation between the timing of complementary feeding and MetS in later life remains unclear	Limited evidence on early introduction of EPL, salt, LCPUFA, and metabolic health later in life
14	T2DM	Vitamin A, retinolbinding protein 4, vitamin D, biotin, and benfotiamine (a derivative of thiamine)	Vitamins and their derivatives have the potential as an effective adjunct prevention of T2DM	Vitamin A and biotin: in vitro or animal data only
37	MetS	Under- and overnutrition in utero	A U-shaped relationship between birth weight and adulthood metabolic diseases: babies with low or high birth weight have increased risks of MetS later in life	Epigenomic mechanisms are mainly based on animal data
29	Hypertension/T2DM/CVD	Magnesium	Magnesium status (intake, serum levels, or urinary secretion) is inversely linked to the risk of hypertension/T2DM/CVD in observational studies	Causality needs to be confirmed in RCTs
3	Obesity	Protein	High-protein diets (1.2–1.6 g protein/kg/day) improve weight management and some metabolic indicators through increased thermogenesis and satiety after the consumption	Short-term (<1 year) evidence is strong; long-term feeding trials (≥1 year) are less consistent
34	Obesity	Fucoxanthin, a natural carotenoid from brown algae	Fucoxanthin in algae has a unique anti-obesity effect by upregulating thermogenesis in human white fat tissues	The anti-diabetic properties of fucoxanthin: animal and in vitro data only
20	Hypertension/T2DM/CVD	Vitamin D	Low vitamin D status is linked to increased prevalence or risks of hypertension, T2DM, and CVD	Benefits of vitamin D supplementation on cardiovascular outcomes have not been confirmed
38	MetS	In utero nutrition	Maternal nutrition during peri-conception, gestation, and lactation periods predisposes babies to adult-onset diseases	Known as “DOHaD”
1	Dyslipidemia	Peptides from dietary proteins (ie, soybean and milk) or synthetic	A human clinical trial shows beneficial effects of lupin protein on lowering plasma lipids	Evidence is mainly based on animal, in vitro, or cell culture data
41	MetS/T2DM/CVD	Low birth weight/reduced fetal muscle mass	Compelling associations between low birth weight/reduced muscle mass and MetS/T2DM/CVD later in life	Related to the DOHaD theory
7	MetS	Dietary components consumed as part of specific diets	Beneficial roles of unsaturated fatty acids (MUFA omega-3/omega-6 PUFA, EPA, DHA, and ALA) on metabolic parameters; adverse influences of saturated and trans fatty acids	Systematic review of prospective and RCT studies: 2000–2012
26	Obesity/CVD	Folate	Correlation between low folate status and adiposity/CVD is observed in epidemiological studies	Causality and efficacy need to be confirmed in well-designed intervention trials
6	MetS	Dairy	Epidemiological and clinical studies suggest an inverse relationship between dairy consumption and MetS parameters	2–3 servings of dairy per day is recommended
23	MetS	Vitamin D	An inverse association between blood 25(OH) D levels and MetS risks is observed among the meta-analysis of cross-sectional data (n=16), but not in cohort or nest case–control studies (n=2)	Cross-sectional data: pooled OR per 25 nmol/L increment in 25(OH)D: OR =0.87; 95% CI: 0.83–0.92; high heterogeneity: I^2=85%
5	T2DM	Branched-chain amino acids; non-esterified fatty acids	Nutrient effects on pancreatic functions are complex at the metabolic level; much is yet to be understood	Focus on the mechanism; few human data
15	MetS/CVD	Antioxidants (vitamins C and E, resveratrol)	Observational data, not RCTs, support the benefits of a minimum 2-year supplementation of antioxidant vitamins (C and E) on reduced incidence of CVD. Resveratrol is shown in two clinical trials to improve endothelial cell function and LDL profiles	A natural supplement containing resveratrol and antioxidant vitamins may be promising to manage CVD burdens
39	MetS	Nutrition during pregnancy	Maternal diet during pregnancy can influence the short- and long-term health of offspring including programming of the MetS	Related to the DOHaD theory
21	MetS/T2DM	Baseline vitamin D status measured as blood 25(OH)D and dietary intakes	Vitamin D status at baseline is inversely associated with risks of MetS and T2DM. Top versus bottom thirds of baseline vitamin D: for MetS: RR =0.86; 95% CI =0.80–0.92. For T2DM: RR =0.81; 95% CI =0.71–0.92	A meta-analysis of 18 prospective studies (literature up to August 2012); results need to be confirmed by intervention trials
2	MetS	Dietary fats	High saturated fatty acid diets have detrimental effects on metabolic health; diets rich in MUFA are advantageous for metabolic parameters. Optimal dietary fat composition for metabolic health is unknown	Epidemiological data on antidiabetic benefits of omega-3 LCPUFA are controversial
13	Glucose metabolism	Dietary antioxidants	The involvement of oxidative stress in insulin resistance is clear; intervention studies assessing antioxidants on glucose metabolism are rare and results are not consistent	The ideal antioxidant supplements may be one that can reproduce the natural combination in plant foods
42	MetS	Childhood infection and growth failure	Childhood infection and growth restriction may be related to MetS in adulthood. Etiology is unclear	Related to the DOHaD theory
10	CVD	Dietary components, antioxidants, vitamin D, alternative supplements (resveratrol, policosanol, red yeast rice, stanols), and exercise	Basic nutrition together with exercise plays a critical role in cardiovascular health	Alternative supplements are promising, but need more data
18	Hypertension	Vitamin D	Observational data support a protective role of vitamin D against hypertension, but RCTs do not support the benefits of vitamin D supplementation	More randomized trials are necessary to confirm the benefits of vitamin D and hypertension
4	Obesity	Proteins	Dietary proteins may help weight management through increasing thermogenesis and satiety. Long-term benefits need to be further studied	Caution for high-protein diets: risks of renal damage especially in diabetics
16	MetS/hypertension/CVD	Vitamin D	Observational data, not intervention trials, are supportive of beneficial roles of vitamin D on metabolic disorders	Future clinical trials are needed to confirm the casual relationship
17	Obesity/T2DM/CVD	Vitamin D insufficiency: 25(OH)D <50 nmol/L	Ethnic minorities have higher prevalence of vitamin D insufficiency than white counterparts. Observational data support links between vitamin D deficiency and obesity-related chronic diseases	Systematic review of observational data in minority groups (narrative synthesis)
12	Insulin resistance	Low-energy sweeteners (aspartame, saccharin, sucrose, acesulfame-K, cyclamate, saccharin, sucralose, stevioside, and rebaudioside-A)	Low-energy sweeteners are not associated with unwanted effects on appetite, glycemic control, or blood pressure	Based on in vivo human and animal data
24	Prediabetes	Vitamin D	Observational data are supportive. Intervention trials indicate no benefits of vitamin D supplementation among people with adequate vitamin D status and normal glucose tolerance. A few short-term trials with a small sample size indicate possible benefits in prediabetes	Systematic review of literature from January 1969 to July 2009; well-designed trials considering relevant confounders (ie, vitamin D status and glucose metabolism) are needed to confirm the efficacy
8	MetS/T2DM	Antioxidants (vitamins, polyphenols, and ALA), minerals (chromium and magnesium), omega 3, soy isoflavones, and fiber	An inverse association between antioxidants and CVD prevention is strong in observational studies, but this is not supported by currently available large clinical trials	More clinical data involving people with high oxidant stress or depletion of natural antioxidant defense systems are needed to confirm the causality
11	MetS/hypertension/T2DM/CVD	SSBs	Clear evidence on SSB consumption and increased risks for metabolic disorders	Meta-analysis of prospective studies
27	MetS	Magnesium	Possible evidence but further investigation is needed	Use with caution in the presence of kidney dysfunction and medications
19	MetS/diabetes/CVD	Vitamin D	Positive evidence from epidemiological data	Similar information to Pittas et al^Citation22
30	MetS/T2DM	Magnesium	Positive evidence on magnesium and MetS/T2DM/insulin resistance from observational studies (cross-sectional and prospective) and a few RCTs	Literature review: 2000–2008; more prospective or RCTs are needed to clarify the benefits
32	MetS/T2DM	Chromium	Supportive evidence but not conclusive according to FDA/American Diabetes Association positions	Literature review: 1996–2006 suggests future studies on certain forms (ie, chromium picolinate) and doses (ie, ≥200 μg/day)
22	MetS/T2DM	Vitamin D/calcium	Observational data support an inverse association of vitamin D and calcium with MetS/T2DM (prevalence or incidence). Intervention data are limited	Systematic review with metaanalysis: observational and clinical data up to January 2007
31	MetS	Magnesium	Magnesium intakes are inversely related to the prevalence and incidence of MetS and its components	Evidence from a few crosssectional and prospective studies
40	Diabetes	Early nutrition	Pool fetal nutrition, early feeding, high-nutrient diet, and rapid growth in infancy may adversely impact the metabolic health later in life	Relevant to the theory of DOHaD
9	MetS	Fatty acids	Replacement of dietary saturated fats with unsaturated fatty acids may benefit metabolic health. Evidence on benefits of individual fatty acids is not conclusive	Diet-gene interactions need to be considered when assessing dietary responsiveness
44^Table Footnotea	Inflammation (CRP & IL-6)	Vitamin-mineral supplementation	There are no differences in CRP and IL-6 between subjects with vitamin–mineral supplementation and placebo controls	A meta-analysis of 18 trials (1,747 participants) for CRP and 9 trials (1,037 subjects) for IL-6 (literature up to May 2009)

