The Journal of Nutrition

Nutrition and Disease

A Dietary Pattern Including Nopal, Chia Seed,

Soy Protein, and Oat Reduces Serum
Triglycerides and Glucose Intolerance in
Patients with Metabolic Syndrome1–4

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Martha Guevara-Cruz,5 Armando R. Tovar,5 Carlos A. Aguilar-Salinas,6 Isabel Medina-Vera,5
Lidia Gil-Zenteno,5 Isaac Hernández-Viveros,5 Patricia López-Romero,5 Guillermo Ordaz-Nava,5
Samuel Canizales-Quinteros,7,8 Luz E. Guillen Pineda,6 and Nimbe Torres5*
5
Departamento de Fisiologı́a de la Nutrición, 6Departamento de Endocrinologı́a y Metabolismo, and 7Unidad de Biologı́a Molecular y
Medicina Genómica del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, D.F; and 8Facultad de Quı́mica,
Universidad Nacional Autónoma de México, Mexico, D.F.

Abstract
Metabolic syndrome (MetS) is a health problem throughout the world and is associated with cardiovascular disease and
diabetes. Thus, the purpose of the present work was to evaluate the effects of a dietary pattern (DP; soy protein, nopal,
chia seed, and oat) on the biochemical variables of MetS, the AUC for glucose and insulin, glucose intolerance (GI), the
relationship of the presence of certain polymorphisms related to MetS, and the response to the DP. In this randomized
trial, the participants consumed their habitual diet but reduced by 500 kcal for 2 wk. They were then assigned to the
placebo (P; n = 35) or DP (n = 32) group and consumed the reduced energy diet plus the P or DP beverage (235 kcal) minus
the energy provided by these for 2 mo. All participants had decreases in body weight (BW), BMI, and waist circumference
during the 2-mo treatment (P , 0.0001); however, only the DP group had decreases in serum TG, C-reactive protein (CRP),
and AUC for insulin and GI after a glucose tolerance test. Interestingly, participants in the DP group with MetS and the
ABCA1 R230C variant had a greater decrease in BW and an increase in serum adiponectin concentration after 2 mo of
dietary treatment than those with the ABCA1 R230R variant. The results from this study suggest that lifestyle
interventions involving specific DP for the treatment of MetS could be more effective if local foods and genetic variations
of the population are considered. J. Nutr. 142: 64–69, 2012.

