Tailoring diet interventions to the specific presentation of the metabolic syndrome may be the best way of reducing the risk factors for cardiovascular disease.

Chronic intake of fish oil (FO) reduces postprandial lipemia. Our aim was to determine whether increased clearance of chylomicrons was the mechanism. Eight normal volunteers were randomly assigned to take 64 mg n-3 fatty acids/kg body wt or an olive oil placebo daily for 4 wk in a double-blind, crossover design. At the end of each phase, an intravenous fat-tolerance test and a four-meal, 24-h oral fat-load test were administered. The latter was designed to mimic normal eating patterns (fat provided 42% of energy). FO lowered chylomicron triglyceride and retinyl palmitate concentrations by 40% (P < 0.01) and very-low-density lipoprotein retinyl palmitate concentrations by 27% (P < 0.01). However, clearance rates of the fat emulsion were not significantly different between treatments. The results suggest that the hypochylomicronemic effect of chronic FO supplementation is not due to increased chylomicron clearance, leaving reduced chylomicron production or secretion as a more likely cause of the reduced postprandial lipemia.

T he prevalence of obesity is increasing among western populations, bringing about a parallel rise in the prevalence of the metabolic syndrome (1), which is strictly related to overweight (2). There is full agreement that lifestyle changes primarily focused on weight reduction are the first-line approach to patients with the metabolic syndrome (3). In short-term trials, even a modest weight reduction has been shown to favorably affect the components of the metabolic syndrome such as hypertension, lipid abnormalities, and glycemic control (4 -8). The long-term effects of weight loss on the cluster of factors that comprise the metabolic syndrome have been studied in both overweight (9) and mildly obese (10) patients. We report here the extent to which a 2-year treatment program with a low-calorie, low-fat diet altered components of the metabolic syndrome in obese, nondiabetic patients presenting with the syndrome. RESEARCH DESIGN AND METHODS -The local ethics committee reviewed and approved the study, and each eligible participant gave written informed consent. We enrolled 41 patients (30 women and 11 men, age 58.7 Ϯ 11.27 years [means Ϯ SD]) with the metabolic syndrome as diagnosed according to the criteria of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATPIII) (2). The inclusion criteria were age Ͼ18 years, BMI Ն30 kg/ m 2 , and a willingness to adhere to the prescribed diet. The exclusion criteria were a history of thyroid disease or diabetes, current pregnancy, an unstable medical condition, and the current use of medications known to affect weight, appetite, and/or blood lipids. Patients on antihypertensive therapy maintained a stable medical regimen throughout the study. All patients were prescribed a low-calorie diet tailored to provide an ϳ500-calorie/day deficit based on their estimated daily energy expenditure (11). The diet was modeled after the NCEP ATPIII diet (2) and provided 30% of energy from fat (Ͻ7% from saturated fat), 55% from carbohydrates, and 15% from protein, with Ͻ200 mg cholesterol/day. The fiber content ranged from 20 to 30 g. The patients were also encouraged to increase their physical activity, preferably by aerobic activities (12). After the initial visit, the patients met in monthly group sessions for 4 months and were then seen in three to four follow-up visits per year for the next 20 months. Laboratory values were measured in the hospital laboratory by standard methods. For each variable, differences between basal conditions and follow-up were assessed using Student's t test for paired data. 2 Test was used to compare discrete variables.RESULTS -At the beginning of the study, all 41 patients had abdominal obesity, 39 (95%) were hypertensive, 26 (63%) had low HDL cholesterol, 22 (54%) had high triglycerides, and 17 (41%) had high blood glucose. The most common triad of metabolic syndrome components was abdominal obesity, hypertension, and low HDL cholesterol (59%). Body weight decreased by 8.5% after 6 months and was 9.9% lower than baseline (range...