Notes: n=44.

a Sun CH, Li Y, Zhang YB, Wang F, Zhou XL, Wang F. The effect of vitamin-mineral supplementation on CRP and IL-6: a systemic review and meta-analysis of randomised controlled trials. Nutr Metab Cardiovasc Dis. 2011;21(8):576–583. (Not referenced in the paper.)

Abbreviations: 25(OH)D, 25-hydroxyvitamin D; ALA, alpha-linoleic acid; AP, Armolipid Plus; CGA, chlorogenic acid; CRP, C-reactive protein; CVD, cardiovascular disease; DHA, docosahexaenoic acid; DOHaD, developmental origins of health and diseases; EPA, eicosapentaenoic acid; EPL, energy-providing liquids; FDA, Food and Drug Administration; HDL, high-density lipoprotein; IL-6, interleukin-6; LDL, low-density lipoprotein; LCPUFA, long-chain polyunsaturated fatty acids; MetS, metabolic syndrome; MUFA, monounsaturated fatty acids; OR, odds ratio; PUFA, polyunsaturated fatty acids; RCTs, randomized clinical trials; RR, relative risk; SSBs, sugar-sweetened beverages; T2DM, type 2 diabetes mellitus; TC, total cholesterol; TG, triglycerides.

Makariou S, Liberopoulos EN, Elisaf M, Challa A. Novel roles of vitamin D in disease: what is new in 2011? Eur J Intern Med. 2011;22(4):355–362.

 Google Scholar