Introduction
The observed increase in the incidence of MetS9 is a worldwide
phenomenon and Mexico is no exception (1–4). This syndrome
is a major risk factor for developing T2D and CVD, which are
the main causes of death in Mexico (2). The juxtaposition of
these issues warrants urgent consideration of the need for
strengthening and implementing strategies that address this
1
Supported by the Instituto de Ciencia y Tecnologı́a del Distrito Federal, grant
no. PICDS08-6, México (to N.T.).
2
Author disclosures: M. Guevara-Cruz, A. R. Tovar, C. A. Aguilar-Salinas, I.
Medina-Vera, L. Gil-Zenteno, I. Hernández-Viveros, P. López-Romero, G.
Ordaz-Nava, S. Canizales-Quinteros, L. Guillen Pineda, and N. Torres, no
conflicts of interest.
3
Supplemental Tables 1–3 and Supplemental Figure 1 are available from the
“Online Supporting Material” link in the online posting of the article and from the
same link in the online table of contents at jn.nutrition.org.
4
This study was registered at www.clinicaltrials.gov as ISRCTN96579359.
9
Abbreviations used: BP, blood pressure; BW, body weight; CVD, cardiovas-
cular disease; DP, dietary pattern; GI, glucose intolerance; HDL-C, HDL
cholesterol; MetS, metabolic syndrome; OGTT, oral glucose tolerance test; P,
placebo; TC, total cholesterol; T2D, type 2 diabetes; WC, waist circumference.
* To whom correspondence should be addressed. E-mail: nimbester@gmail.
com.
64 Manuscript received July 5, 2011. Initial review completed July 19, 2011. Revision accepted October 13, 2011.
important public health problem. Diagnosis of MetS requires
that three of the following five criteria be satisfied: elevated WC
(population and country-specific definitions), TG .1.69 mmol/
L, HDL-C ,1.04 mmol/L in men and 1.30 mmol/L in women,
fasting glucose .5.6 mmol/L, and systolic and diastolic BP
.130 mm Hg and 85 mm Hg, respectively (5–7).
The development of a specific DP for a specific disease within
a defined population has emerged as a method to provide dietary
support for more effective control of diseases. A DP includes two
or more functional foods with health beneficial properties for a
specific condition. International Health Agencies such as the
AHA and the National Cholesterol Education Program recom-
mend the use of DP to control dietary lipids (4). However, a
specific DP has not been identified to reduce the biochemical and
clinical abnormalities that are related to MetS. The DP proposed
for this study consisted of dehydrated nopal, chia seed, oat, and
soy protein. These ingredients were chosen based on their
antihyperglycemic (8,9), antihyperinsulinemic (10,11), hypoli-
pidemic (12–14), antiinflammatory (15), and antioxidant effects
(16), which arise from the content of (n-3) fatty acids, b-glucans,
vegetable protein, fiber, antioxidants, and polyphenols (17).
ã 2012 American Society for Nutrition.
First published online November 16, 2011; doi:10.3945/jn.111.147447.
 A global increase in the incidence of MetS over the last few
decades is a salient example of how the interaction between
lifestyle and genotype can dramatically affect health. The
candidate-gene approach has been the traditional approach for
identifying genes involved in MetS. When the number of
metabolic pathways involved in MetS is considered, it is im-
mediately apparent that the number of potential candidate genes
is large. In Mexico, the polymorphisms of genes that are highly
associated with BMI and T2D are ABCA1 (R230C), TCF7L2
(rs7903146), PPARG (rs1801282), and IRS1 (rs1801278) (18–
21).
Thus, the purpose of the present work was to evaluate the
effect of the consumption of a specific DP for 2 mo on the
biochemical variables of MetS, GI, and the AUC for glucose and
insulin and to investigate the relationship between the biochem-
ical and clinical variables after the consumption of the DP and
the single nucleotide polymorphisms associated with T2D in the
Mexican population.
Participants and Methods
Participants. This study was performed at the Department of Physiol-
ogy of Nutrition of the Instituto Nacional de Ciencias Médicas y
Nutrición, Salvador Zubirán, Mexico City, from August 2009 to June
2010. Participants were Mexican mestizos, aged 20–60 y, BMI $25 and
#39.9 kg/m2, who satisfied 3 positive criteria for MetS (22). Exclusion
criteria included having serum glucose $7 mmol/L, a history of
cardiovascular events, weight loss .3 kg in the last 3 mo, cancer,
AIDS, kidney or liver disease, pregnancy, smoking, substance abuse,
alcohol consumption, or having taken any medication. In addition,
participants were excluded if they had taken any lipid-lowering
medication, antihypertensive, hypoglycemic, and anorectic agents or
medications.
Study design. This study was a single-center, randomized, placebo-
controlled, double-blind, parallel-arm study. MetS participants who
satisfied the selection criteria participated in two stages. In the first stage,
participants were instructed to consume a reduced energy diet according
to (23) and a low-saturated fat and low-cholesterol diet for 2 wk (5).
During the second stage of the study, participants were randomly
assigned to consume either the dietary pattern (DP) or placebo (P) in
addition to the reduced energy diet for 2 mo. The study consisted of four
visits during the monitoring period. In the first visit, a medical history
and 2-h OGTT was performed in which blood glucose and serum insulin
levels were recorded for a period of 120 min after the administration of
75 g of oral glucose. During each subsequent visit, a 24-h dietary recall
was conducted, a physical activity questionnaire was filled out, and
anthropometry and serum biochemical variables were measured. In the
last visit, the 2-h OGTT was repeated. This study was approved by the
Ethics Committee of the Instituto Nacional de Ciencias Médicas y
Nutrición, Salvador Zubirán. Written informed consent was obtained
from the participants.
Sample size. The sample size was estimated to be 35 participants/group
based on an expected effect of a 10% difference; there was 90% power
and an a error of 0.05 for detecting a 10% difference in all of the MetS
biochemical variables for those who consumed the DP. The effect size
was estimated based on a series of successful lifestyle intervention
studies, and a loss of 30% was added during the study follow-up,
