The Impact Of The Mediterranean Diet And Lifestyle Intervention On Lipoprotein Subclass Profiles Among Metabolic Syndrome Patients. Findings Of A Randomized Controlled Trial

BackgroundMetabolic syndrome (MetS) is associated with alterations of lipoprotein structure and function that can be characterized with advanced lipoprotein testing (ADLT). The effect of Mediterranean diet (MedDiet) and of body weight loss on the lipoprotein subclass profile has been scarcely studied. Within the PREDIMED-Plus randomized controlled trial, a sub-study conducted in one of its recruiting centers aimed to evaluate the effects on lipoproteins properties assessed by ADLT of an intensive weight loss program based on an energy-reduced MedDiet (er-MedDiet) and physical activity (PA) promotion (intervention group) compared with energy-unrestricted MedDiet recommendations (control group) on lipoprotein subclasses. Methods202 patients with MetS (n=107, Intervention; n=95, Control) were included in this study. Conventional lipid profile and ADLTs were performed at baseline, 6 months and one year. Linear mixed models were used to assess the effects of intervention on lipoprotein profiles. ResultsThe er-MedDiet+PA led to a significant decrease of body mass index by 1.5 Kg/m2 at 6 months and 1.4 Kg/m2 at 12 months and a reduction of waist circumference by 2.9 cm at 6 months and 2.2 cm at 12 months; an increase of 0.1 mmol/L of HDL-C at 12 months, and decreased triglycerides (Tg) at 6 months; and decreased LDL-C and non-HDL-C at 12 months. ADLT showed a decrease of small dense-LDL-C (sdLDL-C), intermediate-density lipoprotein (IDL)-C, and HDL-Tg, and an increase of large LDL-particles (P). The er-MedDiet+PA model predicted significant reductions of Tg, sdLDL-C, VLDL-Tg and large VLDL-P in the intervention group. ConclusionsIn comparison with MedDiet (control group), er-MedDiet+PA (intervention group) decreased plasma triglyceride, and triglyceride content in HDL and VLDL particles, decreased sdLDL-C, and increased large LDL particles, indicating beneficial changes against cardiovascular disease.