Comparative Effects of 2 Diets in Veterans With the Metabolic Syndrome

The Metabolic Syndrome (MetS) is a common problem among Veterans and is associated with a
greater likelihood of cardiovascular disease (CVD). The Mediterranean diet is the only
popular diet that has been shown to reduce CVD event rates but the extent to which
monounsaturated fatty acid (MUFA) or polyunsaturated fatty acid (PUFA) enrichment results in
improvement in parameters of MetS is unresolved. Similarly, while low intensity exercise
improves the CVD risk factor profile, there have been no comparative investigations
comparing MUFA and PUFA enriched diets and exercise in patients with MetS that have extended
beyond 1 year. Recently, the VA established the MOVE! program, a national weight management
program designed to help Veterans lose weight. Using the VA promoted program, we will
perform a systematic evaluation of the effects of dietary fat composition [comparison
between MUFA-enriched and PUFA enriched diet] with MOVE!. We hypothesize that a
MUFA-enriched diet consisting of antioxidant, lipid reducing and insulin sensitizing
properties will be superior to the less palatable PUFA-enriched diet on improving
cardiometabolic parameters associated with MetS. Specifically, the MUFA MOVE! program is
expected to lead to greater improvements than the PUFA MOVE! program in body composition and
aerobic fitness (Specific Aim 1), endothelial dependent flow mediated vasodilatation and the
postprandial lipid response to a meal load (Specific Aim 2) and the mechanisms (lipolytic
and lipid transfer protein activity, homeostasis model assessment-estimated insulin
resistance) responsible for these effects (Specific Aim 3). Collectively, these studies will
advance our understanding of mechanisms underlying the differential effects of MUFA and
PUFA-enriched dietary regimens on cardiometabolic health and when combined with the MOVE!
program, will provide new and useful information to Veterans (and the general public)
interested in optimizing their diets for CVD disease prevention and improved vascular
health.

Inclusion Criteria:

Presence of 3 or more of the following):

- Waist circumference >102 cm in men or >88 cm women

- Treated Hypertension or Untreated Blood pressure >130/85 and < 160/100 mm Hg

- Treated Hyperglycemia or Untreated Fasting blood glucose (FBG) >100 mg/dL (based on
2006 guidelines)

- Treated Hyperlipidemia or Untreated Triglycerides > 150 mg/dL

- HDL-C < 40 mg/dL men < 50 mg/dL women

Exclusion Criteria:

- Decompensated heart failure (NYHA Class IV);

- Severe Pulmonary disease (Unable to walk on a treadmill at 2.5 mph or greater);

- Chronic renal insufficiency (Cr > 2.5 mg/dL)

- Treated diabetes mellitus with FBG > 180 mg/dL or HbA1C >9g %

- Hematologic or malignant disorders

- Treated SBP >160 mmHg and/or DBP > 95 mmHg ;

- Treated TG > 250 mg/dL

- Use of systemic vasodilators (e.g., nitrates)

- Morbid Obesity (BMI > 50 kg/m2)

- Endocrine (thyroid) or metabolic disorders (unless treated and under control)

- Alcohol consumption greater than (2) 4-ounce glasses of table wine, (2) 12-oz bottles
of beer or 2 shots of spirits in men or women

- Active IV drug abuse within the past 6 months