resulting in 45 participants/group in this study.
Diet. For each dietary stage, participants in the study received 15
different eating plans (50–60% carbohydrates, 15% protein, 25–35%
fat, ,7% saturated fat based on total energy, ,200 mg/d cholesterol,
and 20–30 g/d fiber) (Supplemental Table 1). During the first stage, the
participants consumed a reduced-energy diet tailored to provide a 500-
kcal/d deficit as recommended by the NIH (24) with respect to their
habitual diet for 2 wk. Participants maintained a semiquantitative food
record and reported any variation in physical activity at each monthly
visit. During the second stage, the participants continued to consume the
same reduced energy diet as in the first stage minus the energy provided
by the DP or P (235 kcal).
The DP consisted of a mixture of dehydrated nopal (7 g) equivalent to
100 g of nopal, 4 g of chia seeds, 22 g of oats, 32 g of soybean protein,
0.02 g of sweetener (Splenda), and 1 g flavoring. The amount of each
ingredient in the DP was based on the quantity of each food that is
required to achieve a beneficial effect on the biochemical variables of
MetS. The P consisted of 30 g of calcium caseinate, 30 g of maltodextrin,
0.02 g sweetener, and 1 g flavoring. Each mixture was packed into
envelopes of 33 g or 30.5 g for DP or P respectively, that had similar
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energy, appearance, and taste (Supplemental Table 2). Before the dietary
treatment, a sensorial evaluation of the DP and P powder formulas was
performed using a tasting test conducted by a panel of 100 judges who
were untrained men and women between the ages of 20 and 60 y. Each
panelist ingested 10 mL of each beverage and was handed an evaluation
form to provide his/her opinion about color, viscosity, sweetness, flavor,
and acceptability. The objective of this test was to determine the overall
acceptability of the two beverages. A hedonic scale was established from
1 (unpleasant) to 10 (very acceptable) for each attribute. The taste and
appearance were adjusted to obtain a score higher than 8. The product in
each envelope was dissolved in 250 mL of water. Participants were
instructed to consume a serving of the DP or P once in the morning and
once at night for 2 mo of treatment.
Dietary assessment. Compliance with the diet and the P or DP was
evaluated using three methods: the 24-h diet recall, the 3-d food record
(food log), and measuring the amount of empty food packages returned.
In addition, compliance with the DP or P was monitored by weekly
phone calls by the nutritionists. Data were processed and conversions to
the gram equivalents were performed using the Mexican system of food
equivalents (25).
Anthropometric measurements and BP. BW, height, and WC were
recorded in duplicate according to the method of Lohman (26). The
percentage of fat mass and lean mass was obtained using a whole body
composition analyzer (e-Body 205, Jawon Medical) in the morning after
12 h of fasting. BP was measured after 5 min of rest in the sitting position
on the right arm using a sphygmomanometer (Omron, HEM-781INT).
The BP measurement was performed six times at intervals of 3 min and
only the last four measurements (6, 9, 12, and 15 min) were averaged to
determine the systolic and diastolic pressures.
Blood collection and biochemical analysis. Each blood sample was
collected after 12 h of fasting and serum samples were maintained at
2808C until they were used for analysis. Serum TC, TG, and HDL-C
were determined using the assay kits CT, TG-B, and HDL-D (Beckman
Coulter) using a Synchron CX5D, Beckman Coulter analyzer. LDL was
calculated using the Friedewald formula (27) (LDL cholesterol = serum
total cholesterol – (HDL-C + TG/2.2)). Total serum adiponectin and
leptin concentrations were measured using a commercially available
ELISA kit (EZHADP-61K Millipore; EZHL-80SK Millipore). Serum
leptin and high-sensitivity CRP were measured using the ELISA
(CardioPhase’hs CRP). The 2-h OGTT was performed after 12 h of
fasting and blood glucose and serum insulin were determined at 0, 15,
30, 45, 60, 90, and 120 min following the consumption of 75 g of
glucose. GI was defined as a glucose concentration of 7.8–11.0 mmol/L
(28) after 2 h following the administration of 75 g of oral glucose. Whole
blood glucose was measured using a glucose analyzer (Model 2700, Ysi).
Serum insulin concentration was measured with a RIA kit (Human RIA
Kit, Linco Research).
Genotyping. During the first visit, an additional 5-mL blood sample
was drawn and DNA was extracted from the leukocytes as described
by Miller et al. (29). Single nucleotide polymorphisms of the
ABCA1 R230C (rs9282541), ABCA1 R219K (rs2230806), TCF7L2
(rs7903146), PPARG (rs1801282), and IRS1 (rs1801278) genes were
determined using PCR-based TaqMan allele discrimination assays (ABI
Dietary pattern and metabolic syndrome 65
Prism 7900 HT Sequence Detection System, Applied Biosystems) (30).
These genotypes were distributed according to the Hardy-Weinberg
equilibrium (31).
Statistical analysis. Continuous variables were expressed as the
means 6 SD. Dichotomous variables were expressed as frequencies
and percentages. OGTT 2-h glucose and insulin AUC responses were
calculated using zero as a baseline, employing the trapezoidal rule (32).
Variables were assessed using the Kolmogorov-Smirnov Z test to
examine the distribution type; if the data did not exhibit a normal
distribution, they were logarithmically transformed prior to analysis.
Differences between the P and DP groups with respect to the baseline and
the final measurements (after 2 mo) were determined using ANOVA for
tal Fig. 1). Only 67 completed the study. The majority of the
participants were lost in the 2 mo of treatment, which coincided
with the Christmas holidays. The baseline characteristics of the
participants were similar in the 2 groups.
Energy and nutrient intake
Although energy intake was reduced by 500 kcal in both
groups, macro- and micronutrient intakes did not differ between
the groups during the study. Compliance rates with the diets
were 84.1 and 86.5% for the DP and P groups, respectively, as
assessed from 24-h recall reports and 3-d food records. Com-
pliance rates for ingesting DP and P were 94.8 and 95%,

