Mediterranean Diet and Vascular Inflammation

Background

Dr. Katherine Esposito and colleagues from Second University of Naples published this randomized controlled trial in JAMA (PMID: 15383514, DOI: 10.1001/jama.292.12.1440), demonstrating that a Mediterranean-style diet reduces inflammation and improves endothelial function.

Study Design

Design: Randomized controlled trial Population: 180 patients with metabolic syndrome (90 per group) Intervention: Mediterranean-style diet vs. prudent diet (NCEP Step I) Duration: 2 years Primary endpoints: Inflammatory markers, endothelial function

Key Findings

Marker	Mediterranean Diet	Control	P value
hsCRP reduction	−1.3 mg/L	−0.4 mg/L	<0.001
IL-6 reduction	−0.7 pg/mL	−0.2 pg/mL	0.04
Endothelial function	+2.1 score	+0.3 score	<0.001
MetS resolution	48 patients	25 patients	<0.001

Key finding: 48/90 (53%) in Mediterranean group no longer met metabolic syndrome criteria vs. 28% in control.

Mechanistic Insights

Mediterranean diet benefits derive from:

1. •High polyphenol content (olive oil, wine, vegetables)
2. •Omega-3 fatty acids from fish and nuts
3. •Low glycemic load reducing insulin spikes
4. •Fiber supporting gut microbiome

Clinical Implications

A Mediterranean-style diet is more effective than standard "heart-healthy" advice for metabolic syndrome. The anti-inflammatory effects translate to reduced cardiovascular risk.

Metabolic Health Perspective

This trial supports whole-food dietary approaches over macronutrient restriction alone. The Mediterranean pattern combines carbohydrate quality (not just quantity) with anti-inflammatory fats. For metabolic optimization, the principles can be combined with carbohydrate restriction for enhanced benefits.