title: The effect of dietary changes on distinct components of the metabolic syndrome in a young Sri Lankan population at high risk of CVD.
abstract: South Asian populations are predisposed to early onset of the metabolic syndrome. Lifestyle intervention programmes have demonstrated a reduction in the metabolic syndrome and CVD risk; however, the most effective components of the multi-faceted lifestyle interventions are unknown. We studied 2637 Sri Lankan males (n 1237) and females (n 1380), with a mean BMI of 23·9 (sd 4·2) kg/m2, aged 22·5 (sd 10·0) years, who had participated in a 5-year lifestyle-modification programme to examine the effect of dietary changes on distinct components of the metabolic syndrome. The dietary intervention comprised advice to replace polished starches with unpolished starches, high-fat meat and dairy products with low-fat products and high-sugar beverages and snacks with low-sugar varieties. For the purposes of this analysis, data from the control and intensive lifestyle groups were combined. Anthropometric and biochemical data were recorded, and a FFQ was completed annually. Multiple regression was used to determine the effect of the dietary changes on distinct components of the metabolic syndrome. The ratio unpolished:polished rice was inversely related to change in fasting glucose (β=-0·084, P=0·007) and TAG (β=-0·084, P=0·005) and positively associated with change in HDL-cholesterol (β=0·066, P=0·031) at the 5-year follow-up after controlling for relevant confounders. Red meat intake was positively associated with fasting glucose concentrations (β=0·05, P=0·017), whereas low-fat (β=-0·046, P=0·018) but not high-fat dairy products (β=0·003, P=0·853) was inversely related to glucose tolerance at the follow-up visit. Replacement of polished with unpolished rice may be a particularly effective dietary advice in this and similar populations.
authors.affiliation: 1Department of Medicine,Imperial College London,London W12 0NN,UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Guess
authors.affiliation: 2Diabetes Association of Sri Lanka,Colombo,Sri Lanka.
authors.forename: Mahen
authors.initials: M
authors.lastname: Wijesuriya
authors.affiliation: 2Diabetes Association of Sri Lanka,Colombo,Sri Lanka.
authors.forename: Laksha
authors.initials: L
authors.lastname: Vasantharajah
authors.affiliation: 3King's College London,Primary Care & Public Health Sciences,London SE1 1UL,UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Gulliford
authors.affiliation: 4Cardiovascular Division,King's College London,London SE1 9NH,UK.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Viberti
authors.affiliation: 4Cardiovascular Division,King's College London,London SE1 9NH,UK.
authors.forename: Luigi
authors.initials: L
authors.lastname: Gnudi
authors.affiliation: 4Cardiovascular Division,King's College London,London SE1 9NH,UK.
authors.forename: Janaka
authors.initials: J
authors.lastname: Karalliedde
mesh_terms: D000886:Anthropometry; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D003611:Dairy Products; D018752:Diet, Fat-Restricted / Q000379:methods*; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000178:diet therapy*; D012044:Regression Analysis; D012307:Risk Factors; D040242:Risk Reduction Behavior; D013188:Sri Lanka; D055815:Young Adult
keywords: 2hPG 2-h plasma glucose; Dairy products; Dietary fibres; FPG fasting plasma glucose; Fasting glucose; Glycaemic index; MetS metabolic syndrome; T2DM type 2 diabetes mellitus; WC waist circumference; Whole grains