Effects of a long-term lifestyle intervention program with Mediterranean diet and exercise for the management of patients with metabolic syndrome in a primary care setting

Background: The impact of a lifestyle intervention (LSI) program for the long-term management of subjects with metabolic syndrome in a primary care setting is not known. Methods: This 3-year prospective controlled trial randomized adult subjects with metabolic syndrome to receive intensive LSI or to usual care in a community health centre in Malaga, Spain. LSI subjects received instruction on Mediterranean diet and a regular aerobic exercise program by their primary care professionals. Primary outcome included changes from baseline on different components of metabolic syndrome (abdominal circumference, blood pressure, HDL-cholesterol, fasting plasma glucose and triglycerides). Results: Among the 2,492 subjects screened, 601 subjects with metabolic syndrome (24.1%) were randomized to LSI (n = 298) or to usual care (n = 303); of them, a 77% and a 58%, respectively, completed the study. At the end of the study period, LSI resulted in significant differences vs. usual care in abdominal circumference (-0.4 +/- 6 cm vs. +2.1 +/- 6.7 cm, p < 0.001), systolic blood pressure (-5.5 +/- 15 mmHg vs. -0.6 +/- 19 mmHg, p = 0.004), diastolic blood pressure (-4.6 +/- 10 mmHg vs. -0.2 +/- 13 mmHg, p < 0.001) and HDL-cholesterol (+4 +/- 12 mg/dL vs. +2 +/- 12 mg/dL, p = 0.05); however, there were no differences in fasting plasma glucose and triglyceride concentration (-4 +/- 35 mg/dl vs. -1 +/- 32 mg/dl, p = 0.43 and -0.4 +/- 83 mg/dl vs. +6 +/- 113 mg/dl, p = 0.28). Conclusion: Intensive LSI counseling provided by primary care professionals resulted in significant improvements in abdominal circumference, blood pressure and HDL-cholesterol but had limited effects on glucose and triglyceride levels in patients with metabolic syndrome. (C) 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.