repeated measures adjusted for BMI. When the main effects were
identified by the initial analysis, post hoc analysis using Bonferroni
correction was conducted. The differences between the P and DP groups
with respect to the ABCA1 R230C polymorphism were determined
using multifactor ANOVA adjusted for BMI. When the main effects were
identified by the initial analysis, post hoc analysis using Bonferroni
correction was conducted. To analyze only the differences within groups
between baseline and after 2 mo, a paired t test was used. Differences
between genotypes were analyzed using the Mann-Whitney U test.
Dietary intake over the course of the treatment was compared using a
2-factor (time 3 dietary treatment) ANOVA for repeated measures. To
compare the percentage of participants with GI in the P and DP groups a
chi-square test was used. The significant value of P was set at ,0.05. The
data were analyzed using SPSS for Windows (version 15.00).
Results
Participants
Of 950 people screened, only 97 met the inclusion criteria
and were selected for one of the dietary treatments (Supplemen-
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respectively.
Clinical and biochemical variables
Anthropometric measurements, body composition, and
BP. BW, BMI, and WC decreased from baseline to 2 mo (P ,
0.0001) in both groups, but there were no changes in the
percentages of the lean or fat mass in either group after the
dietary treatment (Table 1).
Blood glucose, serum lipids, insulin, and leptin. There were
no changes in the DP and P groups in blood glucose, serum
insulin, leptin, TC, HDL-C, and LDL cholesterol after 2 mo of
dietary treatment; however, participants in the DP group had a
significant decrease in serum TG (20.32 mmol/L), whereas there
was no change in the P group (+0.04 mmol/L) (Table 1). There
was a significant diet 3 time interaction for serum TG.
AUC for glucose and insulin, and GI. The AUC for glucose
after the 2-h OGTT was not different in the DP and P groups after

TABLE 1 Clinical and biochemical characteristics of participants at baseline and after 2 mo

of dietary treatment in the P and DP groups1

DP (n = 32) P (n = 35) P-interaction2

Baseline After 2 mo Baseline After 2 mo Diet x time

Characteristics
Weight, kg 81.4 6 14.0 79.1 6 14.0* 83.2 6 11.7 81.0 6 11.1* —3
BMI, kg/m2 31.4 6 3.4 30.5 6 3.7* 32.6 6 3.5 31.7 6 3.5* —
WC, cm 95.7 6 8.6 93.0 6 8.9* 95.2 6 9.0 92.1 6 9.0* —
Lean body mass % 55.9 6 4.5 55.8 6 6.1 54.4 6 5.1 54.4 6 6.6 —
Body fat mass % 38.0 6 4.1 38.2 6 6.1 39.7 6 5.0 39.1 6 5.4 —
Systolic BP, mm Hg 111 6 13.5 107 6 11.0 108 6 12.0 105 6 13.1 —
Diastolic BP, mm Hg 76.0 6 9.1 73.4 6 7.7 74.9 6 9.9 73.5 6 9.5 —
Analytes
Blood glucose, mmol/L 4.5 6 0.4 4.5 6 0.5 4.5 6 0.5 4.5 6 0.4 —
Serum insulin,4 pmol/L 164 6 143 149 6 114 157 6 121 121 6 114
Serum TC, mmol/L 5.2 6 0.9 5.0 6 0.9 4.7 6 0.9 4.8 6 0.9 —
Serum TG,4 mmol/L 2.1 6 2.1a 1.8 6 1.6b 1.9 6 1.7b 1.8 6 1.7b 0.05
Serum HDL-C, mmol/L 0.9 6 0.2 0.9 6 0.2 0.9 6 0.2 0.9 6 0.2 —
Serum LDL-C, mmol/L 3.3 6 0.9 3.3 6 0.8 3.0 6 0.6 3.0 6 0.7 —
Serum leptin, mg/L 25.6 6 12.4 24.4 6 14.3 28.9 6 16.2 29.9 6 15.7 —
Serum adiponectin, mg/L 8.2 6 3.4 8.2 6 3.7 8.1 6 2.7 8.3 6 2.6 —
Serum CRP, mg/L 4.3 6 3.3a 3.5 6 2.8b 3.4 6 2.7b 2.9 6 2.4b 0.01
Glucose AUC mmol/L × 2 h 21.6 6 6.4 19.5 6 6.4 20.0 6 8.2 20.5 6 8.3 —
Insulin AUC, nmol/L × 2 h 91.5 6 50.0a 60.5 6 36.0c 80.2 6 42.3a,b,c 74.5 6 43.7b,c 0.001
1
Values are means 6 SD. Means in a row with superscripts without a common letter differ. *Different from baseline (paired t test) P ,
0.0001. BP, blood pressure; DP, dietary pattern; HDL-C, HDL cholesterol; LDL-C, LDL cholesterol; P, placebo; TC, total cholesterol; WC,
waist circumference.
2
Differences are based on repeated-measures ANOVA, adjusted for BMI. The Bonferroni correction was used as post hoc analysis.
3
P $ 0.05.
4
Data were log-transformed before statistical analyses.

66 Guevara-Cruz et al.
the 2 mo of dietary treatment. However, the change in the insulin
AUC from baseline to 2 mo was greater in the DP group (231.0
nmol/L×2 h) than in the P group (25.7 nmol/L×2 h) (P , 0.05)
(Fig. 1) and there was a significant diet 3 time interaction (P ,
0.01).
The percentage of all participants with blood glucose .11.0
mmol/L after 2-h OGTT defined as GI at the beginning of the
study was 37.3% and, after 2 mo independent of the dietary
treatment, was 26.9%. Interestingly, there was no change in the
proportion with GI in the P group (34.3%); however, the
percentage of participants with GI in the DP at baseline was
40.6% and was significantly reduced after 2 mo to 18.8%.
Inflammation markers. There were no changes in the serum
adiponectin concentration in either group after the dietary
treatment. The serum CRP concentration significantly decreased
in the DP group after 2 mo of dietary treatment (Table 1) but not
in the P group. There was a significant diet 3 time interaction for
serum CRP (P , 0.01).
ABCA1,TCF7L2, PPARG, and IRS-1 genotype distributions.
The number of participants with a specific genotype distribution
(wild-type allele homozygote, variant heterozygote, variant
homozygote) for each polymorphism was as follows: ABCA1
R230C (56, 11, 0,); ABCA1 R219K (37, 26, 4); TCF7L2 C/T
(51,13,3); PPARG P12A (58 7,2,); and IRS1 G972R (59 7,1,).
Allele frequencies (wild-type, variant) were as follows: ABCA1
R230C (91.8%, 8.2%); ABCA1 R219K (74.6%, 25.4%);
TCF7L2 C/T (85.8%, 14.2%); PPARG P12A (91.8%, 8.2%);
and IRS1 G972R (93.3%, 6.7%).
Associations between ABCA1 R230C and anthropometric
and biochemical variables. The decrease in BW in the
participants in the DP group with the ABCA1 R230C variant
was significantly greater (25.0 6 1.9 kg) than those with
ABCA1 R230R variant (21.7 6 2 kg), and the increase in the
serum adiponectin concentration in participants with the
ABCA1 R230C variant (1.7 6 1.6 mg/L) was significantly
greater than in those with the ABCA1 R230R variant (0.2 6 1.0
mg/L) after 2 mo. These results remained significant even after
adjusting for weight and BMI (Fig. 2). However, there were no
differences among the gene variant subgroups of the P group
(Supplemental Table 3). The ABCA1 R230C, ABCA1 R219K,
TCF7L2 C/T, PPARG P12A, and IRS1 G972R polymorphisms
were not related to the other clinical or biochemical variables or
the dietary treatments (data not shown).
Discussion
The prevalence of MetS throughout the world is ;20–30% (33)
and in American and Mexican adults, it is 34.5 and 36.8–
49.8%, respectively (34,35). Several intervention studies have
assessed the influence of dietary strategies on MetS and a
common feature of these is the inclusion of an array of plant-
based food sources containing diverse phytochemicals. In our
study, the components of the DP were based on easily accessible
and inexpensive functional foods with previously demonstrated
health benefits (8,10,11,14,36–39). Viscous fibers in oat increase
bile acid losses (40) and are associated with a decrease in TG and
weight loss (41). The presence of (n-3) fatty acids and antiox-
idants in the chia seed could promote a reduction in the
inflammatory response (42). Nopal shows antihyperglycemic
and antihyperinsulinemic effects and promotes a reduction in
the gastrointestinal peptide glucose-insulinotropic-peptide (10),
and soy protein has antihyperinsulinemic effects (11,43). Thus,
the different modes of action of the components of the DP
contributed to producing a beneficial additive effect. However,
MetS results from complex interactions between genetic and
environmental factors. Recent research indicates that currently
ineffective therapeutic dietary recommendations may require a
personalized nutritional approach, wherein the genetic profile
may determine the responsiveness of the patients to specific
dietary interventions (44). One of the target genes in the
Mexican population is ABCA1. The ABCA1 R230C variant was
chosen for this study, because carriers of the ABCA1 R230C
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variant, which is exclusive to Native American individuals, is
associated with low HDL concentrations, obesity, and T2D in
the Mexican population (45). Previous studies have demon-
strated that adults with the ABCA1 R230C polymorphism
respond better to a cholesterol-lowering diet than those with the
R230R genotype (46). The results of this study showed that
changes in the diet that included a simultaneous reduction in
energy intake by 500 kcal (23,35,47) and a reduction in
saturated fat and cholesterol, as suggested by the National
Cholesterol Education Program Adult Treatment Panel III (5),
significantly reduced BW, BMI, and WC in all of the participants
(Table 1). Furthermore, the participants in the DP group also
had decreases in serum TG, CRP, and the insulin AUC after
a glucose challenge (Fig. 1). In addition, the percentage of
participants with GI in the DP group was reduced from 40.6 to
18.8% and there was no reduction of the percentage with GI in
the P group. Interestingly, in spite of the higher risk of
developing obesity or diabetes by Mexican mestizos with the
ABCA1 R230C polymorphism, the participants in this study
with this polymorphism had a better response to the DP and
showed additional beneficial effects such as a greater reduction
in BW and a greater increase in serum adiponectin concentra-
tions (Fig. 2) without differences in energy intake compared to
the participants with the ABCA1 R230R genotype. These results
remained significant even after adjusting for BMI. Although
these results are very encouraging, additional experiments must
be conducted in a larger population of individuals with the
ABCA1 R230C variant to confirm these effects.
A possible explanation for the improved response to the
dietary treatment by the participants with the ABCA1 R230C
polymorphism could be because the C230 allele may have been
necessary for survival in times of food shortages, allowing the
conservation of cholesterol inside the cell. However, under the
current Westernized lifestyle changes, this allele may have
FIGURE 1 AUC for insulin at 0–120 min after the ingestion of a
glucose tolerance test in the DP or P groups at baseline and after 2 mo
of dietary treatment. Values are the mean 6 SEM, n = 35 (P) or 32 (DP).
Means without a common letter differ, P , 0.001 (repeated-measures
ANOVA adjusted for the BMI). DP, dietary pattern; P, placebo.
Dietary pattern and metabolic syndrome 67

FIGURE 2 Changes in BW (A) and serum adiponectin (B) in
participants with MetS who consumed the DP or P for 2 mo with
ABCA1 R230R or ABCA1 R230C genotypes. Values are the mean 6
SEM. Means without a common letter differ, P , 0.01 (repeated-
measures ANOVA adjusted for the BMI). BW, body weight; DP,
dietary pattern; P, placebo.
become a major susceptibility allele for low HDL-C levels,
obesity, and diabetes due to the accumulation of cholesterol in
the pancreatic b-cell (48,49), leading to insulin secretion failure,
which may be an important component of lipotoxicity in
pancreatic islets. Hao et al. (50) found that excess cholesterol
inhibits insulin secretion, which may contribute to b-cell
dysfunction and the onset of diabetes in obese patients.
However, the first dietary intervention in this study with low
saturated fat, low cholesterol, and functional foods (some with
antioxidant activity) possibly helps the functionality of the
ABCA transporter. The efflux of cholesterol becomes more
effective and less cholesterol accumulates in peripheral cells,
improving cell function.
Four additional polymorphisms, ABCA1 R219K, IRS-1
(Gly972Arg), PPARG (P12A), and TCF2L7, were examined in
the current study because they are associated with decreased
coronary heart disease, insulin resistance, weight loss, and
diabetes; however, there was no relationship between the DP
group, the presence of these polymorphisms, and the clinical and
biochemical variables.
The results of this study provide an important tool for
facilitating the development of personalized dietary strategies
for individuals with MetS who have a high risk of developing
diabetes and CVD. To be successful, these dietary strategies need
to ensure a high response without the side effects of pharma-
cological treatments.
This dietary intervention can be easily achieved in a free-
living population and can be translated to individuals at risk for
diabetes and CVD who prefer to include local, beneficial foods
in their diet as a way to improve the biochemical and clinical
abnormalities associated with MetS. However, a limitation of
this study is that the sample size was designed to study the effect
of DP on clinical and biochemical variables of MetS and not to
study the association between DP and the presence of polymor-
phisms and MetS biochemical abnormalities. This study could
aid in the development of new studies with larger MetS cohorts.
The benefits of the DP used in the present study included a
high compliance (94.8%) to the dietary treatment, probably due
68 Guevara-Cruz et al.
to the easy preparation of the DP; the low glycemic index of the
DP (38.6); the abundance of phytochemicals with antioxidant,
antihyperinsulinemic, hypolipidemic, and antiinflammatory ac-
tivities; and the moderate satiety induced by ingestion of the DP.
Finally, this type of dietary intervention could be adapted to
different ethnic groups by incorporating native foods. Dietary
recommendations could be more efficient if they are given based
on their mechanism of action. To achieve the potential benefits
associated with the concept of nutrigenetics, it should include a
team-based approach with a greater integration of physicians,
food and nutrition professionals, and genetic counselors (51).
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Acknowledgments
M.G-C., A.R.T., and N.T. designed the research; M.G-C.,
I.M-V., L.G-Z., P.L-R., G.O-N., and L.E.G.P. conducted the
research; M.G-C., N.T., C.A.A-S., and S.C-Q. analyzed the
data; N.T., M.G-C., and A.R.T. wrote the paper; and N.T. had
primary responsibility for the final content. All the authors read
and approved the final manuscript.
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Dietary pattern and metabolic syndrome 69